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).
Sandy
05/29/2018 (9:02 pm)
I was diagnosed with Branch Retinal Artery Occlusions in April 2018 and Babesiosis about 6-weeks later. I have Hollenhorst Plaques in the Occlusions. I am 40 and do not have high blood pressure, high cholesterol, my echocardiogram and carotid doplar were good. I saw a hematologist and there has been no indication of a blood clotting disorder. I underwent a stroke assessment with an MRI/MRA and that was clear. I have severe fatigue, night sweats, chills, elevated temperature, excessive yawning after being up about 6hrs, and sometimes day sweats. My PCP prescribed the anitibiotic/antiparasitic that the CDC recommends. I am thinking I should see an Infectious Disease Specialist for the Babesiosis. Could the Babesiosis cause the BRAO or contribute to aortic issues that may have released the plaque? I also have a history of illness and less effective immune system. My PCP was thinking my case was mild, but I’m wondering if there is more cause for concern? Thanks for your input
Dr. Daniel Cameron
05/29/2018 (11:47 pm)
I have not seen any information to address whether the retinal or aortic issues are related. There are doctors who are reluctant to treat Babesia unless the parasites are seen in the red cells and then only for 10 days. Doctors are divided on their approach to Babesia.
Katie
04/04/2019 (5:34 am)
Sandy,
I had retinal occlusions as well. I have chromosomal disorders of the blood but not necessarily the cause. One evening, my right sideof my face was psrtially paralyzed and was experiencing numbness and tingling in my right arm and right leg. The er dr diagnosed Herpetic Neurolgia. I have not been able to work in an office. I am fatigued w sporadic high fevers/night sweats, headaches (right eye ) and joint pain. The clinical diagnosis is Bartonella in addition to thr lsbs that showed babesiosis (duncan) and Anaplasma. Try Bartonella?? Good luck.
Katie O
06/18/2019 (7:03 pm)
Sandy,
When I was 45, I was diagnosed with retinal vein occlusions. I, too have normal to low cholesterol, normal to low blood pressure- MRI/CAT scan- all negative.
Went to Hematologist- had some chromosonal disorders of blood but none which should cause
clotting issues.
And, my same eye, was also very painful and times, lots of pressure , headaches right behind the eye.
Three years later, hospitalized at Stamford Hospital for facial tingling, right side numbness, weakness. They ruled out a stroke and TIA. Ultimately, bc I kept insisting I could feel something in my ear as well, diagnosed w Herpetic Neurolgia (although a frequent sufferer of Heroes Simplex I – no cold sores at the time.). It did NOT feel correct.
Three years later, I go to Dr. Boyboulis in Darien and he diagnosed me w Babesiosis, Bartonella, Egrlichia, Anaplasma and walking pneumonia. I spent ten years going to every specialist in CT and NY with edema, brain fog, tiredness, red spots on body, Severe night sweats, bladder infections which never tested for bacteria and ultimately became diagnosed to be interstitial cystitis (sp), sore neck, muscle aches from climbing stairs, plantar fasciitis….and I spent hundreds of thousands of dollars. Saw Head of Infectious Diseases at Greenwich Hospital- I mention the hospitals bc given their location (southern CT!)- I cannot believe that I was told I was getting old, four bouts of severe cold and flys in winter of 2018 did not inspire ANY CURIOSITY from my Stamford Hospital Primary Carr Physician!!!
Only after spending another $2000 on labs that were not covered, were the co-infections found. How is it possible that OCCULAR VEIN OCCLUSIONS and all of these SYMPTOMS AFTER being diagnosed with Lyme multiple times, and NOT ONE of the many, both in and out of network doctors – hematologist, cardiologist, dermatologist (3), retinal specialist, thyroid dr, auto-immune specialist, gastroenterologist, gynecologist, gynecologust urologist – NOONE thought of
cO INFECTIONS??? Hundreds of thousands of
Dollars later.
In any event, I know the retinal vein occlusions were probably the parasites clumping together.
I have been four months on doxy, malarone and azythromycin and feel much, much better. I stopped taking malarone for a few days and the joint pain and sweats came right back so back on it.
I really do feel much better. I think it is a crime that
So many Fairfield/NY doctors heard my symptoms and failed to mention co-infections. Tragic.
Dr. Daniel Cameron
06/19/2019 (6:22 pm)
Thanks for sharing your journal. I find that treatment is often effective despite the treatment delays.
