Babesia and Lyme — it’s worse than you think
Babesia, a tick-borne infection that causes malaria-like symptoms, has been making headlines over the past two years as the number of reported cases increases, and concerns grow over the seriousness of the disease and its ability to be transmitted through the blood supply.
Although Lyme disease is the most talked about tick-transmitted disease, Babesia is more common than you might think. In the 2015 issue of Trends in Parasitology, Diuk-Wasser and colleagues report that up to 40% of patients with Lyme disease experienced concurrent Babesiosis. [1]
This means that out of the estimated 300,000 cases of Lyme disease reported annually in the U.S., 120,000 of those individuals may also have Babesia. This is particularly alarming given that the disease can go undetected in asymptomatic individuals and is transmissible through blood transfusions or congenitally. Additionally, Babesia requires different treatment than Lyme disease.
The Babesia microti (B. microti) parasite that leads to Babesia is commonly seen in blacklegged deer ticks. But according to the authors, it’s also common to find ticks and enzootic hosts carrying both Borrelia burgdorferi (the causative agent of Lyme disease) and B. microti. In fact, between 12% and 42% of rodents are co-infected with both agents. This would suggest that “coinfection provides a survival advantage for both pathogens.” [1]
Source: CDC. Number of Babesiosis cases since it become a nationally reportable disease in 2011.
The first case of Babesiosis caused by the B. microti parasite was identified in 1969 in an individual who had vacationed in Massachusetts. It wasn’t until 2011, that it became a nationally notifiable disease with more than 1100 cases reported by the Centers for Disease Control and Prevention (CDC). Two years later, this number had risen to nearly 1800.
Setty and colleagues summarized their concern in a 2003 review, “Parasitemia in humans is transient and episodic. For this reason, there is a risk of asymptomatic donors transmitting the disease to recipients.” The authors raised concerns that there were 20 cases of Babesiosis and a variant Babesia strain called WA1 by red blood cells and blood component transfusions by 2003.
Babesia can lead to serious illness. Patients have presented with atrial fibrillation, [2] noncardiogenic pulmonary edema, [3] and anemia. [2] In New York, between 1982 and 1991, 7 people with Babesia died, while another patient on Nantucket Island developed pancarditis and died. [4]
Babesia occurs in individuals without the risk factors of increased age, prior splenectomy, immunosuppression, prematurity, and liver disease. [2] In one study of 192 patients, the average age was 46 years for individuals with Babesia. [5] The ages ranged from 27 to 83 years in a New York case series. [6] Five of 192 patients were immunosuppressed, [5] while none of the four subjects in another study had a splenectomy. [2]
Babesia can increase the severity of Lyme disease. Coinfected patients were more likely to have experienced fatigue, headache, sweats, chills, anorexia, emotional lability, nausea, conjunctivitis, and splenomegaly more frequently than those with Lyme disease alone. [7]
Babesia can also increase the duration of illness with Lyme disease. Babesia patients can remain symptomatic for years with constitutional, musculoskeletal, or neurological symptoms. One study found that 50% of coinfected patients were symptomatic for 3 months or longer, compared to only 4% of patients who had Lyme disease alone. [7] Meanwhile, one-third of patients with a history of both Babesia and Lyme disease remained symptomatic an average of 6 years. [2]
“The clinical pictures for 3 out of our 4 coinfected patients included a large number of symptoms, and 1 coinfected patient had persistent fatigue after treatment,” according to a study by Steere and colleagues. [8] [bctt tweet=”Babesia and Lyme — it’s worse than you think” username=”DrDanielCameron”]
Babesia – difficult to diagnose
Equally worrisome is the fact that the disease can be difficult to diagnose based on symptoms. Nearly all patients with Babesia reported sweats. However, if the patient was coinfected with Lyme disease, the incidence of sweats dropped to 42%. Sweats can also be reported in other tick borne illnesses. [5]
Babesia can also be difficult to diagnose with current testing. The parasite was detected microscopically in as few as one-third of patients with Babesia. [5] Specific amplifiable DNA and IgM antibody were more likely to be positive. [5] The reliability of tests for Babesia in actual practice remains to be determined.
