Babesia infant cases are rare—but this one proves no baby is too young for tick-borne disease. In this Inside Lyme case study, I discuss a 6-week-old baby boy with Babesia from Long Island, New York.
This case was described in the journal Pediatrics by Handel and colleagues in 2019.
How a Babesia Infant Got Infected
The baby boy was seen in an emergency department in Long Island, New York, an area endemic for Lyme disease. The baby spent “minimal time outside,” according to Handel. There was tall grass in the yard and the father painted home exteriors.
The parents did not report seeing a tick. Instead, the parents removed a bloody “flea” from his arm 20 days before hospitalization. This highlights the difficulties parents can face in recognizing a tick.
Babesia is a parasitic disease that is typically contracted by the same tick that carries Lyme disease. Babesia can also be contracted through the blood supply or during pregnancy.
Diagnosis of the Babesia Infant
The baby boy with Babesia was irritable, throwing up, not eating well, and had a temperature of 101.1°F. The doctors were initially not able to identify the reason the baby was ill or why there was anemia or a low platelet count. The doctors prescribed three antibiotics—ampicillin, ceftriaxone, and vancomycin—until they could determine a cause of the illness.
The baby was transferred to a second hospital. The blood tests again showed anemia and a low platelet count along with abnormal liver function tests. The spleen appeared large.
The laboratory tests now revealed the parasite Babesia in the red blood cells under the microscope. 3.6% of the baby’s red cells showed parasites.
Treatment of the Babesia Infant
The baby boy was prescribed oral atovaquone and intravenous azithromycin. These drugs are marketed as Mepron and Zithromax in the US.
The anemia worsened. The hemoglobin dropped to 6.9 g/dL, which is quite low. The doctors transfused a unit of blood.
The doctors were concerned that the baby might also have suffered from Lyme disease. The doctors added 14 days of amoxicillin to the treatment.
The baby remained well on follow-up, according to the doctors.
What This Babesia Infant Case Teaches Us
- Parents need to look for tick bites even in babies
- Babies can be infected with a tick-borne infection even with little outdoor exposure
- It can be difficult to determine if a baby has Babesia—this baby was not diagnosed until transferred to a second hospital
- Doctors may need to treat for co-infections like Lyme disease even without confirmation
Questions This Case Raises
- Would it have been helpful if the parents had recognized the “bloody flea” as a tick?
- Would the doctor have recognized Babesia if the parasite were not seen under the microscope?
- What if the baby had evidence of Ehrlichia or Anaplasmosis? Doctors have been reluctant to prescribe doxycycline in young children as it may discolor teeth—though the CDC has noted that two weeks of doxycycline is safe in all children.
- What is the best combination of treatment and length of treatment to prevent long-term complications in children?
- How do you know a baby is well when they cannot communicate how they are feeling?
Editor’s Note
We need more doctors with skills diagnosing and treating Babesia in children. We could use a reliable test to determine who has Babesia and a test to be sure Babesia has resolved. We need to determine the best course of treatment for babies.
We also need to give doctors the freedom to treat these difficult cases without undue interference by colleagues, insurance companies, medical societies, and medical boards.
Parents concerned about tick-borne illness in their children should also read about Babesia and Bartonella in children.
Frequently Asked Questions
Can infants get Babesia from a tick bite?
Yes. This babesia infant case proves that even 6-week-old babies can get infected from a single tick bite—even with minimal outdoor exposure.
How was this baby infected?
The parents removed what they thought was a “bloody flea” from the baby’s arm. It was actually a tick. The baby developed symptoms 20 days later.
What are the symptoms of Babesia in infants?
Symptoms include irritability, poor feeding, vomiting, fever, anemia, and low platelet count. These are nonspecific, which is why diagnosis is often delayed.
How can I protect my baby from ticks?
Check babies after outdoor time, even in strollers. Cover carriers with netting. Check pets and adults who may bring ticks inside. Ticks can be as small as a poppy seed.
How is Babesia diagnosed in infants?
This baby was diagnosed when doctors saw parasites in the red blood cells under a microscope. It took transfer to a second hospital before the diagnosis was made.
How is Babesia treated in infants?
This baby was treated with oral atovaquone and intravenous azithromycin. He also received a blood transfusion for severe anemia and amoxicillin for possible Lyme disease co-infection.
Can babies get Babesia without going outside?
Yes. This baby spent minimal time outside, but there was tall grass in the yard and the father worked outdoors painting homes. Ticks can be brought inside on clothing or pets.
References
- Handel AS, Hellman H, Hymes SR. Two Neonates With Postnatally Acquired Tickborne Infections. Pediatrics. 2019;144.
Twenty five years ago I gave birth to a female baby after multiple episodes of preterm labor. Low birth weight I could tell she wasn’t healthy. Hospitalized at day 10 of life for one week. Treated for “encephalitis “ and discharged home. The sad part is doctors attributed this to my breastfeeding while on Prozac. A paper was published by one of the major Texas universities that Prozac May lead to this condition. I am 62, have post Lyme syndrome and three Lyme positive children who are in denial. Makes me sad as I look back. Her encephalitis was more likely caused by a bacterial infection than pharmaceutical drug. So sad and not good science with what we know now. I’m barely functional and look at my children and grandchild and wonder what their lives will be like
I also have complicated patients in my practice. Thanks for sharing.