Richard
05/29/2018 (3:49 pm)
I have had Lyme several times over the past 20 years and had a doctor that specialized in the treatment of it. He has since retired from practice and my present Dr does not support long term treatment. I have tested positive/inconclusive for B. microti and cannot donate blood. My question is has there been any research on using colloidal silver? I used it with the antibiotics with the first Dr and told him and he said there was no reason to think it would not work as it was used to treat syphilis.
Dr. Daniel Cameron
05/29/2018 (11:41 pm)
I am not familiar with the research on colloidal silver. I assume your treatment included medications for Babesia.
Nancy G.
05/17/2018 (2:32 pm)
That’s interesting about kidney disease being associated with babesia. I didn’t know that. I have babesia, Lyme and bartonella. My kidney function test showed low filtration since at least 2015. GP’s and Internists don’t even mention it until their patients are critical and need dialysis, but my LLMD, who is a functional medicine doctor, was alarmed enough to suggest that I might need to see a kidney specialist. She also suggested I take Trizomal Gluthatione liquid, which can help heal kidneys. After a couple of months of that, my last kidney function test was normal, for the first time in two or three years.
Dr. Daniel Cameron
05/19/2018 (11:59 pm)
I have not seen renal disease in Babesia. I understand renal disease is common in dogs.
Fred
02/22/2021 (2:07 pm)
You are right, because dogs are Bartonella carriers, Bartonella can cause kidney, eye and heart damage big time. You can be infected via tick bite or dog bite/scratch.
Steve
05/12/2018 (1:21 am)
Hello Dr. Cameron and fellow lyme peeps : )
No lyme disease for me as I can find from past ELISA and Western blot test but a recent blood work on me included a Babesia Microti Anti Panel test, and came back positive on the IgG @ 1:80. I suspect infection happened back in November 2013, but can not be sure.
My Dr wrote me a prescription for 42 -100mg doxycycline capsules to be taken 2 times a day. But from the info here and elsewhere that is not the antibiotic that is normally used for babesia. When i questioned him on his choice of antibiotic he stated it was the normally prescribed antibiotic for babesia. I will be seeing a LLMD that is listed with the ILADS organization in about a week for a second opinion on that. 1 1/2 hour commute but it is very important to me to get this right.
Severe headaches on the left side along with many of the other reported symptoms for me. I am a bit worried about my 55 year old kidneys feeling the strain of the last four years. I was miss diagnosed with cluster headaches and migraines by various neurologist and previous family doctor.
I was very pleased that a new family doctor agreed to include various lyme co-infections tests with latest blood work. But was confused by his doxycycline script. I am thinking of picking up the doxycycline anyway or should I wait until I see a LLMD?
Thanks
Dr. Daniel Cameron
05/12/2018 (7:00 pm)
The best treatment for Babesia is a combination of Mepron with Zithromax since the article by Krause PJ1, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, Brassard P, Pearl D, Azlanzadeh J, Christianson D, McGrath D, Spielman A. in the N Engl J Med. November 2000 Nov. called Atovaquone and azithromycin for the treatment of babesiosis in https://www.ncbi.nlm.nih.gov/pubmed/11078770
Until then quinine and clindamycin had been preferred. Some have used a lower does Malarene for Mepron for the atovaquone.
MT
05/04/2018 (10:04 am)
Last August I was sent a letter from the RI CDC that I was infected with B. Microti, recognized after a blood donation. I believe I was infected early summer. After convincing PCP to test , got tested in OCTober, smear neg. PCR was positive, serology not performed, and not given treatment. Pursued PCP due to symptoms, though not debilitating but present and affecting quality of life. Retested in Feb., smear was neg, PCR was neg, antibodies in sereology were 256. Granted treatment of Zpack and meprone. Felt good for a couple of weeks. Fatigue and joint pain resurfaced, more than before. pursued more blood work. Smear and PCR clear. Antibodies at 64. PCP declares success. I think otherwise, do symptoms still appear after a successful treatment? Is a second opinion recommended? Will this clear up on its own? Is bloodwork the holy grail of diagnoses? Aargh, its frustrating when you live in ground zero for these infections and you would think there would be more knowledge about them. You make an inquiry but all you hear is crickets. I asked the CDC director in the beginning via email if there were any research I could get involved in but she said she did not. It all seems strange to me. Sorry for rambling and there are those who are much worse off than I, just needed to vent and this seemed like a good place.
Dr. Daniel Cameron
05/04/2018 (2:17 pm)
I am happy to hear your doctor has worked hard with some success. It can be difficult to resolve the illness. Sometimes a change in treatment to include Babesia is helpful. There is no test to verify an infection has resolved. It is also important to rule out other causes. I typically have to do a complete evaluation to look for opportunities that might have been overlooked.