The Babesia tests can become negative. The Babesia sporozoites can be too few in number to be detected on a thin smear or can resolve with or without treatment. It’s been reported that a positive serologic test for B. microti will decay over time, leading to a negative test. Half of the patients with positive serologic tests for B. microti were negative on follow-up. [2]
Treating Babesia
Babesia cannot be treated with the same medications used to treat Lyme disease. Doxycycline is effective for Lyme disease, Ehrlichia, and Anaplasmosis but not for Babesia. Treatment with Mepron and Zithromax has been effective for Babesia. Quinine and clindamycin have also been effective but are associated with a higher rate of side effects. Flagyl and Tindamax drugs have been proposed but not well studied. The optimal treatment for Babesia has yet to be worked out.
Physicians have different views over the diagnosis and treatment of Babesia. The Infectious Diseases Society of America’s (IDSA) guidelines advise:
- Symptomatic patients whose serum contains antibody to Babesia but whose blood lacks identifiable Babesia parasites on smear or Babesia DNA by PCR should not receive treatment.
- Treatment is also not recommended for asymptomatic individuals, regardless of the results of serologic examination, blood smears, or PCR.
- Asymptomatic patients with positive Babesial smears and/or PCR should have these studies repeated, and a course of treatment should be considered if Parasitemia persists for >3 months. [9]
There are physicians who have elected not to treat Babesia patients, who are asymptomatic. In 1998, Krause and colleagues reported, “24 of 46 Babesia-infected subjects, who received no specific treatment, had Babesia DNA detectable in their blood for an average of 82 days.” [10]
In 2002, Krause et al reported, “Because symptoms had resolved or improved by the time concurrent Babesiosis or HGE was diagnosed, therapy was not administered to 38 (58%) of the patients with Lyme disease plus Babesiosis.” [5]
There are physicians concerned that symptoms of Babesia may be overlooked when evaluating patients. [11] The symptoms of chronic Lyme disease were overlooked for up to 14 years until reported in the 1990 New England Journal of Medicine by Logigian et al. [12] Meanwhile, the symptoms of Lyme disease were dismissed in by the IDSA Lyme disease guideline committee in 2000 and 2006 as nothing more than the aches and pains of daily living. [11] And the severity of the chronic manifestations were not validated until the 4 National Institutes of Health (NIH) sponsored clinical trials were completed. [13]
Sources:
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. Trends Parasitol, (2015).
- Wang TJ, Liang MH, Sangha O et al. Coexposure to Borrelia burgdorferi and Babesia microti does not worsen the long-term outcome of lyme disease. Clin Infect Dis, 31(5), 1149-1154 (2000).
- Golightly LM, Hirschhorn LR, Weller PF. Fever and headache in a splenectomized woman. Rev Infect Dis, 11(4), 629-637 (1989).
- Marcus LC, Steere AC, Duray PH, Anderson AE, Mahoney EB. Fatal pancarditis in a patient with coexistent Lyme disease and babesiosis. Demonstration of spirochetes in the myocardium. Ann Intern Med, 103(3), 374-376 (1985).
- Krause PJ, McKay K, Thompson CA et al. Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease. Clin Infect Dis, 34(9), 1184-1191 (2002).
- Meldrum SC, Birkhead GS, White DJ, Benach JL, Morse DL. Human babesiosis in New York State: an epidemiological description of 136 cases. Clin Infect Dis, 15(6), 1019-1023 (1992).
- Krause PJ, Feder HM, Jr. Lyme disease and babesiosis. Adv Pediatr Infect Dis, 9, 183-209 (1994).
- Steere AC, McHugh G, Suarez C, Hoitt J, Damle N, Sikand VK. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis, 36(8), 1078-1081 (2003).
- Wormser GP, Dattwyler RJ, Shapiro ED et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 43(9), 1089-1134 (2006).
- Krause PJ, Spielman A, Telford SR, 3rd et al. Persistent parasitemia after acute babesiosis. N Engl J Med, 339(3), 160-165 (1998).
- Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther, 1-33 (2014).
- Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of Lyme disease. N Engl J Med, 323(21), 1438-1444 (1990).
- Cameron DJ. Clinical trials validate the severity of persistent Lyme disease symptoms. Med Hypotheses, 72, 153-156 (2008).
