Lyme Disease in Infants and Babies: Babesia and Tick-Borne Infections
Lyme disease can occur in infants after an infected tick bite
Babesia may be transmitted by ticks, blood transfusion, or during pregnancy or delivery
Symptoms in babies may be subtle and difficult to recognize
Can babies get Lyme disease? Yes. Although Lyme disease is uncommon in very young infants, published case reports show that babies can become infected after the bite of an infected black-legged tick. Babesia infections have also been reported in infants following tick exposure, transfusion of blood from an infected donor, or probable transmission during pregnancy or delivery.
Lyme disease in infants is rarely discussed in the medical literature. Diagnosis can be difficult because babies cannot describe symptoms such as headache, dizziness, fatigue, or pain. Tick exposure may not be recognized, physical findings may be subtle, and antibody tests can be negative early in Lyme disease.
Published reports involving Lyme disease and Babesia in infants remain limited, with much of the available evidence coming from individual cases and small case series.
Although Lyme disease is more commonly reported in school-aged children, these cases demonstrate that tick-borne infections can occur in newborns and very young infants.
For a broader discussion of Lyme disease in young patients, see the pediatric Lyme disease guide.
Lyme Disease Symptoms in Babies and Infants
Possible signs of Lyme disease in a baby may include:
- An expanding red rash or multiple expanding rashes
- Fever
- Irritability
- Poor feeding
- Unusual sleepiness or lethargy
- Facial weakness or other neurologic changes
Babesia infects red blood cells and may produce a different pattern of illness. Findings reported in infants with babesiosis have included fever, pallor, jaundice, anemia, low platelet counts, poor feeding, lethargy, and breathing difficulty.
These findings are not specific to Lyme disease or Babesia and may occur with many other illnesses. A fever, unusual rash, poor feeding, marked irritability, lethargy, breathing difficulty, or neurologic change in a young infant warrants prompt medical evaluation.
Lyme Disease in a 5-Week-Old Infant
Handel and colleagues described an otherwise healthy 5-week-old girl from Long Island, New York, who developed early disseminated Lyme disease.1
Six days before her symptoms began, the parents removed what they described as an engorged black “bug” from behind her left ear. They had not initially recognized it as a tick.
The infant subsequently developed a fever of 101.1°F, irritability, and multiple expanding skin lesions consistent with erythema migrans. One rash appeared near the suspected bite site.
Although the infant rarely spent time outdoors, the family had a dog that went outside. The report raised the possibility that a tick had been carried into the home, but the precise route of exposure could not be established.
Initial Lyme disease antibody testing was negative. This did not exclude early Lyme disease because antibodies may not yet be detectable during the earliest stage of infection. The multiple erythema migrans rashes and recent tick exposure provided important clinical evidence.
The physicians were concerned about possible Lyme meningitis. A lumbar puncture was attempted but was unsuccessful. Because meningitis could not be excluded, the infant received intravenous ceftriaxone for 14 days. No complications were reported during follow-up.
This case is discussed in greater detail in Lyme disease in a 5-week-old infant.
How Could a Baby Encounter a Tick?
Infants may have little direct outdoor exposure, but that does not eliminate the possibility of a tick bite. A tick may be encountered when a baby is:
- Carried through a yard, park, or wooded area
- Placed on grass or near leaf litter
- Near clothing, blankets, equipment, or other items brought indoors
- In a household where people or pets have recently been outdoors
These are possible exposure pathways rather than proof that a particular person or pet carried a tick into the home.
Transfusion-Transmitted Babesia in Premature Infants
Babesia is usually transmitted through the bite of an infected tick, but it can also be transmitted through donated blood because the parasite infects red blood cells.
Glanternik and colleagues described three premature infants in a neonatal intensive care unit who contracted Babesia microti from blood components traced to a single infected donor.2
The infants developed parasitemia and were treated with azithromycin and atovaquone. This cluster demonstrated that babesiosis should be considered when a transfused infant develops otherwise unexplained anemia, thrombocytopenia, fever, or evidence of red blood cell destruction.
