Borrelia miyamotoi is a type of Gram-negative, anaerobic and spirochete bacteria. B. miyamotoi is consider as relapsing fever borrelia that is present in all species of Ixodes ticks that transmit B. burgdorferi infection, but a much lower proportion of these ticks are infected with B. miyamotoi compared with Lyme borrelia. B. miyamotoi infection can cause a febrile illness in association with leukopenia, thrombocytopenia, and abnormal liver function tests. Although infection can cause some similar symptoms including fever, headache, fatigue, and muscle aches, acute Lyme disease often presents with rash, while infection with B. miyamotoi does not. B. miyamotoi is increasingly being recognized as the agent of a nonspecific febrile illness often misdiagnosed as acute Lyme disease without rash, or as ehrlichiosis.