MedicalResearch.com Interview with: Sam R. Telford III, ScD Department of Infectious Disease and Global Health, Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA Borrelia miyamotoi Infection Presenting as Human Granulocytic Anaplasmosis: A Case Report MedicalResearch.com: What are the main findings of the study? Answer: The study presents two additional cases of BMD (Borrelia miyamotoi disease) that add to our knowledge of the spectrum of illness of this recently recognized zoonosis.  Our report of the North American index case in NEJM in January 2013 described a case-patient who was elderly and immunocompromised and it was not clear whether that case was just very unusual.  With our Annals report, we describe cases in immune-intact individuals and suggest that cases of BMD may have been under our noses all along, just presumptively diagnosed as HGA and successfully treated with doxycycline with no followup (e.g., lab confirmation of diagnosis of HGA Human Granulocytic Anaplasmosis).  Hence, individuals presenting with fever, headache, myalgia, and show leukopenia and elevated LFTs may have either HGA or BMD and confirmatory testing should be done accordingly.  It should be noted that all tick borne diseases are clinical diagnoses and treatment of an acute case should not depend on "lab tests".  Both these infections are effectively managed by oral doxycycline, hence those with these signs and symptoms might be empirically treated with doxycyline, which would be important in areas where RMSF and tularemia (which also produce leukopenia and elevated LFTs) co-occur with deer tick -transmitted infections such as Lyme disease; waiting for "lab tests" to confirm RMSF or tularemia might lead to a negative outcome.  RMSF and tularemia are the most dangerous of the tick American tick borne diseases, although I would certainly place the very rare deer tick virus and Powassan virus in the same category.