If a person is not treated for coinfections near the beginning of treatment, it is difficult to recover from chronic Lyme disease. Here is my diagnostic approach to two of the coinfections, bartonella and babesia.
The tests for babesia and bartonella are unreliable. For instance, by some estimates there are 30 strains of bartonella like organisms and we have antibody detection for up to different strains depending on the lab. For babeisa there are 15 to 20 strains with antibody testing for 2 of the strains. So like many LLMDs I treat by symptoms and do not suggest testing.
Symptoms and signs of bartonella are: day sweats, ongoing anxiety, pain on the soles of the feet, swollen lymph nodes, a rash that looks like stretch marks, severe cognitive dysfunction, neurologic symptoms of numbness or sharp, shooting, stabbing or burning pain, abdominal pain for which there is not an identifiable cause, bladder symptoms of pain, urgency or burning, and psychiatric problems.
Symptoms and signs of babesia are: night sweats, temperature fluctuations, panic anxiety attacks, frontal headaches, feeling off balance while walking, air hunger, racing or skipping of the heart, and regular de ja vu experiences.
Figuring out if a person has bartonella or babesia as part of Lyme disease is like putting together the pieces of a puzzle. If there are enough (but not all) of signs or symptoms of these or one or both of these coinfections, I treat for them. Each of these co-infections requires a separate antimicrobial approach which is different than the antimicrobial approach for Lyme.