A babesia mayo clinic case series offers valuable insights into how this tick-borne infection presents in the real world. In their review of 38 Babesia cases, Fida and colleagues found that nearly 50% of patients did not recall a tick bite and had a delay in diagnosis due to the broad range of symptoms.
The average age was 63. None of the patients died.
Babesia Mayo Clinic Findings: Symptoms
Malaise was the most common symptom (84%) reported, followed by fever (71%), chills (52%), and joint pain (32%).
These symptoms overlap significantly with Lyme disease, which may explain why diagnosis is often delayed. Classic Babesia symptoms like night sweats and air hunger were not specifically reported in this series.
Hospitalization and ICU Rates
Sixty-eight percent of patients required hospitalization, with 21% of those admitted to the intensive care unit.
Indications for ICU admission included:
- Hemolytic anemia
- Shock requiring vasopressor support
- Acute respiratory distress syndrome
Importantly, 2 out of 3 hospitalized patients were NOT immunocompromised. This challenges the assumption that only high-risk patients develop severe Babesia.
Babesia Mayo Clinic Data on Co-infections
Overall, 24% of patients were co-infected with Lyme disease; 5% with Anaplasma; and 8% with both Lyme disease and Anaplasma.
“Co-infection with Borrelia spp. or Anaplasma spp. resulted in increased severity of symptoms and a higher chance of hospitalization,” writes Fida.
This underscores why clinicians should always consider co-infections when evaluating patients with tick-borne illness. Patients with both Babesia and Anaplasmosis may present with more complex symptoms.
Babesia Mayo Clinic Treatment Approaches
What were the most common treatment approaches?
- 68% of patients were initially treated with azithromycin and atovaquone (Mepron)
- 32% received clindamycin and quinine or quinidine—most had to switch to azithromycin and atovaquone due to quinine side effects
- 3 severely ill patients received an exchange transfusion
The treatment duration depended upon clinical response but ranged at least between 7 to 10 days, writes Fida.
One patient, however, was treated for 6 months due to “persistently positive blood smears.” This patient was also co-infected with Lyme disease and had a previous splenectomy for leukemia.
Asymptomatic Babesia Infections
The authors estimate that 40% of children and 20% of adults “may experience asymptomatic infection,” showing no outward signs or symptoms of the disease.
This is concerning for the blood supply, as asymptomatic carriers can unknowingly donate infected blood. It also means that some patients with Lyme disease relapse may actually have unrecognized Babesia that was never treated.
Editor’s Note
The study looked at Babesia patients identified through the Mayo Clinic Database. Most of my Babesia cases in my practice in New York were never hospitalized—suggesting this series may skew toward more severe presentations.
We need additional Babesia studies that address the best treatment when other tick-borne illnesses are present. Out of those individuals hospitalized, “28.9% of patients also had Lyme disease and 10.5% had Anaplasma co-infection,” Fida and colleagues point out.
The finding that 2 out of 3 patients were not immunocompromised is particularly important. Babesia should be considered in any patient with compatible symptoms who has been in an endemic area—regardless of their immune status.
Frequently Asked Questions
What did the Mayo Clinic study find about Babesia symptoms?
Malaise was most common (84%), followed by fever (71%), chills (52%), and joint pain (32%). Nearly 50% of patients didn’t recall a tick bite, contributing to diagnostic delays.
How many Babesia patients need hospitalization?
In this series, 68% required hospitalization and 21% of those were admitted to ICU for hemolytic anemia, shock, or respiratory distress.
What is the best treatment for Babesia?
68% were treated with azithromycin and atovaquone. Quinine-based regimens had more side effects and many patients had to switch. Treatment lasted 7-10 days minimum, but one patient needed 6 months.
How common are Lyme and Babesia co-infections?
24% had Lyme disease, 5% had Anaplasma, and 8% had both. Co-infection increased symptom severity and hospitalization risk.
Can healthy people get severe Babesia?
Yes. Two out of three hospitalized patients in this series were NOT immunocompromised. Anyone in an endemic area with compatible symptoms should be evaluated.
References
- Fida M, Challener D, Hamdi A, O’Horo J, Abu Saleh O. Babesiosis: A Retrospective Review of 38 Cases in the Upper Midwest. Open Forum Infect Dis. 2019;6(7).
