Tick-borne relapsing fever is part of the larger Borrelia story, and that matters for Morgellons disease. Most people who hear the word Borrelia think of Lyme disease, but Lyme disease is only one part of the picture. Research by Marianne Middelveen, Raphael Stricker, and colleagues raises an important question: what if the spirochetal discussion around Morgellons is bigger than classic Lyme disease alone?
This article is not saying every person with Morgellons has tick-borne relapsing fever. It is not saying every skin lesion, fiber, or chronic symptom comes from one infection. It is also not saying Bartonella is a proven tick-borne co-infection. The point is more careful: Morgellons research has reported evidence involving both Lyme-group Borrelia and relapsing-fever Borrelia, while newer Bartonella evidence shows why patients should be cautious about repeating unsupported tick-borne claims.
If you are new to this topic, start with the basics first: what Morgellons is, how to document skin findings, why fibers need careful evaluation, and why no single test or internet theory should replace a real clinical workup.
Why Tick-Borne Relapsing Fever Matters to Morgellons Research
MorgellonsSurvey.org has recently focused on a patient-safety theme: Morgellons should not be dismissed, but it should also not be forced into one oversimplified explanation.
That matters here because tick-borne relapsing fever can easily confuse the Lyme conversation. A person may hear “Borrelia” and assume “Lyme disease.” But not every Borrelia organism is the same. Lyme-group Borrelia and relapsing-fever Borrelia are related, but they are not identical.
This article connects with several recent Morgellons Survey topics:
- Morgellons doesn’t automatically mean Lyme disease. A Lyme-only explanation can miss relapsing-fever Borrelia, syphilis, rash differentials, geography, test cross-reactivity, and other important clues.
- Bartonella is not a demonstrated tick infection in humans. Bartonella may be clinically relevant in some patients, but current evidence does not support treating it as a routine tick-borne co-infection.
- When it might not be Morgellons. Fibers, lesions, neuropathic sensations, and rash patterns should be evaluated carefully before patients or clinicians jump to conclusions.
- Morgellons and Lyme disease red flags. Support groups can help patients, but they can also pressure people into approved narratives instead of careful evidence.
- The exploitation of Morgellons. Unsupported certainty, miracle cures, fear campaigns, and loyalty tests can hurt patients who are already vulnerable.
The goal is not to make the subject more complicated for the sake of it. The goal is to make the question more accurate.
What Is Tick-Borne Relapsing Fever?
Tick-borne relapsing fever is an infection caused by certain Borrelia spirochetes. Spirochetes are spiral-shaped bacteria. Lyme disease is most often associated with Lyme-group Borrelia, especially Borrelia burgdorferi in the United States. Relapsing fever is associated with a different group often called relapsing-fever Borrelia, or RFB.
The “relapsing” part refers to the fever pattern seen in many cases. A person may have several days of fever, chills, headache, muscle pain, joint pain, sweats, and fatigue, followed by several days of improvement, followed by another fever episode. In soft tick relapsing fever, this cycle can repeat multiple times if untreated.
Public health sources commonly separate tick-related relapsing fever into two major categories:
- Soft tick relapsing fever, associated with soft-bodied Ornithodoros ticks and Borrelia species such as Borrelia hermsii and Borrelia turicatae.
- Hard tick relapsing fever, most often associated with Borrelia miyamotoi, which is transmitted by blacklegged ticks — the same general tick group involved in Lyme disease transmission.
This is one reason the topic becomes confusing. Many people were taught to think “blacklegged tick equals Lyme disease,” but blacklegged ticks can be involved in more than one infection. A patient can also have Lyme-like symptoms without fitting the classic Lyme disease picture.
Video: NIH Research on Tick-Borne Relapsing Fever
Helpful background video: The NIH/NIAID has documented field research into tick-borne relapsing fever. This video is not about Morgellons disease, but it helps explain why relapsing-fever Borrelia should be understood as a real medical and research topic — separate from classic Lyme disease.
How Is Tick-Borne Relapsing Fever Different From Lyme Disease?
Lyme disease and tick-borne relapsing fever are both Borrelia infections, but they are not identical. They can involve different Borrelia species, different tick vectors, different fever patterns, and different testing problems.