Elisa Masslich
04/15/2018 (9:45 pm)
I used to go to you, Dr. Cameron, for treatment, but since I am very far and do not drive long distances and feel so very sick every day, I don’t know what to do. I tested positive for Lyme and Babesia microti, but recent tests from regular pc came back negative for both; I believe they used any old lab. I suffer with joint pain, night sweats, stiffness, constipation, heartburn, but MOST OF ALL SOMETHING I NEVER HEARD ANYONE MENTION, I HAVE CONSTANT BURNING LIKE A FIRE INSIDE MY ANAL AREA, 24/7, ALL DAY. gASTRO SAID IT MAY BE PUDENDAL NERVE DAMAGE. i HAVE HAD SHOTS FOR pn with no success. Have you heard of Babesia microti causing this burning, from any of your patients. Some doctors have told me I am a psychopath with all these strange symptoms, especially the burning sympton. It’s like having a fireplace lit inside my rectal/anal area.
Dr. Daniel Cameron
04/16/2018 (12:04 am)
Sorry to hear you remain ill. I have not seen the pain you describe. Perhaps others have. It sounds as if pudendal nerve blocks have also failed. Keep working on finding a solution.
Gabriel Saks
04/10/2018 (5:52 pm)
Hi Dr. Cameron. I found an adult deer tick on me (feeding near armpit) and removed it, and sent it to be tested at UMass “tickreport”. The tick tested positive for Babesia microti. It has been 10 days since I removed it, I am still asymptomatic (I have been feeling somewhat lethargic/depressed, and my arm on that side is slightly sore, but it may not be related). Should I get antibiotics just in case, since early treatment is more able to eradicate it?
Thank you very much!
Gabe
Dr. Daniel Cameron
04/10/2018 (9:45 pm)
I am always concerned when my patients have any symptoms within 6 weeks of a tick bite. Babesia may take awhile to develop symptoms. see my blog at https://danielcameronmd.com/blood-donor-infects-premature-infants-babesia/ I can’t give individual advised without an office visit. You should consult your doctor given the symptoms even if they are not so clear cut.
Guy Langellotti
03/22/2018 (4:56 pm)
Good Morning Dr. Cameron…
I came across this web page as a result of my search looking into repercussions for having Babesiosis…
I was diagnosed with Babesiosis in July of 2016 (as well as Lyme, have had quite a few times) and had quite a bout with the Babesiosis. It’s a long story as to how I came to be tested though just the same, I definitely had it (or might I say still “have it”). I was blessed that my Emergency Room Doctor knew of the denial game that is going on and had my blood samples sent to California …
At that time, the only suggested antibiotics to take was Zithromax with Mepron, though the insurance would not approve the Mepron because it was not an approved medication at that time by the FDA for addressing Babesiosis (don’t know if it is still not an approved medication for Babesiosis)…
Because the insurance would not approve the Mepron and that the price I was told was ridiculously high, much more than I could afford, I searched the internet for anything else that could be used. I felt that if the insurance wouldn’t approve the medication that there might be other medications that might be available to use against this parasite. That possibly the insurance had something else in mind that they were not mentioning…
I came across a site which mentioned that one doctor had good results with using Doxycycline, Zithromax, and Clindamycin taken together. I was already on Doxycycline for the Lyme (yes, of course I had that as well…lol) and before the Dr. learned the Mepron was not approved had me on the Zithromax as well, it was on filling the scripts for the Zithromax and Mepron that I learned about the insurance concerns for the Mepron. Was approved for the Zithromax so I started taking that with the Doxycycline…
So I mentioned me findings to my Family Dr. who then gave me a script for the Clindamycin as well….
