Lyme Babesia Anaplasmosis: Triple Tick Infection Case
Welcome to an Inside Lyme case study. I find that the best way to understand Lyme disease is by reviewing real patient cases. In this case study, I discuss a 74-year-old woman with Lyme Babesia Anaplasmosis — a rare triple tick-borne infection.
Ticks can transmit more than one pathogen at the same time. When this occurs, patients may develop multiple infections such as Lyme disease, Babesia, and Anaplasmosis from a single tick bite.
Patients bitten by ticks may develop more than one infection at the same time. These infections are known as Lyme disease coinfections and can complicate diagnosis and treatment.
A single tick bite can transmit multiple tick-borne infections. In some cases, patients may be infected with Lyme disease, Babesia, and Anaplasmosis at the same time. These infections are called Lyme disease coinfections and can make diagnosis and treatment more complicated.
This case was described in the journal Cureus, written by Kumar and colleagues in 2019.
Case presentation
A 74-year-old woman with underlying medical conditions developed severe illness. She had chronic obstructive pulmonary disease (COPD), hypertension, and a history of smoking.
She was initially treated for pneumonia with ceftriaxone and azithromycin. Doctors later identified Babesia infection.
A blood smear revealed parasites typical of Babesia within her red blood cells during Babesia testing. Babesia is a parasitic infection transmitted by the same deer tick that carries the bacteria responsible for Lyme disease.
More than 9% of her red blood cells contained parasites — indicating a severe infection.
Initial treatment
The doctors added atovaquone for Babesia. Atovaquone is marketed under the name Mepron in the United States.
Doxycycline was also prescribed due to concerns that the woman might have Lyme disease or another tick-borne infection.
The patient became critically ill, developing severe Lyme disease symptoms affecting multiple organ systems. She required a respirator and medications to raise her blood pressure.
Because of the high parasite burden, doctors performed erythrocytapheresis. During erythrocytapheresis, infected red blood cells are removed and replaced with donor blood.
The percentage of infected red cells dropped from 9% to 5.54%. However, the patient remained in shock and her kidney function worsened due to hemolysis.
Lyme disease coinfections confirmed
The woman’s blood test confirmed Lyme disease, Babesia, and Anaplasmosis — a rare triple tick-borne coinfection.
Studies have shown that ticks can carry multiple pathogens at the same time. Although triple infections are considered uncommon, they are increasingly recognized in clinical practice.
In my own clinical experience, I have seen individuals infected with three or more tick-borne pathogens whose cases were never formally published.
Treatment adjustment leads to recovery
The doctors made one final adjustment to the treatment plan.
The Babesia therapy was changed from atovaquone and azithromycin to clindamycin and quinine, a regimen often used in severe or difficult-to-treat cases.
The patient gradually improved. She was able to come off the respirator, and her blood counts and kidney function returned to normal after 14 days of treatment.
Clinical implications
I support Kumar’s recommendation for maintaining a low threshold of suspicion for coinfections.
“A low threshold for suspicion should be held for a co-infection when patients exhibit a presentation that would be atypical for single pathogen exposure,” Kumar writes.
A delay in diagnosis can lead to prolonged illness and more complications.
Kumar also discussed limitations in testing.
While a blood smear is considered the gold standard for diagnosing Babesiosis, PCR testing may be more sensitive when parasite levels are low.
Testing for Anaplasmosis can also be challenging. PCR and serologic tests may be more sensitive than traditional blood smear methods.
Kumar further recommends longer treatment courses for Babesia in high-risk patients.
For immunocompromised individuals, treatment for six weeks is recommended, including two weeks after parasites are no longer visible on blood smear.
What can we learn from this case?
- Doctors should consider tick-borne infections even in patients with underlying illnesses.
- Patients can suffer from more than one tick-borne infection at the same time, a pattern commonly seen with Lyme disease coinfections.
- Coinfections can lead to severe illness and require aggressive treatment.
What questions does this case raise?
- Would Babesia have been discovered if the parasite had not been seen under the microscope?
- What is the best combination of treatment and length of treatment to prevent long-term complications in patients with Lyme Babesia Anaplasmosis?
Treating tick-borne disease
We need more physicians skilled in diagnosing and treating individuals with multiple tick-borne infections.
Reliable diagnostic tests are needed to determine who has these infections and when they have resolved.
Understanding the complex symptoms of Lyme disease and related infections is essential to preventing chronic illness.
Physicians should also have the clinical freedom to treat complex cases without undue interference by colleagues, insurance companies, medical societies, or medical boards.
Frequently Asked Questions
Can you have Lyme, Babesia, and Anaplasmosis at the same time?
Yes. A single tick bite can transmit multiple pathogens. This case shows a patient infected with Lyme disease, Babesia, and Anaplasmosis at the same time.
How serious can multiple tick infections be?
Multiple tick infections can be severe because each pathogen affects the body differently. In this case, the patient required intensive care support.
How are triple tick infections treated?
Each infection requires different medications. Lyme disease and Anaplasmosis are typically treated with doxycycline, while Babesia requires antiparasitic therapy such as atovaquone and azithromycin or clindamycin and quinine.
Why do multiple tick infections make illness worse?
When Lyme disease occurs with Babesia or Anaplasmosis, symptoms may become more severe because the infections affect different parts of the immune system and bloodstream.
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 7 bulls eye rashes and was hit several times as well as my dogs had the engorged ticks. This was due to a leak in the AC drain into the plumbing line that unknowingly filled the foam under the bamboo flooring. I was really sick but due to a swift diagnosis by my infectious disease doctor I was put on Alinia and Doxycycline. I was diagnosed with Morgellons as well.
great outcome.
Is it possible to get Lyme from a spider or other small bug bite? No bullseye. Very sick that night, couldn’t stand up. Temp 102 in doctor’s office the next day. He started me on an antibiotic. Which made me sick. Two weeks later a Lyme disease tested positive.
The research funds dried up after the identification of the tick. There are Lyme disease rashes that can look like a spider bite. Finally, there are Lyme disease cases where you never see the tick.