Classic Lyme disease discussions usually focus on Borrelia burgdorferi sensu lato. Tick-borne relapsing fever discussions focus on relapsing-fever Borrelia. These organisms overlap enough to cause diagnostic confusion, but they are different enough that a test designed around one group may not reliably answer questions about the other.
That is the key point for Morgellons patients: a negative or incomplete Lyme workup does not automatically rule out the broader universe of Borrelia-related illness. It also does not prove Morgellons is infectious in every case. It simply means the investigation should be careful, specific, and honest about limitations.
Why Patients May Never Notice the Tick Bite
Many people with tick-borne illness do not remember a tick bite. With soft ticks, this is especially understandable. Soft ticks may feed quickly, often at night, and their bites may be painless. Some exposures are associated with sleeping in cabins or buildings where rodents and soft ticks are present. A person may wake up sick days later and have no obvious tick attached to remove.
Hard ticks are different. They usually attach for a longer period of time. But even then, nymphal ticks can be tiny, bites may be missed, and not every tick-borne infection produces the classic bullseye rash people associate with Lyme disease.
This is why Morgellons patients should document exposure history without exaggerating it. Tick bites, outdoor exposure, pets, travel, cabins, rodent-infested buildings, unexplained fever episodes, rashes, neurologic symptoms, and prior testing may all matter. But the evidence still has to be interpreted carefully.
The Middelveen and Stricker Connection
In 2018, Marianne Middelveen, Iris Du Cruz, Melissa Fesler, Raphael Stricker, and Jyotsna Shah published a study titled Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques. The study looked at 30 Morgellons disease patients and tested for antibody reactivity and DNA evidence involving two Borrelia categories:
- Bb, meaning the Borrelia burgdorferi group associated with Lyme disease.
- RFB, meaning relapsing-fever Borrelia.
The findings were striking. By combined Western blot and PCR testing, the study reported that 27 of 30 Morgellons patients had a positive result for Bb and/or RFB exposure or infection. In the combined results, RFB-only positivity was more common than Bb-only positivity.
That matters because it challenges the simplified idea that Morgellons, if infectious in some patients, must be explained only by classic Lyme disease. The study suggested that Morgellons may be associated with a broader spectrum of Borrelia organisms, including relapsing-fever Borrelia.
This does not settle the Morgellons debate. A 30-patient study is not the final word. But it does sharpen the question: if relapsing-fever Borrelia markers are reported in Morgellons patients, then why should Morgellons research stop at classic Lyme disease testing alone?
Why This Supports a Broader Spirochete Question
Morgellons has often been discussed through a Lyme disease lens. That makes sense historically because multiple Morgellons papers have proposed an association with Borrelia infection, Lyme disease, or tick-borne illness. The Morgellons research library includes papers on spirochetal infection, filament formation, Lyme disease association, and Morgellons as a filamentous borrelial dermatitis.
But the broader spirochete question matters. Spirochetes include more than one organism and more than one disease pattern. Lyme disease, relapsing-fever Borrelia, and syphilis are not the same disease. They should not be collapsed into one category. But they do show why skin findings, neurologic symptoms, rashes, test cross-reactivity, and chronic diagnostic confusion should be handled carefully.
This is also why the article Morgellons doesn’t automatically mean Lyme disease is important. A Lyme-only explanation can create blind spots. Relapsing-fever Borrelia may complicate Lyme testing. Syphilis may belong in the differential diagnosis when rash pattern, neurologic findings, congenital concerns, or testing history make it relevant. Geography may matter too, as discussed in the article on Morgellons reports in Australia.
Where Bartonella Fits — and Where It Does Not
This is where the language has to be especially careful. Bartonella is real. Bartonella infections can cause real illness. The 2018 Morgellons study did report Bartonella henselae findings in a subset of Morgellons patients. But that does not mean Bartonella is a proven tick-borne infection, and it does not mean Bartonella should be treated as the automatic explanation for Morgellons.
