Background
This case involves a 17-year-old female athlete who lived near wooded areas and regularly participated in cross-country running and 400-meter hurdles. Until the onset of her symptoms, she had been healthy and highly active in sports.
The First Symptoms
Her health problems began in 2022 with increasing pain and stiffness in her legs. Over time, the symptoms worsened significantly. After one competition, she could barely stand up due to severe pain and mobility issues.
Laboratory findings showed elevated inflammatory markers, including a high erythrocyte sedimentation rate (ESR). Rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies were also positive. Both small and large joints were sensitive to pressure.
Based on these findings, she was initially diagnosed with juvenile rheumatoid arthritis (juvenile RA).
Initial Treatment
Following the diagnosis, she received steroid therapy (Medrol) and methotrexate. She was also advised to stop participating in sports.
As her symptoms persisted, Lyme disease was considered. Serological testing later indicated Borrelia exposure, and she received a one-week course of doxycycline. However, her condition showed no meaningful improvement.
Condition at the Time of DualDur Testing
When she presented for DualDur testing, her condition had continued to deteriorate.
Her main symptoms included:
- Severe joint pain
- Difficulty walking
- Progressive worsening of her overall condition
The symptoms had a major impact on both her daily life and athletic performance.
Diagnostic Findings
On April 19, 2023, DualDur dark-field AI microscopy detected the presence of Borrelia.
A modified Western blot test showed:
- IgM positive
- IgG borderline
Both microscopy and serology identified the presence of Borrelia garinii.
In addition, dark-field microscopy revealed:
- Borrelia afzelii
- Borrelia burgdorferi sensu stricto
- Bartonella
- Mycoplasma
Based on the findings, Borrelia afzelii, Bartonella, and Mycoplasma were identified as the primary infections requiring targeted treatment.
Treatment Protocol
The patient underwent an eight-week personalized treatment program.
The protocol included:
- Minocycline: 3–4 × 50 mg daily
- Ciprofloxacin: 2–3 × 250 mg daily
- Tinidazole: 2 × 500 mg / 2 × 250 mg (3 days on, 4 days off)
- Rifampicin: 2–3 × 150 mg daily
Dosages were adjusted using alternating higher and lower dosing schedules every second day.
Supportive measures included:
- Probiotics
- Mushroom extracts
- Vitamins
- Trace elements and micronutrients
- A meat-free diet
Outcome
By the end of treatment, the patient’s symptoms had completely resolved.
She reported:
- No remaining joint pain
- Normal mobility
- Full return to sports activities
Her quality of life improved dramatically, allowing her to resume the active lifestyle she had enjoyed before becoming ill.
Follow-Up Results
A follow-up evaluation was performed on October 10, 2023.
Dark-field AI microscopy showed that Borrelia was no longer detectable at clinically significant levels, with only a very low residual presence remaining.
The previously detected Borrelia afzelii and Borrelia burgdorferi sensu stricto were no longer identified.
Both microscopy and serology indicated only a low-level presence of Borrelia garinii.
One of the most notable findings was the change in Borrelia density measured by dark-field AI microscopy:
2.5 spirochetes per field of view → 0.3 spirochetes per field of view
This represented an approximately 88% reduction following treatment.
Conclusion
This case highlights the complexity of diagnosing Lyme disease and associated co-infections, particularly when symptoms overlap with other conditions such as juvenile rheumatoid arthritis.
The combination of direct pathogen detection and comprehensive laboratory assessment provided valuable information that helped guide treatment decisions and monitor therapeutic response.
For this patient, identifying the underlying infections ultimately led to symptom resolution and a successful return to sports.