Babesia and Lyme Disease: Symptoms, Testing, Treatment, and Why It’s Often Missed
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 treatment.
When this parasite goes unrecognized, patients don’t fully recover.
Babesia is transmitted by the same ticks that carry Borrelia burgdorferi. In some regions, up to 40% of patients may have both infections.
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 show distinct patterns:
- Night sweats — drenching, cyclical, and unexplained
- Air hunger — shortness of breath with normal oxygen levels
- Severe fatigue — disproportionate to activity
- Chills and fever — often cyclical
- Autonomic instability — dizziness, temperature swings, sense of doom
These symptoms reflect the parasite’s effect on red blood cells and oxygen delivery and may contribute to autonomic dysfunction.
Related Reading: Symptoms
- Night Sweats Babesia
- Sweats May Be a Sign of Babesia
- Shortness of Breath with Normal Oxygen
- Babesia Air Hunger
Babesia Testing
Babesia testing has important limitations:
- Blood smears may miss low-level infection
- PCR may fail to detect certain species
- Antibody levels may decline over time
A negative test does not rule out Babesia.
Related Reading: Testing
Babesia Treatment
Babesia requires different treatment than Lyme disease.
- Doxycycline does not treat Babesia
- Typical therapy includes atovaquone + azithromycin
Treatment duration varies depending on symptom severity and immune status.
Related Reading: Treatment
Babesia Co-infection with Lyme Disease
When Lyme treatment fails, Babesia is often the reason.
This parasite can drive persistent symptoms that do not respond to antibiotics alone.
Related Reading: Co-infection
Blood Transfusion Risk
Babesia can also be transmitted through blood transfusion.
Although screening has improved, awareness remains important for donors and recipients.
Related Reading: Blood Risk
Special Populations
Babesia can be more severe in:
- Older adults
- Immunocompromised patients
- Patients without a spleen
- Pregnant women and infants
Related Reading: Special Populations
Frequently Asked Questions
What is the difference between Babesia and Lyme disease?
Lyme disease is bacterial. Babesia is a parasite that infects red blood cells and requires different treatment.
Can you have Babesia without Lyme disease?
Yes—but co-infection is common.
Why is Babesia often missed?
Testing limitations and overlapping symptoms contribute to missed diagnosis.
Can Babesia relapse?
Yes, especially in immunocompromised patients.
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.