That distinction matters because many Lyme and Morgellons communities have repeated the idea that Bartonella is a common tick-borne “co-infection.” But large tick studies using modern testing methods have found little to no Bartonella in the ticks most relevant to Lyme disease transmission. Current public health guidance also does not support demonstrated human tick-bite transmission of Bartonella.
So why does Bartonella keep appearing in Lyme and Morgellons conversations? Because symptom overlap, positive lab results, clinical experience, and online narratives can blur together. Someone can have Lyme disease and Bartonella without one tick having transmitted both. Someone can have Morgellons-like symptoms and a Bartonella result without Bartonella being the cause of the skin findings. Someone can have a complicated illness picture that requires more than one medical lens.
The responsible framing is this: Bartonella may be clinically relevant in some patients, but it should not be used to confuse the specific Borrelia question. Tick-borne relapsing fever is a Borrelia issue. Bartonella is a separate organism with different transmission evidence.
For the Bartonella evidence review, see: Over 10,000 Ticks Tested: Bartonella Is Not a Tick Infection.
Testing for Relapsing-Fever Borrelia Can Be Confusing
Relapsing-fever Borrelia can complicate testing. Some tests may cross-react. Some early serum tests may be negative. Some assays may not clearly distinguish between hard tick and soft tick relapsing fever. Patients with relapsing fever may also have false-positive Lyme serology.
That does not make testing useless. It means testing should be interpreted with clinical context. A useful evaluation may need to consider fever patterns, geography, travel, tick exposure, cabin exposure, rodent exposure, rash morphology, neurologic symptoms, immune status, prior antibiotics, and which laboratory method was used.
For Morgellons patients, this also connects to the broader testing problem on the site: a single home test, a single symptom, a single photo, or a single lab result should not be treated as the entire answer. The Morgellons testing page explains why popular internet tests, such as the red wine test, cannot diagnose Morgellons. The same principle applies here: the question should move toward clinical evidence, not shortcuts.
Fibers Still Matter
It is easy for a tick-borne disease article to drift away from the defining Morgellons question. Morgellons is not simply “having Lyme disease.” It is not simply “feeling crawling sensations.” It is not simply “testing positive for something.” The most important Morgellons feature is the report of unusual filaments that may be embedded in, attached to, or projecting from skin lesions.
That is why documentation matters. If fibers are superficial lint, pet hair, textile material, wound debris, or contamination stuck to irritated skin, that matters. If fibers appear embedded in or projecting from skin tissue, that matters too. Patients deserve a careful evaluation that separates observation from interpretation.
The practical next step is not panic. It is documentation. Photograph lesions under consistent lighting. Use a scale when possible. Avoid filters. Avoid digging, scraping, harsh chemicals, or extreme cleaning routines that can injure the skin and confuse the picture. Bring a concise timeline to a clinician rather than a pile of internet theories.
For a broader rule-out approach, read: When It Might Not Be Morgellons: How to Rule Out Lookalikes Without Dismissing Patients.
Why This Distinction Protects Patients
Morgellons patients are often trapped between two forms of overconfidence. On one side, some clinicians dismiss the condition as psychiatric without carefully examining the skin. On the other side, some patient communities insist that Morgellons must always be Lyme disease, Bartonella, parasites, nanotechnology, a bioweapon, or some other single explanation.
Neither approach is good enough.
The Borrelia question is important because Borrelia includes more than one organism. Lyme-group Borrelia and relapsing-fever Borrelia are not the same thing. Testing for one does not automatically settle the other. If Morgellons patients show evidence of RFB exposure or infection, then the conversation should not stop at standard Lyme disease testing.
The Bartonella question is different. Bartonella may deserve clinical consideration in some patients, but current evidence does not support treating Bartonella as a demonstrated tick-borne infection in humans. Keeping those categories separate makes the argument stronger, not weaker.
This also protects patients from exploitation. When a community is built around certainty instead of evidence, people can be pressured to repeat claims that are not well supported. Patients should not have to choose between being dismissed by medicine and being captured by bad information. A better advocacy model can say: this is documented, this is plausible, this is disputed, this is unknown, and this still deserves research.
For more on that patient-safety issue, read The Exploitation of Morgellons and Morgellons and Lyme Disease: Evidence, Misinformation, and Support Group Red Flags.
