Caroline serves as Chief Operating Officer of Indigo Integrative Health Clinic, where she drives the expansion of Indigo’s pioneering root-cause approach to medical care.
Drawing on her extensive experience as a Parsley Health provider, educator and board-certified Health Coach, Caroline combines operational leadership with clinical insight to advance Indigo’s mission of delivering transformative, personalized care.
Many people who find their way to us have been told their results arenormal. They have also been sick for years. Both things are true.
Co-infections are one of the most common reasons patients with Lymedisease stay sick after treatment, and one of the most consistently missed. Thestandard Lyme test was built to look for one infection. When the same tickcarries several others, that test comes back clean and the damage continuesundetected.
In a 2024 study of more than 3,500 patients, 42% of people with Babesiacarried a second tick infection at the same time. View study Almost every other patient.
● One tick bite can pass onmore than one infection. In one study, 42% of people with Babesia also had asecond.
● The standard Lyme testonly looks for Lyme. It ignores Babesia, Bartonella, Ehrlichia, and Anaplasma.
● Each one needs its owntest and its own treatment. The standard Lyme antibiotic does not treat Babesiaand often fails against Bartonella.
● A negative test alongsideongoing symptoms often means no one ran the full set.
Ticks are not picky eaters. A tick feeds at each stage of its life, usually ona different animal, and picks up whatever pathogens that host was carrying. Bythe time one reaches you, it can transmit more than one in a single bite.
The odds are getting worse. A 2025 study in the journal Ecosphere tracked more than 2,000 ticks inthe Northeast for nearly ten years. By the end, about 1 in 10 carried two ormore pathogens, and that number kept climbing. The most common pair was thebacteria that causes Lyme and the parasite Babesia.
These four show up most often alongside Lyme, and the standard panelignores every one. They are not the only co-infections, but they are the ones most likelyto be missed. Each needs its own test. Each needs its own treatment.
Herxheimer Reaction vs. Side Effects
| Herxheimer reaction | Medication side effect | Allergic reaction | |
|---|---|---|---|
| When it appears | Shortly after treatment begins | Any time during treatment | Shortly after taking the medication |
| What symptoms look like | Worsening of existing Lyme symptoms — fatigue, pain, brain fog, chills | New symptoms unrelated to Lyme — stomach upset, headache, dizziness | Hives, throat tightening, swelling, difficulty breathing |
| How long it lasts | Days to a few weeks; self-limiting | Varies; may persist throughout treatment | Rapid onset; requires immediate evaluation |
| What to do | Stay in contact with your clinician; do not stop treatment without guidance | Contact your clinician to discuss | Contact your provider or emergency services immediately |
Common Coinfections
| Infection | What it is | Most common symptoms | Test it needs | Does the standard Lyme antibiotic treat it? |
|---|---|---|---|---|
| Babesia | A parasite that acts like malaria | Night sweats, trouble getting a full breath, fatigue that comes in waves, headaches that come and go | A blood test made to find Babesia | No. It needs a different medicine that kills parasites. |
| Bartonella | A pathogen that targets blood vessels and is linked to nerve and brain symptoms | Burning or crawling feeling on the skin, sudden anxiety, brain fog, a streaky rash that can look like stretch marks | A test that looks for the pathogen itself | Usually not. It often needs a different treatment approach. |
| Ehrlichia | A pathogen that attacks the cells that fight infection | High fever, body aches, a drop in blood cell counts | A test that looks for the pathogen itself | Yes. A Lyme course often clears it, if the dose and length are enough. |
| Anaplasma | A pathogen that attacks the cells that fight infection | High fever, body aches, a drop in blood cell counts | A test that looks for the pathogen itself | Yes. A Lyme course often clears it, if the dose and length are enough. |
The standard Lyme antibiotic does not treat Babesia, because Babesia isa parasite, not a bacterium. Treat only Lyme, and the parasite keeps running. So dothe symptoms.
It brings night sweats, waves of fatigue, headaches that come and go,and a constant sense of air hunger, that unsettling feeling of not being ableto get a full breath. A Lyme test looks for one thing: signs your body foughtthe Lyme bacteria. Babesia needs its own blood test, and no standard panelincludes it.
The crawling skin and the anxiety thatcame out of nowhere are not random. Bartonella targetsblood vessels and is linked to nerve and brain symptoms: burning or crawlingskin sensations, sudden anxiety, brain fog, and a streaky rash that looks likestretch marks in places you would not expect.
Bartonella henselae, the species mostcommonly discussed in routine clinical care, is the bacteria behind cat scratchdisease. It spreads primarily through flea feces on cat scratches or bites, andit is more common than most patients realize. It also spreads through fleas andlice more broadly, which is why it tends to appear alongside tick-borneinfections in patients who have outdoor or animal exposure.
