6 cases of Babesia in early Lyme disease
In their article “Co-infections in early Lyme disease,” Wormser and colleagues describe 52 adult patients with erythema migran rashes who were evaluated for the presence of co-infections. (Patients with extracutaneous manifestations were excluded.)
Out of the 52 patients, 4 (7.7%) “had convincing evidence of Babesia microti co-infection,” writes Wormser. These patients, along with 2 additional cases of suspected Babesia, were highlighted in the article.
Patient 1: 69-year-old with fever on day 4 of amoxicillin therapy. Positive for B. microti by blood smear and DNA by PCR.
Patient 2: 58-year-old with fever before development of a single erythema migrans lesion. Positive for B. microti DNA by PCR.
Patient 3: 61-year-old without fever with thrombocytopenia and anemia. Two days after starting treatment for Lyme disease, the patient was positive for B. microti DNA by PCR.Babesia co-infection is emerging as a real threat to the public. Click To Tweet
Patient 4: 45-year-old with febrile illness with an acute-phase titer of <1:64 followed by a convalescent-phase IgG titer of 1:512.
Patient 5: 54-year-old without fever with an acute-phase titer of <1:64 followed by a convalescent-phase IgG titer of 1:512.
Patient 6: 32-year-old without fever with an acute-phase titer of <1:64 followed by a convalescent-phase IgG titer of 1:512.
Three of the six patients were treated for active babesiosis. And all of the patients recovered from Lyme disease.
“Our finding of B. microti co-infection documents the increasing clinical relevance of this emerging infection,” the authors write.
- The authors did not discuss whether the 6 patients recovered from Babesia.
- The study excluded patients with extracutaneous symptoms and may have inadvertently excluded the more severe Babesia cases.
- The study was not designed to determine if Babesia might develop later since the mean convalescent-phase blood sample was 16.7 days [range 7–30 days].
- Wormser GP, McKenna D, Scavarda C, et al. Co-infections in Persons with Early Lyme Disease, New York, USA. Emerg Infect Dis. 2019;25(4):748-752.