Babesia Transmitted During Pregnancy or Delivery
Case reports have also described probable congenital babesiosis, in which Babesia was believed to have been transmitted from a mother to her baby during pregnancy or delivery.3,4
In one reported case, an infant developed fever, pallor, anemia, thrombocytopenia, and an enlarged spleen several weeks after birth. The delayed presentation illustrates why congenital babesiosis may not be apparent immediately following delivery.
Congenital babesiosis and Lyme disease acquired after a postnatal tick bite are separate clinical situations. Evidence supporting congenital transmission of Babesia should not automatically be applied to Lyme disease.
Why Lyme Disease in Infants Can Be Difficult to Diagnose
Recognizing Lyme disease in infants can be difficult for several reasons:
- Babies cannot describe headache, pain, dizziness, or fatigue
- A tick may never be found
- A rash may be hidden, overlooked, or mistaken for another skin condition
- Fever and irritability have many possible causes
- Antibody testing may be negative early in Lyme disease
- Published experience involving very young infants is limited
Evaluation should consider the infant’s age, symptoms, physical examination, possible tick exposure, geographic location, laboratory findings, and other potential causes of illness. Lyme disease and Babesia require different diagnostic approaches and treatments.
Frequently Asked Questions
Can babies get Lyme disease?
Yes. Although uncommon in very young infants, Lyme disease can develop after the bite of an infected black-legged tick. Published reports include a 5-week-old infant with fever and multiple erythema migrans rashes.
What are the symptoms of Lyme disease in babies?
Possible signs include an expanding rash, multiple expanding rashes, fever, irritability, poor feeding, lethargy, or neurologic changes. These findings are not specific to Lyme disease and require medical evaluation.
Can an infant have Lyme disease without a positive blood test?
Yes. Lyme disease antibody testing can be negative during early infection because the immune response may not yet be detectable. Physicians may need to consider the rash, possible tick exposure, symptoms, and timing of testing.
Can infants get Babesia?
Yes. Babesia infections have been reported in infants following tick exposure, transfusion of blood from an infected donor, and probable transmission during pregnancy or delivery.
When should a baby with a possible tick bite see a doctor?
Parents should promptly contact a medical professional if a young infant develops a fever, expanding rash, poor feeding, marked irritability, unusual sleepiness, pallor, breathing difficulty, or neurologic changes. A fever in a very young infant requires prompt medical evaluation, regardless of whether a tick bite was recognized.
Clinical Takeaway
Lyme disease and Babesia are uncommon in very young infants, but published cases demonstrate that these infections can occur. Lyme disease may follow an infected tick bite, while Babesia may be acquired from a tick, transfusion of blood from an infected donor, or probable transmission during pregnancy or delivery.
Because babies cannot describe their symptoms and may have no recognized tick exposure, clinicians may need to consider tick-borne infections when the history, examination, rash, or laboratory findings raise concern.
Prompt medical evaluation is particularly important when a young infant develops fever, an expanding rash, poor feeding, unusual lethargy, breathing difficulty, or neurologic changes.
Related Articles
Babesia and Lyme disease
Lyme disease co-infections
Lyme disease test accuracy
References
- Handel AS, Hellman H, Hymes SR. Two neonates with postnatally acquired tickborne infections. Pediatrics. 2019;144(6):e20191937.
- Glanternik JR, Baine IL, Rychalsky MR, Tormey CA, Shapiro ED, Baltimore RS. A cluster of cases of Babesia microti among neonates traced to a single unit of donor blood. Pediatric Infectious Disease Journal. 2018;37(3):269–271.
- Fox LM, Wingerter S, Ahmed A, Arnold A, Chou J, Rhein L, Levy O. Neonatal babesiosis: Case report and review of the literature. Pediatric Infectious Disease Journal. 2006;25(2):169–173.
- Sethi S, Alcid D, Kesarwala H, Tolan RW Jr. Probable congenital babesiosis in infant, New Jersey, USA. Emerging Infectious Diseases. 2009;15(5):788–791.
- Leiby DA. Transfusion-transmitted Babesia spp.: Bull’s-eye on Babesia microti. Clinical Microbiology Reviews. 2011;24(1):14–28.
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
