Babesia elderly patients can present without the classic symptoms—and that’s what makes these cases so dangerous. In the article “An Atypical Case Presentation of Babesiosis,” Allen and colleagues describe a unique 75-year-old patient who contracted Babesiosis but did not exhibit many of the typical symptoms, such as night sweats, chills, shortness of breath and weight loss. Instead, his symptoms were limited to weakness, fever, tachycardia and leg pain.
Case Report: Babesia Elderly Patient with Atypical Symptoms
A 75-year-old man was admitted to the emergency department with generalized weakness that had been ongoing for one week, a fever and tachycardia. He also had mild swelling of his left leg and leg pain, which he described as intermittent stabbing pain in his left thigh.
The man had a past medical history of hypertension and hyperlipidemia. His initial laboratory test results revealed mild anemia, thrombocytopenia, and renal dysfunction. All other testing was normal.
The patient was treated empirically with acetaminophen and intravenous ceftriaxone and vancomycin.
“On the first day of hospitalization, blood parasites were noted to be present on the patient’s complete blood count (CBC),” the authors state.
His treatment was switched and he was prescribed a 10-day course of azithromycin and atovaquone for a possible diagnosis of Babesiosis. However, the patient’s condition deteriorated rapidly.
Why This Babesia Elderly Case Turned Critical
“The patient’s renal function, anemia, thrombocytopenia and mental status progressively worsened and by hospital day 3 the patient was transferred to the Intensive Care Unit.”
He was then treated successfully with a red blood cell exchange and plasma exchange therapy.
“The patient’s kidney function improved, along with his anemia and thrombocytopenia,” the authors state. “The percentage of parasitemia had decreased to 1% from a maximum of 22% on Day 1 of admission.”
Subsequently, PCR testing for Babesiosis was positive for Babesia microti.
What Clinicians Should Know
The authors conclude:
- “Tick-borne illnesses should be included in the differential even in low-risk populations and non-endemic regions due to the severity of disease complications.”
- “When patients present with vague symptoms, it is important to keep a broad differential.”
- “In this case, it could have been beneficial to inquire if the patient spent time outdoors or had any pets or other means by which he may have been exposed to a tick.”
Babesia elderly patients are at higher risk for severe disease—especially those with compromised immune systems, without a spleen, or with underlying health conditions. Atypical presentations can delay diagnosis and lead to life-threatening complications.
Frequently Asked Questions
Why do elderly patients get sicker from Babesia?
Babesia elderly patients often have weaker immune systems, underlying health conditions, or reduced spleen function—all of which make it harder to fight the parasite and increase the risk of severe disease.
What are atypical Babesia symptoms?
While classic symptoms include night sweats, air hunger, and chills, some patients—especially the elderly—present with only weakness, fever, leg pain, or confusion. This can delay diagnosis.
When is exchange therapy needed for Babesia?
Red blood cell exchange is used in severe cases with high parasitemia (often over 10%), organ failure, or rapid deterioration—as seen in this case where parasitemia reached 22%.
Can Babesia be fatal in elderly patients?
Yes. Babesia can cause life-threatening complications including severe anemia, kidney failure, respiratory distress, and death—particularly in elderly or immunocompromised patients.
How is Babesia diagnosed in atypical cases?
Blood smear may reveal parasites, but PCR testing is often needed to confirm the diagnosis—especially when symptoms don’t fit the classic pattern.
References
- Allen D, Getto L. An Atypical Case Presentation of Babesiosis. Cureus. 2024 May 10;16(5):e60036.