In a 2025 study from North Carolina StateUniversity, published in Pathogens, an entire family, children included,carried both Bartonella and Babesia, with neurological symptoms thatearlier workups had missed. The researchers concluded these pathogens may playa far larger role in neurological illness than previously understood.
Finding Bartonella requires a test builtto detect the pathogen itself. No standard workup includes it.
These two can crash your blood counts in days. They attack the white blood cellsyour body uses to fight infection and bring high fever, body aches, and fallingcounts that worsen fast if no one catches them.
They do not always travel together. Anaplasma rides the same tick thatcarries Lyme. Ehrlichia usually comes from the lone star tick, which is wellestablished across Virginia, Maryland, and DC.
This is where people get trapped. The standard Lyme antibiotic doestreat both, so a Lyme course often clears them when the dose and length aresufficient. But that same drug does not treat Babesia, and it often failsagainst Bartonella. One course can quietly resolve two infections while the twohardest ones keep running. That is why so many people feel a little better,then stall and never fully recover.
The test is not broken. It is answering the wrong question.
It was built to do one job: find signs your body fought the Lymebacteria. It does that job well. It was never built to screen for anythingelse, and that is the entire problem. Babesia, Bartonella, Ehrlichia, andAnaplasma each need their own test, and most providers never order them becausethe standard guidelines do not ask for them.
This is not about bad doctors. It is about rules that were never builtfor something this complex.
A diagnosis names what is happening. It rarely explains why. For most ofour patients, the why is where the work begins.
Treating one infection while others run is not treatment. It is a headstart for the ones no one looked for.
The labels pile up: unexplained illness, anxiety, lingering symptomsafter antibiotics. Every month in that loop has a price, more tests that comeback normal, more treatments aimed at the wrong target, more time lost to ananswer a single panel was never going to give.
We see this regularly in our practice. Snejana Sharkar, RND, NP whoco-founded Indigo after her own experience with missed tick-borne illness,built the clinic's diagnostic model around exactly this gap.
The patients who reach us followed the standard protocol from start tofinish. They stayed sick. Often because a co-infection was never on the table.
A real workup looks for what the standard one skips.
That means a separate, targeted test for each co-infection, specialtylabs that catch what routine labs miss, and a close read of your full symptomhistory alongside your numbers. Your location raises the odds. Patients inVirginia, Maryland, and the DC area sit in one of the highest tick-burdenregions in the country, where blacklegged and lone star ticks are bothestablished and these infections are all found.
Numbers tell part of the story. You tell the rest. We use both.
A negative test alongside real symptoms is not a dead end. It is amissing question.
The Johns Hopkins LymeDisease Research Center states plainly that no reliable blood test exists to confirm thattreatment worked. The NIH funds research into why people stay sick after antibiotics, and co-infections are onits list ofactive investigations. This is not fringe medicine. Major academic medicalcenters are publishing on this right now.
The Discovery Call is a 20-minute clinical screening. On it, we reviewyour symptom history, past testing, and treatment timeline, and help determinewhether Indigo is the right fit for where you are in your care right now.
This content is for educational purposes only. It is not medical advice,a diagnosis, or a treatment recommendation. Always work with a qualified healthprovider regarding your own health.
Scientific references
Ssentongo P, Venugopal N, Ba D, et al. Beyond human babesiosis:prevalence and association of Babesia coinfection with mortality in the UnitedStates, 2015-2022. Open Forum Infectious Diseases. 2024;11(10):ofae504. View study
LaDeau SL, Oggenfuss K, Schmidt A, et al. Ecological dynamics ofblacklegged ticks, vertebrate hosts, and associated zoonotic pathogens innortheastern forests. Ecosphere. 2025;16(12):e70508. View study
Breitschwerdt EB, Maggi RG, Robveille C, et al. A One Health zoonoticvector borne infectious disease family outbreak investigation. Pathogens.2025;14(2):110.View study
Johns Hopkins Lyme Disease Research Center. Diagnosis of Lyme disease. View source
National Institute of Allergy and Infectious Diseases (NIH).Understanding persistent signs and symptoms attributed to post-treatment Lymedisease. View funding program
This content is provided by Indigo Integrative Health Clinic for educational purposes only. It does not constitute medical advice, a diagnosis, or a treatment recommendation, and does not establish a provider-patient relationship. Individual health conditions vary — information presented here may not apply to your specific situation. Always consult a qualified, licensed healthcare provider before making decisions about your health, medications, supplements, or treatment plan.
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