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.

[bctt tweet=”Babesia co-infection is emerging as a real threat to the public. ” username=”DrDanielCameron”]

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.

Editor’s concerns:

1. The authors did not discuss whether the 6 patients recovered from Babesia.
2. The study excluded patients with extracutaneous symptoms and may have inadvertently excluded the more severe Babesia cases.
3. 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].