Babesia Cases Explode in New York’s Hudson Valley
Babesia infections increased dramatically in New York’s Hudson Valley.
The rise extends beyond traditionally recognized endemic counties.
Clinicians may need to consider Babesia more often in symptomatic patients.
In their article “Increasing incidence and changing epidemiology of babesiosis in the Hudson Valley region of New York State: 2009-2016,” Joseph and colleagues questioned how Babesia infections are spreading given that animal reservoirs such as mice, shrews, and voles typically do not travel long distances.
Cases of Babesia had previously been concentrated in counties east of the Hudson River, including Dutchess County and Westchester County, the authors explain. Westchester County alone has a population approaching 1 million residents.
However, since 2009, cases of Babesia infection have increased sharply in the Upper Hudson Valley region of New York, including Albany County, Columbia County, Greene County, and Rensselaer County.
Read More: Babesia remains a clinical diagnosis for some patients.
Babesia Cases Increased More Than 16-Fold
Over an 8-year period between 2009 and 2016, the incidence of Babesia cases in the Upper Hudson Valley region increased 16.8-fold.
[bctt tweet=”The number of Babesia cases explodes in the upper Hudson Valley, NY region.” username=”DrDanielCameron”]
The number of cases also increased in the Lower Hudson Valley region, which includes Dutchess County, Putnam County, Westchester County, Orange County, Rockland County, Sullivan County, and Ulster County.
Why the Number of Babesia Cases May Be Higher Than Reported
The actual number of Babesia infections may be substantially higher than official reports suggest.
- Babesia did not become a nationally reportable disease through the Centers for Disease Control and Prevention (CDC) until 2011. Between 2011 and 2016, New York State reported 2,750 Babesia cases—the highest number reported by any state in the U.S.
- Babesia can be difficult to diagnose because parasites within red blood cells may clear quickly and become difficult to identify.
- Some Babesia cases may never be officially recorded if physicians do not report them to public health agencies.
“In conclusion, babesiosis is a rapidly emerging infection in the Hudson Valley region of New York State, the geographic region now accounting for more cases than any other single geographic area in the state,” the authors wrote.
The authors advised that clinicians caring for patients with symptoms compatible with babesiosis who live in or have traveled to the Hudson Valley region should consider the possibility of Babesia infection.
Why Babesia Diagnosis Matters in Lyme-Endemic Regions
Babesia has important implications for patients with Lyme disease because co-infections can complicate diagnosis, symptoms, and treatment decisions.
Unlike Lyme disease, Babesia is a parasitic infection. Neither doxycycline nor amoxicillin alone are considered effective treatments for Babesia.
Patients with Lyme disease who are co-infected with Babesia may require combination therapy that includes anti-parasitic medications such as azithromycin and atovaquone.
Learn more about Babesia duncani and emerging treatment challenges.
Editor’s Perspective on Babesia in the Hudson Valley
Editor’s Note: I have practiced medicine in the Hudson Valley region of New York for more than three decades and have treated patients with Babesia infections throughout that time.
Many of the earlier patients diagnosed with Babesia microti were identified when parasites could still be seen within red blood cells. Today, diagnosis may rely more heavily on antibody testing and clinical judgment because laboratory confirmation is not always straightforward.
The authors focused primarily on Babesia microti in their paper. However, I have also seen evidence suggesting that Babesia duncani, once thought to be largely confined to the West Coast, may also be emerging as a problem in the region.
We still need more research to better understand how Babesia is spreading, how often it is being missed, and how best to manage these infections.
Frequently Asked Questions
What is Babesia?
Babesia is a parasite that infects red blood cells and is commonly transmitted through tick bites. It can occur alone or alongside Lyme disease.
What are common symptoms of babesiosis?
Symptoms may include fatigue, fevers, chills, sweats, headaches, shortness of breath, dizziness, and anemia. Some patients experience persistent symptoms that overlap with Lyme disease.
Why can Babesia be difficult to diagnose?
The parasite may no longer be visible in red blood cells by the time testing is performed. Clinicians may rely on antibody testing, clinical judgment, and assessment of symptoms and exposure history.
Can Babesia occur with Lyme disease?
Yes. Babesia and Lyme disease are both transmitted by ticks, and co-infection is not uncommon in endemic areas.
Does doxycycline treat Babesia?