It was a terrible 10 days taking the Clindamycin with the other medications with acid reflux that could kill a bull (oh, did I burn…lol) though it seemed to take away the symptoms I was having from the Babesiosis…
I have a local Infectious Disease Doctor who originally came out of Stony Brook University’s Infectious Disease group. I am not happy at all with the information I received from this Doctor, I seem to get a run around from anyone coming from the group at Stony Brook (I had originally seen one of the doctors there many years ago after my first bout with Lyme, same run around)…
I keep all my record history pertaining to my Lyme tests, both IgG (6) and IgM (2-3) are lit up across the board on the last few tests. I am told now that I will not be tested anymore because the results with be the same no matter what…that I will always show positive now with the western blot using the IgG and IgM bands…
I recently called my present Infectious Disease Doctor about some new tests at this time and was very dissapointed that he had no idea of any (Nanotraps is one, I hope I spelled it right) after I brought this to his attention he then found that the tests are real and most likely not covered by the insurance yet…
I am on Long Island NY and I am wondering if there is more information on dealing with both Babesiosis and Lyme and their aftermath…I am concerned…wait…more than concerned…I feel one or both of these are still attacking my system…
I am a person who is quite tough (or should I say I was)…I am now 62 and can’t tell if my issues are just because of my age or are they related to having these diseases still active in my system…
Please, if you can, help…lol…is there any light you can shed on this…
I thank you in advance for your time and consideration…
Sincerely
Guy Langellotti
Dr. Daniel Cameron
03/22/2018 (5:38 pm)
Most antibiotics are not approved by the FDA. I don’t believe that doxycycline, amoxicillin, Zithromax or IV Rocephin are FDA approved. Clindamycin combined with quinine has been recommended for Babesia but has more side effects that Mepron and Zithromax. It is not clear that clindamycin works without quinine for Babesia. You may find a lower dose Mepron or oral Malarone might help your doctor. The cost is lower if you can use the GoodRx app.
Guy Langellotti
03/24/2018 (11:55 am)
So what you are saying in that I did not have the Clindamycin with quinine I might still have the Babesiosis? I was only given the combination Doxycycline, Zithromax, and Clindamycin taken together as I stated. Also, is it worth me coming to see you in that your address shows you are 1 hr 40 min away from me. I am with Health First with the Gold Leaf Premier policy? I really am not getting much attention from the local infectious doctors, as I stated, they seem to have a printed statement concerning these diseases.
Guy
Dr. Daniel Cameron
03/25/2018 (3:07 am)
I am not convinced that clindamycin works without quinine. You are welcome to call the office agt 914 666 4665.
Carolyn
03/21/2018 (5:52 pm)
I tested positive for Lyme back in 2007. Did 21 days of doxy and was fine. This past Oct I wasn’t feeling well…tested positive for Lyme but the doxy didn’t help this time. I went to a LLMD she has made taking zythromax and malorone along wth allergy meds. I have been feeling better with some bad days mixed in. I have read the symptoms on MS however and can not believe how similar they are to my symptoms. I feel like I haven’t had “classic” babesia symptoms. My worst symptom is I feel a shakey sensation in my head. Some other symptoms been fatigue, feeling sore in my hips when I lay down, air hunger, and anxiety. Should I be doing other testing or is it safe to say this is most likely babesia and/or bartonella. She is treating the babesia currently but thinks we will most likely be tackling bartonella next…
Jillory
03/18/2018 (10:47 pm)
I have had these symptoms for 25+ years. Lived in Oregon and Maine spending much time in the woods. Main symptoms, body pain, horrible sweats, vivid wild dreams, depression, restlessness, brain fog, tremor, unsteady balance, itching, increases heart rate and palpitations, chest pain, bladder instability anxiety, fatigue and more. Had to quit my nursing career because I could not deal with the stress. Was framed with diagnosis of Fibromyalgia. Last fall had 6 weeks of severe vertigo and doctor sent blood work to Stanford. Came back with Babesia lab value of 160. Have been put on all the top antibiotics mentioned here, even the Doxycycline. Have felt no improvement at all. If I have had it for so long is it useless to do antibiotics anymore?
Saw a cardiologist for chest pain. Was put on 400mg magnesium a day due to profuse sweating and my chest discomfort has dropped 85%. So that was helpful but feel that five months of antibiotics have not changed my symptoms with the exception of having a bad herxing reactions. Almost died after trip flying from Maine to California on New Year’s Day 2018.
They said my kidneys were dry and said I was in critical condition . My body felt that it was shutting down. I don’t know if I should pursue treatment or accept things as they are after having it so long.
But was hoping I would have improved after that and didn’t. In bed most of my days. My SaO2 in RA is 94. Should I give in to the fact that this is just who I am now.?
Dr. Daniel Cameron
03/19/2018 (12:18 am)
I am happy to hear the doctors considered Babesia. It can be difficult to find a solution. You also need to consult other doctors to rule out other illnesses.