Dr. Daniel Cameron: Inside Lyme Podcast
Two mothers transmit Babesia to their babies. An Inside Lyme Podcast.
Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. I will be discussing two mothers who transmitted Babesia to their babies.
Saetre and colleagues first described these cases in the Journal of the Pediatric Infectious Disease Society in 2017.
Babesia can be contracted from the bite of a deer tick, a blood transfusion, or during pregnancy. In this case study, Babesia was transmitted from the mothers to their babies during pregnancy.
I discussed this paper from the baby’s perspective in an earlier Inside Lyme podcast titled – Two children who contracted Babesia from their mothers.
In this podcast, I will be focusing on the mothers.
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First mother with Babesia
The first mother lived in Westchester County, New York, an area endemic for Lyme disease. I live and practice medicine in the same county.
The mother was diagnosed with Lyme disease in her third trimester at 32 weeks gestation. She presented with an erythema migrans rash (EM).
She was treated with amoxicillin. Amoxicillin has been commonly prescribed during pregnancy. I use amoxicillin for pregnant women in my practice.
I use other antibiotics, e.g., azithromycin. I work with my patient’s obstetrician as needed.
I advise mothers that neither amoxicillin nor azithromycin is effective against other common tick-borne infections such as Ehrlichia, Anaplasmosis, and Babesia.
I advise my patients to return for follow-up to ensure their Lyme disease has been successfully treated and to reassess for evidence of Ehrlichia, Anaplasmosis, or Babesia.
The doctors followed the mother. The mother was positive for Babesia by IgM laboratory testing two weeks after her diagnosis of Lyme disease. A positive IgM test would be consistent with an early infection of Babesia. I would have treated the mother for Babesia.
The mother was not treated for Babesia. The mother and her baby boy went home.
The mother’s baby boy was diagnosed and treated for Babesia 4 ½ weeks after going home.
The mother was again positive for Babesia. The tests were now positive for Babesia by an IgG western blot. The conversion from a positive IgM western blot test to a positive IgG western blot test was further evidence that the mother contracted Babesia during her third trimester. I would still have treated the mother for Babesia.
Again the mother was not treated for Babesia.
Second mother with Babesia
The second mother lived in Putnam County, New York, an area endemic for Lyme disease. Putnam County is located just north of Westchester County.
The mother initially had muscle soreness and a fever for two weeks. The mother was diagnosed with Lyme disease in her third trimester at 37 weeks gestation. She presented with an EM rash.
She was treated with amoxicillin.
The mother’s laboratory tests for a tick-borne infection were not positive at the time of her EM rash.
Her baby girl was tested for Babesia after delivery. Her girl’s blood test was positive for Babesia microti by PCR. The doctors did not look for Babesia in her baby girl’s red blood cells under the microscope. The doctors concluded that the baby girl showed no symptoms. Her baby girl was not treated for Babesia.
The mother and her baby girl went home.
Her baby girl had evidence of Babesia in her red blood cells when she was 18-days-old. Her girl was hospitalized and treated with a series of antibiotics, antiparasitic medications, and a blood transfusion.
The mother’s blood tests were now positive for Babesia by PCR, IgM, and IgG tests. The conversion from a positive IgM western blot test to a positive IgG Western blot test was further evidence that the mother contracted Babesia during her third trimester.
The mother was not treated for Babesia. The baby girl was.
What can we learn from these cases?
- Women can contract Babesia during their pregnancy.
- Pregnant women with Babesia can transmit Babesia to their babies in utero.
- There can be a delay in the onset of Babesia after contracting Lyme disease. In these cases, the Babesia occurred weeks after the mother contracted Lyme disease.
What questions do these cases raise?
- How often do mothers contract Babesia during their pregnancy from a tick bite?
- Is there an effective and safe treatment for Babesia for a pregnant woman?
- How does a mother or doctor recognize Babesia in a pregnant mother?
- Should doctors follow pregnant mothers with a tick bite or Lyme disease for Babesia? I follow a mother and their child for evidence of Babesia.
- Should the two mothers have been treated for Babesia?
- Will the mothers develop complications of Babesia in the future if not treated?
Treating Tick-Borne Disease
We need more doctors with skills diagnosing and treating Babesia in children and their mothers. We need to determine the best course of treatment for pregnant woman and their children. We hope that if a professional sees a pregnant woman with a tick-borne illness that they can use these cases to remind them to look for Babesia and treat accordingly.
Inside Lyme Podcast Series
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- 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.