No. Babesia is a parasitic infection and generally requires anti-parasitic treatment rather than doxycycline alone.
Related Articles:
Severe Babesia infection leads to exchange transfusion
Case series looks at the complexity of Babesia
Podcast: Two children who contracted Babesia from their mothers
References:
- Joseph JT, John M, Visintainer P, Wormser GP. Increasing incidence and changing epidemiology of babesiosis in the Hudson Valley region of New York State: 2009-2016. Diagn Microbiol Infect Dis. 2020 Feb;96(2):114958.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Hi Dr. Cameron. Just letting you know that when I was tested for Lyme (it took 4 mos to get a positive for BB) I was also tested more than once for Babesia but the tests were negative. I was told Babesia and Anaplasmosis were the most common co-infections in MN. When I went to the ER from the second nymph bites with a multiple lesion rash. I had red blotchy palms that prompted the ER doc to ask me “what’s that?” I said I didn’t know. Nothing said past that about it. I still have varying degree’s of blotchy palms since (7/17) I was wondering what the most prevalent clinical signs for Babesia look like in your studies. I know the sweats and chills for two years may be Babesia and would explain why Doxy didn’t work. Do Chronic Lyme patients need to be concerned about being exposed to COVID-19? Also I was recently rear ended and pushed into cars in front of me so there were two impacts that resulted in a diagnosis of whiplash and concussion. Is there anything I need to talk to my PT about concerning any other Lyme related conditions? I feel like I can’t say the word Lyme. It’s not being brought up as I am going through PT (Concussion therapy next). Is that because in MN there is still no protection for physicians to treat Lyme? I hear about people getting treated with a positive BB result but other than the original antibiotic treatment with Doxy, nothing has been brought up by any of my specialists or GP. (Only what I previously told you about Dr. Gary Bryant, Rheumatology at the U of M involved in the second attempt at a vaccine) That testing and treatments just aren’t there and he hopes to see it before he dies. I’m getting confusing messages but it would seem I may be in the wrong state to ask such questions. Most U of M physicians are IDSA members. Just wondering. Little nervous about going back to the hospital for PT today with the lack of discussion concerning Lyme, accident injuries and COVID-19. Lots in my questions and a bit of confusion but maybe you can take a crack at it. 🙂 Hope you are doing well. Stay safe.
I have patients in my practice who are equally confused and frustrated. I have to use clinical judgment as to whether to treat for a co-infection e.g., Babesia. I find that some of my Lyme disease patients do not realize they suffer from a tick-borne illness until they get a concussion. We do not know about COVID-19 and Lyme yet.
BTW I grew up in Minnesota. I practice in New York.
I live in northern California and back in the early 1990’s people came and tested our entire hillside community. The were a lot of positive results for lyme and babesia. My whole family was discovered to have babesia, but not lyme. All we were told at the time was to never donate blood. Is it possible that my siblings and I should be treated for babesia? Is it possible with treatment for me to be able to donate blood? Do you have recommendations for doctors in California?
I typically recommend an evaluation for Babesia and Lyme disease if I have a patient who is ill or never has been treated. I am not sure the blood back would clear you even if you are treated for Babesia. You could contact LymeDisease.org or ILADS.org.
Hi Doctor Cameron,
My ex husband knows you from Belizzi and Pizza Pizzazz and knows what a great doctor you are – he sent me here! I tested positive for Babesia microti last September (2021) and my titers were 1:20. They retested me in November (2021) and my titers were stable at 1:20. I still felt fatigue and unwell and just retested an my titers were 1:80. Do you think it’s time to begin treatment? If so, I look forward to seeing you soon.
We live in southern Ulster County. My daughter was first infected with Babesia in 2010 at age five. Her pediatrician recommended against treatment, citing CDC guidelines. When her initial symptoms were replaced with other ongoing concerns, we found a doctor willing to treat her four months after the infection began. She improved over the course of six months of medication, and we stopped treatment.
Over the years her IgG remained at 1:40 and she had several cycles of some symptoms and brief treatment. Last summer she had a new tick bite and confirmed Lyme, and her Babesia IgG went up to 1:320. She has had marked improvement with atovaquone and azithromycin, but is still struggling with symptoms. I wonder if it is something she will carry with her for the rest of her life to some degree.
I am happy to hear she had marked improvement with atovaquone and azithromycin. I have patients who have benefited from additional antibiotic treatment.