Tick-Borne Infections in Infants: Lyme Disease and Babesia

Lyme disease in infants is rarely discussed in the medical literature, in part because diagnosis can be difficult. Infants cannot describe symptoms such as headache, dizziness, or fatigue, and physical examination findings may be subtle. In addition, current testing methods may be less reliable early in infection.

Published reports describing Lyme disease or Babesia infection in infants remain limited, with most cases appearing as isolated case reports.

Although Lyme disease is most commonly diagnosed in school-aged children, documented cases illustrate that tick-borne infections can occur even in very young infants through a variety of exposure pathways.

For a broader overview of how Lyme disease affects young patients, see the Pediatric Lyme Disease guide.

Symptoms of Tick-Borne Infections in Infants

Because infants cannot describe symptoms, illness may present with nonspecific findings. Possible signs may include:

• fever
• irritability
• poor feeding
• lethargy
• pallor or anemia
• breathing difficulty
• neurologic symptoms such as seizures or altered responsiveness

These symptoms may resemble many other childhood illnesses, which can make tick-borne infections difficult to recognize early.

Lyme Disease in a 5-Week-Old Infant

An otherwise healthy 5-week-old girl living in Long Island, New York, was diagnosed with Lyme disease.

Exposure may have occurred when the family dog brought ticks into the home. Because of concern for Lyme meningitis, clinicians treated the infant with intravenous ceftriaxone for two weeks.

This case illustrates that tick exposure may occur even in very young infants who have limited direct outdoor activity.

Transfusion-Transmitted Babesia in Premature Infants

Researchers from Yale School of Medicine described three premature infants in one neonatal intensive care unit who contracted Babesia from a single infected blood donor.

The infants developed parasitemia and were treated with azithromycin and atovaquone.

This cluster demonstrated that tick-borne infections such as Babesia may occasionally be transmitted through blood transfusion.

Delayed Babesia Infection in Newborns

A Mayo Clinic report described two newborn infants diagnosed with Babesia weeks after their mothers had been treated for Lyme disease during pregnancy.

The delayed appearance of infection highlighted the importance of careful follow-up in newborns when maternal tick-borne infection has been documented.

Diagnosing Lyme Disease in Infants Can Be Challenging

Recognizing Lyme disease in infants can be difficult for several reasons.

• infants cannot describe symptoms
• tick exposure may not be recognized
• rash may be absent or unnoticed
• symptoms may resemble other childhood illnesses
• laboratory testing may be inconclusive early in infection

For these reasons, clinicians may not immediately consider tick-borne illness in very young patients.

Clinical Perspective

In my experience, Lyme disease is far more commonly diagnosed in school-aged children. However, these infant cases demonstrate that tick-borne infections can occur even in very young patients and may arise through unusual pathways such as transfusion or maternal infection.

Because symptoms may be subtle and difficult to interpret, awareness of these possibilities may help clinicians consider tick-borne illness earlier when evaluating unexplained illness in infants.

References

1. Leiby DA. (2011). Transfusion-transmitted Babesia spp.: bull’s-eye on Babesia microti. Clinical Microbiology Reviews, 24(1), 14–28. https://doi.org/10.1128/CMR.00022-10
2. Joseph JT, Roy S, Shams N, Visintainer P, Nadelman RB, Wormser GP. (2012). Congenital babesiosis: a case report and review of the literature. Pediatrics, 129(5), e1329–e1332. https://doi.org/10.1542/peds.2011-1996
3. Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. (1996). Lyme disease in children in southeastern Connecticut. Pediatrics, 98(2), 193–199. https://pubmed.ncbi.nlm.nih.gov/8692623/
4. Arvikar SL, Steere AC. (2015). Diagnosis and treatment of Lyme arthritis. Infectious Disease Clinics of North America, 29(2), 269–280. https://doi.org/10.1016/j.idc.2015.02.004
5. Gerber MA, Shapiro ED. (1998). Lyme disease in children. Clinical Infectious Diseases, 27(3), 519–524. https://doi.org/10.1086/514678