Babesia clinical presentations can vary widely, as one case demonstrates. The woman was admitted to the emergency room with fever, chills, lethargy, fatigue, and marked changes in sensorium. Clinicians initially believed her symptoms were due to sepsis, but she was later diagnosed with concurrent Babesia and anaplasmosis.
Her case demonstrates how “patients with babesiosis show a wide range of symptoms and clinical presentations,” writes Paparone.
Laboratory Findings in This Babesia Case
The patient’s maximum temperature was 100.6°F. And her laboratory abnormalities included:
- Anemia (dropped from 10.5 g/dL to a low of 8 g/dL)
- Leukopenia (dropped from 5.0 × 10⁹/L to 2.6 × 10⁹/L)
- Thrombocytopenia (dropped to 39 × 10⁹/L)
- Positive peripheral smear for Babesia
- Babesia immunoglobulin M (IgM) of 1:160
- Anaplasma IgM of 1:320
In addition to Babesia, clinicians suspected she also had anaplasmosis, given her leukopenia and thrombocytopenia findings.
“Generally, the greater number of concurrent tick-borne infections and the higher the parasitemia load, the more toxic the presentation.”
Treatment for Babesia and Anaplasmosis
The woman was treated for 14 days with doxycycline, Atovaquone suspension, and azithromycin. This combination addresses both Babesia and anaplasmosis, which require different antimicrobial approaches.
Her cognitive function improved dramatically following treatment, despite the significant changes in her mental activity upon admission. The resolution of her mental status changes underscores how Babesia can affect the brain, particularly in older adults.
Why Variable Babesia Presentations Matter
This case “shows the unusual effect of babesiosis on the sensorium in the older adult,” writes Paparone.
Furthermore, it “illustrates the need for the NP [Nurse Practitioner] to appreciate the variable clinical presentations of babesiosis to facilitate prompt diagnosis, provide proper therapeutic management, and avoid the poor outcomes associated with this disease.”
“Staying knowledgeable of babesiosis is essential,” Paparone concludes. For patients and clinicians alike, recognizing the broad spectrum of Babesia symptoms — from mild fatigue to severe cognitive impairment — can mean the difference between timely treatment and prolonged illness.
References
- Paparone P, Paparone PW. Variable clinical presentations of babesiosis. Nurse Pract. 2018;43(10):48-54.
