Babesiosis missed diagnosis can have serious consequences—especially when patients are infected with both Lyme disease and Babesia. This case highlights why clinicians must consider tick-borne co-infections in endemic areas.
The woman had a three-week history of fever (maximum temperature 104°F), chills, nausea, and a productive cough with yellow sputum.
Six weeks before the onset of symptoms, she had vacationed in Connecticut—an area endemic for Lyme disease and other tick-borne infections. She reported experiencing two tick bites during the previous year.
Her examination and laboratory testing were largely normal except for pancytopenia. A manual peripheral blood smear revealed Babesia microti infection within red blood cells. Initially, 1.7% of the patient’s red blood cells were infected with Babesia microti.
Atypical Presentation Led to Babesiosis Missed Diagnosis
“The unique feature of our case was the atypical presentation with no rash and no joint pain, but the patient had only constitutional symptoms such as weakness and intermittent fever,” the authors reported.
The patient was started on
azithromycin and atovaquone for babesiosis and doxycycline for Lyme disease because clinicians initially suspected a
tick-borne co-infection.
The plan was to discontinue doxycycline if Lyme disease testing ultimately proved negative.
She was discharged home on the three oral medications.
Dire Consequences When Treatment Is Delayed
The authors emphasized that delayed treatment of babesiosis can lead to serious complications.
Patients may develop severe hemolytic anemia, disseminated intravascular coagulation, respiratory failure, or renal failure. In severe cases, erythrocyte exchange transfusion may be required.
“Clinicians should consider co-infection when suspecting tick-borne disease, which can lead to fatal consequences if not addressed promptly,” the authors cautioned.
Delayed initiation of therapy may require aggressive interventions and significantly worsen patient outcomes.
Second Case: Persistent Symptoms Until Babesia Was Treated
The authors cited another case illustrating the importance of timely diagnosis of Babesia infection.
A 67-year-old woman was treated for
Lyme disease, but her fever, rash, and myalgias persisted despite a 21-day course of amoxicillin.
Further testing revealed pancytopenia and laboratory evidence of Babesia infection. Once treatment for babesiosis began, the patient’s symptoms improved.
This case reinforces that babesiosis missed diagnosis can prolong illness and lead to serious complications when clinicians treat Lyme disease alone without evaluating for tick-borne co-infections.
Clinical Takeaway
Patients with suspected tick-borne illness—especially those with persistent fever, pancytopenia, or incomplete response to Lyme disease treatment—should be evaluated for babesiosis. Early recognition of Babesia infection is essential because untreated babesiosis can progress to severe or life-threatening disease.
References
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Bhesania S, Arora KS, Tokarski M, et al.
A Case of Tick Bite Induced Babesiosis With Lyme Disease
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Cureus. 2021;13(8):e17401.
I had two video appointments with 2 different so called specialists at a Pittsburgh infectious disease center who said chronic Lyme doesn’t exist and that 3 months of doxycycline was more than sufficient. I’m suffering horribly. I have no choice but to try herbs. No doctors in western Pennsylvania has a clue as how to treat Lyme disease. I was told I do not have bartonella but was only tested for 3/4 strains. There are about 15. I have all the symptoms of babesia, but they won’t test me for that. They say people in western Pennsylvania don’t get that. They need to be sued.
Call Dr Joseph in Hermitage. He is a Lyme expert and has helped numerous people I know.
I believe you. People come literally from all over the world for treatment in Pgh. Hospitals. But to find a Lyme Specialist, is almost impossible. Anyone have any recommendation of a great knowledgeable doctor in the tri-state area? My husband had undiagnosed Lyme for 2 years. It went to his nervous system. It not only affected his body but also affected his brain, mind and mental stability. He took his own life. Chronic Lyme DOES exist and suicide is a very common way of treating yourself. Come on people! Get the facts. Get the word out there that 2 days of Doxycycline doesn’t cure everyone! Doctors, get educated! If you are suffering and nobody knows what’s wrong with you, demand a Lyme test. Demand treatment. You could be saving your own life.
Keep looking for lymes literate physician
Even if you have to go out of state. It will save your life. I’m from Wisconsin and have received care there it saved my life. 2 years into this deal there is light at the end of the tunnel.
I was a nurse working 12 hrs a day, it shocks me that drs have so little training especially infectious disease. Worked in medicine for 40 years never saw such treatment of people. The long term effects of no treatment for people will bring heavy consequences to the healthcare system.
We are in MN, what specialist did you go see? I too am in healthcare and many health professionals don’t believe in chronic Lyme’s disease.
Robert-Send your blood to IGENEX in California. Contact them. I too am in PA, and that was the way I found out for myself. Take care.
I was diagnosed this year with Lyme I’m on doxocycline and hydroqloricine but I do not feel they help whatever is wrong with me the family doctor said I’ve probably had for several years but acts like I’m fine..my arms and legs tingle and hurt at times..my knees have been having major problems..I feel tired alot..and there’s so much more..but I can’t get myself to do things I used to no matter how much I want to, I just don’t move the same,it’s like I’m aging so much..I used to be a store manager for a restraunt and now I don’t work..I can’t keep a job with everything..my mind is so messed up..I am really depressed..I already had manic depression since childhood but it was fine without meds as an adult until all this..I have tumer history and the doctor said that it was easier for other doctors to say it was from the tumer history than to check for lyme..so I am not really sure what to think or believe at this point
I am sorry to hear you are ill. It sounds as if your doctor has been careful to consider other illnesses. I find a changed in treatment for a tick borne illness has been helpful for some of my patients, including treatment for Babesia.
Yale has done a new study and now has a new protocol for treating babesia. Using Azrithomyacin and tafenoquine works better than CDC proticol which is harder on the patient and has many relapses. Tafenoquine seems to clear the liver better thus preventing less relapses. Best for compromised patients.