What This Research Does Not Prove
A 30-patient study is not the final word on Morgellons disease. It does not prove that every Morgellons case is caused by Borrelia. It does not prove that every patient with fibers has tick-borne relapsing fever. It does not prove that Bartonella causes Morgellons. It also does not replace a proper medical evaluation.
The study does, however, raise a serious scientific question: if relapsing-fever Borrelia markers are reported in Morgellons patients, why should Morgellons research be restricted to classic Lyme disease testing alone?
That question becomes even more important because relapsing-fever testing is not always part of a routine tick-borne disease workup, and many clinicians are less familiar with relapsing-fever Borrelia than they are with Lyme disease.
A Better Way to Frame the Question
The wrong question is: “Is Morgellons just Lyme disease?”
A better question is: “Can Morgellons be a filamentous skin condition associated with a broader range of spirochetal infections in some patients?”
That framing leaves room for complexity. It allows Lyme-group Borrelia to remain important. It allows relapsing-fever Borrelia to be investigated. It allows Bartonella to be discussed carefully without falsely calling it a proven tick infection. It allows syphilis and other spirochetal diseases to remain in the differential when clinically relevant. It also leaves room for non-infectious contributors, immune differences, skin barrier dysfunction, environmental exposures, neuropathy, dermatologic disease, and other diagnoses that may mimic or overlap with Morgellons.
What Patients Can Do
Patients should not try to diagnose tick-borne relapsing fever from an online article. But they can use this information to have a more productive conversation with a clinician.
- Document fever patterns, especially episodes that come and go.
- Photograph skin findings under consistent lighting.
- Track tick exposure, cabin exposure, rodent-infested buildings, outdoor activity, pets, travel, and previous tick bites.
- If Bartonella is suspected or positive, also consider more likely exposure routes such as cats, fleas, body lice, or sand flies depending on history and geography.
- Ask whether Lyme disease, relapsing-fever Borrelia, Bartonella, syphilis, dermatologic conditions, immune issues, neuropathy, and other explanations are clinically relevant to your case.
- Avoid extreme cleaning, skin digging, harsh chemicals, or aggressive self-treatment routines that can worsen lesions and confuse the clinical picture.
The goal is not to force every case into one explanation. The goal is to prevent real findings from being dismissed before they are properly examined.
Where to Go Next
If you are trying to understand Morgellons disease, use this article as one piece of a larger roadmap:
- Start with the Morgellons Survey homepage for the basic overview, patient survey, and main topic areas.
- Visit the research library for peer-reviewed papers on Morgellons, fibers, Borrelia, spirochetal associations, and differential diagnosis.
- Read the doctor-finding guide if you need help looking for a clinician who may examine skin findings and review your history without immediate dismissal.
- Use the resources page for practical patient materials, books, and documentation tools.
- Take the Morgellons Survey if you have, or believe you have, Morgellons and want to contribute to patient experience documentation.
The Bottom Line on Tick-Borne Relapsing Fever and Morgellons
Tick-borne relapsing fever is part of the larger Borrelia story. For Morgellons disease, that matters because research has reported relapsing-fever Borrelia markers in Morgellons patients, not only Lyme-group Borrelia markers. That does not settle the debate, but it does make the debate more specific.
Bartonella should not be used to muddy that point. Bartonella infections are real, but current evidence does not support the common claim that Bartonella is a demonstrated tick-borne infection in humans. The cleaner scientific question is whether Morgellons, in at least some patients, reflects a filamentous skin condition associated with diverse spirochetal infections — including Lyme-group Borrelia and relapsing-fever Borrelia.
That question deserves research, not ridicule.
References
- Middelveen MJ, Du Cruz I, Fesler MC, Stricker RB, Shah JS. Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques. Clinical, Cosmetic and Investigational Dermatology. 2018;11:561–569.
- CDC. Clinical Guidance for Hard Tick Relapsing Fever.
- CDC. About Soft Tick Relapsing Fever.
- CDC. About Bartonella.
- NIH/NIAID. NIH Searches for Tickborne Relapsing Fever in Mali.
