Can Babesiosis Be Passed From Mother to Baby? Two Newborn Cases
Congenital babesiosis has been reported in newborns
Two infants developed Babesia microti infection after maternal Lyme disease
Mother-to-child transmission appears possible
Can babesiosis be passed from mother to baby during pregnancy? Although uncommon, congenital babesiosis has been reported in newborns, including the two cases described here.
Congenital transmission has been described in seven previous cases, in which infants presented with fever, anemia, and thrombocytopenia. According to Saetre and colleagues, all previously reported infants required blood transfusions.
These are the first reported cases, to the authors’ knowledge, in which the mothers were diagnosed with Lyme disease before delivery and were subsequently found to have evidence of subclinical Babesia microti infection.
Congenital transmission refers to infection passed from mother to infant during pregnancy or around the time of delivery.
“We describe the cases of 2 infants with congenital babesiosis born to mothers with prepartum Lyme disease and subclinical Babesia microti infection,” wrote Saetre and colleagues.¹
What Is Congenital Babesiosis?
Congenital babesiosis occurs when Babesia parasites are transmitted from mother to infant during pregnancy or around the time of delivery.
Reported symptoms in newborns include:
- Fever
- Anemia
- Thrombocytopenia
- Pallor
- Irritability
- Poor feeding
- Splenomegaly
Both infants described in this report were born to mothers diagnosed with Lyme disease during pregnancy who were subsequently found to have evidence of Babesia microti infection.
Two Newborns With Congenital Babesiosis
Infant #1
The first infant, a 4½-week-old male, presented with a fever of 101.7°F, sleepiness, and periodic irritability.
His mother had been diagnosed with Lyme disease during the third trimester at 32 weeks’ gestation after developing an erythema migrans rash. She was treated successfully with amoxicillin.
Testing of the infant included a blood smear, which revealed 2% parasitemia for Babesia species.
He was treated with atovaquone and azithromycin. According to the authors, these medications were selected because they are generally better tolerated than clindamycin and quinine.¹
The infant did not require a blood transfusion and tested negative for antibodies to Borrelia burgdorferi, the bacterium that causes Lyme disease.
At his two-month follow-up visit, he was clinically well and his splenomegaly had resolved.
Infant #2
At 35 weeks’ gestation, the mother developed fevers and myalgias. An erythema migrans rash appeared at 37 weeks’ gestation, and she was treated with amoxicillin.
The infant was born at 38 weeks without perinatal complications.
The 18-day-old female infant was initially asymptomatic despite a positive B. microti PCR assay.
One week later, however, she developed neutropenia and anemia.
She was hospitalized and treated with azithromycin and atovaquone.
Because of symptomatic anemia, including malaise, tachycardia, and pallor, she required a blood transfusion on the second day of hospitalization.
Due to persistently elevated parasitemia and a falling hematocrit, clindamycin was added on hospital day four.
The infant ultimately received all three antimicrobial agents for 14 days.
How Did Babesiosis Present in These Newborns?
The clinical presentation of these two infants closely resembled previously reported cases of congenital babesiosis.
According to the investigators:
- Symptoms developed between 19 and 41 days of age.
- Both infants developed low-level parasitemia.
- Fever was present.
- Anemia developed.
- Thrombocytopenia was identified.
- Neutropenia was present.
- One infant required blood transfusion support.
“Each infant developed symptoms between 19 and 41 days of age and, at the time of presentation to medical attention, had fever, pallor, hemolytic anemia, and thrombocytopenia,” explained Saetre.¹
Babesia and Lyme Disease Coinfection During Pregnancy
The authors highlighted the growing importance of Babesia coinfection.
Depending on the geographic region, 2% to 40% of patients with early Lyme disease may also be infected with babesiosis.
A 2010 study evaluating ticks in Westchester County, New York, found that 3.6% to 22.4% of ticks were coinfected with both B. burgdorferi and B. microti.
Babesia is one of several tick-borne coinfections that may accompany Lyme disease.
Questions Raised by These Cases
These two cases raise several important clinical questions regarding Babesia infection during pregnancy and the risk of congenital transmission.
- Could Babesia infection during the first or second trimester lead to complications or fetal loss?
- Would clinicians recognize Babesia infection in a pregnant woman or newborn without an erythema migrans rash?
- Would the second infant have avoided complications if treatment had been initiated immediately after the positive PCR test?
- Should pregnant women diagnosed with Lyme disease be evaluated for Babesia coinfection?
Frequently Asked Questions
Can babesiosis be passed from mother to baby?
Yes. Although uncommon, published case reports have documented congenital babesiosis in newborns born to mothers infected with Babesia microti during pregnancy.
Can a pregnant woman with Lyme disease also have Babesia?
Yes. Lyme disease and babesiosis can be transmitted by the same tick, making coinfection possible in endemic regions.
What symptoms can congenital babesiosis cause?
Reported symptoms include fever, anemia, thrombocytopenia, splenomegaly, irritability, and poor feeding.
Can congenital babesiosis require a blood transfusion?
Yes. Several published cases have required transfusion support because of severe anemia.
Clinical Takeaway
These two newborn cases add to the growing literature describing congenital babesiosis.
Both infants were born to mothers diagnosed with Lyme disease during pregnancy who were subsequently found to have evidence of Babesia microti infection.
Although congenital babesiosis appears to be uncommon, published cases demonstrate that transmission from mother to infant can occur and should be considered when newborns present with fever, anemia, thrombocytopenia, or splenomegaly.
These cases raise important questions about maternal screening, recognition of Babesia coinfection during pregnancy, and early diagnosis of babesiosis in newborns.
Related Articles
Babesia: Symptoms, Diagnosis, and Treatment
References
- Saetre K, Godhwani N, Maria M, Patel D, Wang G, Li KI, Wormser GP, Nolan SM. Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. J Pediatric Infect Dis Soc. 2018;7(2):e1-e5.
- Wormser GP, Dattwyler RJ, Shapiro ED, et al. The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134.
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
