Babesia Symptoms Weeks Later: Understanding Delayed Babesia After Lyme Disease Treatment
Delayed Babesia may explain why some Lyme disease patients relapse after initially improving with antibiotics. In this case, a 67-year-old woman developed a Babesia infection three weeks after treatment for Lyme disease—raising important questions about how clinicians evaluate and follow these patients.
Hoversten and colleagues first discussed this case in the British Medical Journal Case Reports in 2018.
The Case: Delayed Babesia After Lyme Treatment
A 67-year-old woman from Wisconsin had extensive tick exposure as an avid gardener who spent considerable time outdoors. She did not see a tick, but she did develop a rash consistent with erythema migrans.
She was prescribed amoxicillin for three weeks because she was allergic to doxycycline.
Near the end of her three-week course of amoxicillin, she became ill. Her fever rose to 102.9°F, and she complained of myalgias, dizziness, and fatigue.
Her blood test showed mild anemia, a low platelet count and neutrophil count, and a very high C-reactive protein level. She was admitted to the hospital. Doctors initially suspected sepsis or another tick-borne infection.
Her red blood cell count and platelets continued to drop, and she was transferred to a second hospital. Blood cultures were negative after five days, making sepsis unlikely.
Diagnosing Delayed Babesia
She was diagnosed with the parasite Babesia microti by PCR testing and a thin smear of her red blood cells. In her case, 0.4% of red blood cells showed the parasite on the smear.
Babesia infections can be severe and, in rare cases, life-threatening. This patient was at higher risk because she was over 50 years of age and had a history of colon cancer.
She was prescribed a 10-day course of azithromycin and atovaquone. By the fifth day of treatment, her fever had resolved, and her platelet count had more than doubled—from a low of 17,000 per dl to 42,000 per dl.
The authors reported that the woman remained fatigued after completing treatment, which is consistent with what we often see in patients with persistent symptoms.
Why Delayed Babesia Matters
The authors discussed the nearly three-week gap between the patient’s erythema migrans rash and her diagnosis of Babesia. This delay in symptom onset has been reported in other cases of delayed Babesia.
Two additional papers described a three- to four-week delay in the onset of Babesia symptoms. I described a similar pattern in an earlier podcast where two babies contracted Babesia from their mothers. In that case, the infants did not present with Babesia until after being discharged from the hospital.
This delay may explain why some Lyme disease patients relapse after initially improving with doxycycline or amoxicillin. These antibiotics treat Lyme disease but are not effective against Babesia.
Key Takeaways
- Delayed Babesia may appear several weeks after Lyme disease symptoms begin
- Standard Lyme treatment (doxycycline or amoxicillin) does not treat Babesia
- Delayed Babesia may explain relapse after initial improvement with Lyme antibiotics
- Patients with Lyme disease should seek follow-up care if symptoms recur
Frequently Asked Questions
Can Babesia appear weeks after a tick bite?
Yes. Delayed Babesia can present three to four weeks after initial Lyme disease symptoms, even after Lyme treatment has ended.
Why doesn’t Lyme treatment work for Babesia?
Lyme disease is caused by bacteria treated with doxycycline or amoxicillin. Babesia is a parasite that requires different medications, typically atovaquone and azithromycin.
Could this explain why some Lyme patients relapse?
Yes. If Babesia is present but undiagnosed, patients may initially improve on Lyme treatment and then relapse when delayed Babesia symptoms appear.
Should Lyme patients be tested for Babesia at diagnosis?
Given the frequency of tick-borne co-infections, testing for Babesia at the time of Lyme diagnosis—especially in endemic areas—is reasonable.
What are the symptoms of delayed Babesia?
Common symptoms include fever, fatigue, myalgias, dizziness, anemia, and low platelet counts, often appearing after Lyme treatment has concluded.
References
- Hoversten K, Bartlett MA. Diagnosis of a tick-borne coinfection in a patient with persistent symptoms following treatment for Lyme disease. BMJ Case Rep. 2018.
- Saetre K, Godhwani N, Maria M, et al. Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. J Pediatric Infect Dis Soc. 2017.
Related Reading
- Babesia and Lyme: What Patients Need to Know
- When Lyme Treatment Fails: Could It Be Babesia?
- Babesia Treatment Duration: When 10 Days Isn’t Enough
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 was just diagnosed with Lyme disease and I think I have had it for a long time. I had been bitten by a tick in early spring but my doctor was not worried and never ordered test. I became extremely ill. Fatigued, nauseous, just didn’t feel good. I soon started getting these spells where I would suddenly feel like I was going to pass out, then I would start dry heaving and then I would be okay. Then suddenly it would happen again. I went to emergency room with pain in my left arm left chest and jaw and they did a bunch of bloodwork. My potassium was down to 2.4 and they said that was the cause and gave me potassium. After some time I felt somewhat better and thought I would be ok. About 3 months later it all began again, my potassium was low again despite my being on supplements daily since the first time. After about two weeks I felt again somewhat better but not normal. Still suffering from fatigue and swelling in my leg so bad that at times I could barely walk. About a month ago I began having massive pain in my legs but it felt like it was deep. My leg muscles ached so bad that it’s hard to even stand up. I went to get my knee checked out but my other leg had swollen to about three times it’s normal size and the pain in my muscles and joints was beyond anything I have ever felt. The doctor ordered a test for Lyme disease and it was positive. I am now on doxycycline and it’s been a week with no changes in swelling or symptoms. How long before I start feeling better? The pain is debilitating, the swelling is still massive dispute taking ibuprofen and Tylenol and I am not able to take anything else for the pain because I have had a previous issue with opiates and have been in recovery for years and doing great. I already suffer with chronic depression and this doesn’t help. The pain is so bad and I don’t know what to do at this point I’ve been sick for months with short spirts of feeling okay. Please help me to understand what could be happening
I have Lyme disease patients with similar stories. I don’t typically see much change after a week of doxycycline if one had been ill for a long time. I have seen Lyme disease increase pain even from old injuries. I also advise my patients to work with other specialists to rule out other causes of illness.