Babesiosis and Lyme Disease Coinfection: A Missed Diagnosis
Babesiosis may occur alongside Lyme disease
Coinfections can be difficult to recognize
Delayed treatment may lead to serious complications
A woman presented with a three-week history of fever, chills, nausea, and a productive cough with yellow sputum. Six weeks before becoming ill, she had vacationed in Connecticut, an area endemic for both Lyme disease and Babesia. She also reported two tick bites during the previous year.
Her examination and testing were largely unremarkable except for pancytopenia. A manual peripheral blood smear revealed Babesia microti infection, with 1.7% of red blood cells initially infected.
Early Babesiosis often presents with fever, chills, fatigue, and laboratory abnormalities such as anemia, thrombocytopenia, or pancytopenia. However, the clinical presentation can vary, and some patients may later present with more nonspecific symptoms that make the diagnosis more difficult.
Babesiosis and Lyme Disease Coinfections Can Be Difficult to Recognize
Babesiosis and Lyme disease are transmitted by the same tick species and may occur together. Because symptoms can overlap, tick-borne coinfections may be overlooked when clinicians focus on a single 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 like weakness and occasional fever…”
“The patient was started on azithromycin, atovaquone for Babesiosis, and doxycycline to treat Lyme disease with initial suspicion of co-infection and a plan to deescalate once the Lyme disease was ruled out,” the authors state.
She was discharged home with the combination of the three oral treatments.
Delayed Diagnosis Can Have Serious Consequences
“Cases with severe hemolytic anemia, disseminated intravascular coagulation, respiratory failure, renal failure erythrocyte apheresis should be considered,” the authors suggest.
And, “Clinicians should consider co-infection when suspecting tick-borne disease which can lead to fatal consequences if not addressed promptly.”
“If there is delayed initiation of therapy in these kinds of patients, there may be dire consequences that may require aggressive therapy.”
The authors cited another case report to highlight the importance of a timely diagnosis.
A 67-year-old woman was treated for Lyme disease. But her fever, rash, and myalgias persisted despite a 21-day course of amoxicillin. The patient was also found to have pancytopenia and evidence of Babesia. Once she began treatment for Babesia, her symptoms improved.
This second case highlights the importance of evaluating for Babesiosis when patients with suspected Lyme disease have an atypical clinical course or fail to improve as expected.
Frequently Asked Questions
Can Babesia occur with Lyme disease?
Yes. Babesia and Lyme disease may be transmitted by the same tick and can occur simultaneously.
What are common symptoms of Babesiosis?
Common symptoms include fever, chills, fatigue, sweats, anemia, and other flu-like symptoms.
Why are Babesia coinfections sometimes missed?
Babesiosis and Lyme disease can produce overlapping symptoms, making coinfections more difficult to recognize.
Can delayed treatment of Babesiosis be serious?
Yes. Severe cases may lead to significant complications, including hemolytic anemia, respiratory failure, kidney injury, and other life-threatening conditions.
Clinical Takeaway
This case highlights the importance of considering Babesiosis in patients with suspected Lyme disease, particularly when symptoms appear atypical or the clinical course is more severe than expected.
Early recognition of tick-borne coinfections may help prevent serious complications and delays in appropriate treatment.
Related Articles
Case series shows wide range of Babesia symptoms and presentations
The case of an untreated Babesia infection
Babesia symptoms can be deadly: A family’s story
References
- Bhesania S, Arora KS, Tokarski M, et al. A Case of Tick Bite Induced Babesiosis With Lyme Disease. Cureus. 2021;13(8):e17401.
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 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.