Babesia and Asplenia: Why Treatment May Take Longer
Babesia infection may persist longer in patients without a spleen
Parasitemia can remain despite standard treatment
Careful follow-up may reduce relapse risk
Babesia infection can be more severe and more difficult to clear in patients with asplenia. Without a functioning spleen, the body may have greater difficulty removing infected red blood cells, allowing Babesia parasitemia to persist despite treatment.
In some cases, patients may require prolonged therapy and close follow-up because relapse can occur even after apparent clinical improvement.
Case report of prolonged Babesia infection
In their study “Trust the Process: Prolonged Babesia Parasitemia in an Elderly Man with Asplenia from the American Midwest”, Ivancich and colleagues described an 89-year-old man with multiple comorbidities and prior splenectomy who required nearly 8 weeks of treatment for Babesia infection to clear.
The man was evaluated after a fall at home. Before presentation, he reportedly had:
- fever for 2 to 3 days
- loss of appetite
- generalized weakness
Laboratory testing revealed thrombocytopenia, leukocytosis with neutrophilia, elevated liver enzymes, hyperbilirubinemia, and elevated creatine kinase levels consistent with tick-borne illness.
The patient lived in rural Wisconsin and had outdoor tick exposure risk factors.
Testing confirmed Lyme disease and Babesia
The patient tested positive for Lyme disease and Babesia infection based on:
- blood smear findings
- positive PCR testing
- positive antibody testing
Initial treatment included doxycycline and intravenous ceftriaxone before therapy was changed to azithromycin and atovaquone.
Despite treatment, Babesia parasitemia increased to 7.37%, and parasites remained detectable in red blood cells for more than 6 weeks.
After an extended 8-week course of azithromycin and atovaquone, the patient ultimately demonstrated clinical improvement and a negative blood smear.
Why asplenia increases Babesia risk
The spleen plays an important role in filtering infected red blood cells and helping control Babesia infection.
Patients with asplenia or impaired splenic function may therefore face:
- higher parasite burdens
- longer duration of infection
- more severe disease
- increased relapse risk
Older age, immune dysfunction, and coinfections may further complicate recovery.
Learn more about Lyme disease coinfections and Babesia symptoms and treatment.
Why prolonged follow-up may matter
The authors noted that prolonged Babesia infections can relapse months or even years later, particularly in immunocompromised or asplenic patients.
Because symptoms may fluctuate and parasitemia can persist despite therapy, follow-up evaluation may be important even after apparent improvement.
The case also raises an important clinical question: what happens when Babesia infection is not recognized until parasites are no longer easily detected in red blood cells?
Persistent fatigue, sweats, weakness, cognitive symptoms, or autonomic complaints may continue in some patients despite negative smears.
Frequently Asked Questions
Why is Babesia more severe in patients with asplenia?
The spleen helps remove infected red blood cells. Without a functioning spleen, Babesia infection may persist longer and become more severe.
Can Babesia infection relapse?
Yes. Relapse has been reported in some patients, particularly those who are immunocompromised or asplenic.
How long is Babesia usually treated?
Typical Babesia treatment may last 7 to 10 days, although some patients require much longer therapy.
Can Lyme disease and Babesia occur together?
Yes. Coinfection with Lyme disease and Babesia is well recognized because both infections may be transmitted by the same tick species.
Can Babesia symptoms continue after treatment?
Some patients report persistent fatigue, sweats, weakness, or cognitive symptoms after treatment, although causes may vary.
Clinical Takeaway
Babesia infection may persist longer and relapse more frequently in patients with asplenia, particularly when coinfections or immune dysfunction are present.
Careful follow-up and individualized treatment duration may be important when Babesia parasitemia persists despite standard therapy.
Related Articles
These related articles explore Babesia symptoms, persistent infection, delayed diagnosis, tick-borne coinfections, and recovery challenges.
Babesia and Lyme Disease
Delayed Lyme Disease Diagnosis
Persistent Lyme Disease
Recovery From Lyme Disease
Post-Treatment Lyme Disease Syndrome
References
- Ivancich M, Lutwick L, Shweta FNU. Trust the Process: Prolonged Babesia Parasitemia in an Elderly Man with Asplenia from the American Midwest. Am J Case Rep. 2022;23:e936326.
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
I had an extensive case of babesiosis and had a fitful 4 days in ICU. I was put on atova/azithromax for 3 weeks, went off the meds, but the organism came back. I then went on atova/proguanil and azithromax for another 2 full years despite the fact I was, for all intents and purposes, free of the parasite after 10 months. I stayed on the meds for another 14 months, and after asking twice why I was still on the meds, I was “allowed” to get off the meds. I had smears and PCR’s, AOK after 10months. Any ideas why I was kept on the meds so long?