Babesia and Lyme Disease: Symptoms, Testing, Treatment, and Why It’s Often Missed
Babesia is a common Lyme coinfection.
Night sweats and air hunger are important clues.
Testing limitations often delay diagnosis.
Babesia is one of the most common—and most overlooked—coinfections in Lyme disease. It can cause symptoms that persist, fluctuate, or fail to respond to standard Lyme disease treatment.
Common Babesia symptoms include night sweats, air hunger, fatigue, chills, and relapsing illness patterns.
When this parasite goes unrecognized, patients often do not fully recover.
Babesia is transmitted by the same ticks that carry Borrelia burgdorferi. Studies suggest that co-infection rates may be substantial in endemic regions. 1,2
For a broader overview, see our coinfections hub.
📖 New to Babesia? Start here:
Why Babesia and Lyme Is Worse Than You Think
Babesia Symptoms
Babesia symptoms often overlap with Lyme disease but may follow a distinct clinical pattern.
- Night sweats — drenching, cyclical, and unexplained
- Air hunger — shortness of breath despite normal oxygen levels
- Severe fatigue — disproportionate to activity
- Chills and fever — often fluctuating or cyclical
- Autonomic instability — dizziness, temperature swings, internal unease
These symptoms may reflect the parasite’s effect on red blood cells and oxygen transport.
Babesia symptoms may also contribute to autonomic dysfunction.
Related Reading: Symptoms
- Night Sweats and Babesia
- Sweats May Be a Sign of Babesia
- Shortness of Breath with Normal Oxygen
- Babesia Air Hunger
- Babesia Symptoms: Night Sweats, Air Hunger, and Fatigue
Babesia Testing
Babesia testing has important limitations.
- Blood smears may miss low-level infection
- PCR testing may fail to detect certain species
- Antibody levels may decline over time
A negative test does not always exclude Babesia.
Related Reading: Testing
Babesia Treatment
Babesia requires different treatment than Lyme disease.
- Doxycycline alone does not treat Babesia
- Typical therapy often includes atovaquone plus azithromycin
- More severe illness may require alternative regimens
Treatment duration varies depending on symptom severity, immune status, and co-infections. 3,4
Related Reading: Treatment
Babesia Co-infection With Lyme Disease
When Lyme treatment fails, Babesia may be part of the explanation.
This parasite can contribute to persistent symptoms that do not fully respond to antibiotics directed only at Lyme disease.
Patients with Babesia co-infection may experience more severe illness, prolonged recovery, or relapsing symptoms. 1,2
Related Reading: Co-infection
Blood Transfusion Risk
Babesia can also be transmitted through blood transfusion.
Although donor screening has improved, transfusion-associated babesiosis remains an important concern. 5
Related Reading: Blood Risk
Special Populations
Babesia may be more severe in:
- Older adults
- Immunocompromised patients
- Patients without a spleen
- Pregnant women and infants
Severe babesiosis has been associated with prolonged illness, organ dysfunction, and relapse in high-risk populations. 3,4
Related Reading: Special Populations
Frequently Asked Questions
What is the difference between Babesia and Lyme disease?
Lyme disease is caused by bacteria. Babesia is a parasite that infects red blood cells and requires different treatment.
Can you have Babesia without Lyme disease?
Yes. However, co-infection is common because both illnesses may be transmitted by the same tick.
Why is Babesia often missed?
Testing limitations and overlapping symptoms contribute to delayed or missed diagnosis.
Can Babesia relapse?
Yes. Relapsing symptoms may occur, particularly in immunocompromised patients.
References:
- 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. 2002;34(9):1184-1191.
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes tick-borne pathogens: ecological, epidemiological, and clinical consequences. Trends Parasitol. 2016;32(1):30-42.
- Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis. Clin Infect Dis. 2006;43(9):1089-1134.
- Vannier E, Gewurz BE, Krause PJ. Human babesiosis. Infect Dis Clin North Am. 2008;22(3):469-488.
- Levin AE, Krause PJ. Transfusion-transmitted babesiosis: is it time to screen the blood supply? Curr Opin Hematol. 2016;23(6):573-580.
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 was infected with Lyme disease with co-infections Bartonella and Babesia in the upper Midwest eight years ago. I was blown off by the clinic Up North because I am from Texas. Texas is just now starting to see Lyme. However, treatment been very challenging to obtain. I am extremely sensitive to drugs and some herbs (I’m told one in 2000). I’m now trying to deal with Babesia, but the herbs are worse than the disease if tolerated at all. My age is a factor so need to figure this out before it gets any more severe. I hit a wall last week physically and emotionally.
Thank you for sharing this—what you’re describing is something I hear from many patients, especially when symptoms are complex and treatment is difficult to tolerate.
I can’t offer individual medical advice here, but sensitivity to medications and challenges with infections like Babesia infection and Bartonella infection are real concerns that deserve careful, individualized care.
If you’ve hit a wall physically and emotionally, that’s important to recognize—this is where a thoughtful, step-by-step approach with a clinician experienced in complex tick-borne illness can make a difference.