Neurological manifestations of Babesiosis

Man with neurological symptoms from babesiosis sitting on hospital bed.

Babesiosis is an infectious disease caused by Babesia, microscopic parasites that infect a person’s red blood cells. Babesia can be transmitted through the bite of an infected deer tick. In their study, Venigalla and colleagues highlight the severe neurologic symptoms which occurred in two individuals with the disease. [1]

Individuals with babesiosis can experience fevers, chills, myalgias, anorexia, headache, nausea, and vomiting. According to the authors, “The least common are shortness of breath, sore throat, neck stiffness, emotional lability, photophobia, and dark urine.”

In their study entitled “Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations,”  the authors summarize two cases which presented with stroke-like/transient ischemic attack (TIA)-like signs and symptoms.

Both patients were in their 70’s with multiple co-morbidities. They were admitted to the hospital “with similar symptoms of confusion/cognitive impairment, slurred speech, ataxia, fever, myalgias and chills, urinary frequency, and urgency,” the authors wrote. They had no history of travelling outside the country or having noticed a tick bite.

Two cases of babesiosis with neurological symptoms

The first patient was treated successfully for babesiosis, Anaplasma, and Lyme disease with a combination of atovaquone, azithromycin, and doxycycline for a total duration of 10 days.

The second patient with babesiosis was “initially started on broad-spectrum antibiotics, vancomycin and piperacillin-tazobactam, for suspicion of sepsis,” wrote the authors. He also received a blood transfusion along with fluid resuscitation and maintenance fluids and required pressor support along with midodrine for hypotension. The patient was treated successfully for Babesiosis, Lyme disease, and Mycoplasma pneumoniae with a combination of atovaquone, azithromycin, and doxycycline for a total duration of 10 days.

According to the authors, there are few reports in the literature of neurologic manifestations associated with babesiosis involving cognitive and motor dysfunction. Published studies involving neurologic manifestations have been typically attributed to Lyme disease and anaplasmosis rather than with babesiosis.

“There is a huge gap in knowledge about tick-borne infections, especially babesiosis, which is grossly under-studied and underdiagnosed,” the authors concluded.

“This is a diagnosis associated with complete recovery on prompt diagnosis and treatment, and it could be fatal if left undiagnosed or with a delayed diagnosis.”

Editor’s note: The authors’ cases were well documented. It is harder to publish cases involving  babesiosis with neurologic involvement if the parasites are not seen on a red blood smear and testing is negative.

  1. Venigalla T, Adekayode C, Doreswamy S, Al-Sudani H, Sekhar S. Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations. Cureus. Jul 2022;14(7):e26811. doi:10.7759/cureus.26811

25 Replies to "Neurological manifestations of Babesiosis"

  • Sydney Hampton
    10/14/2022 (4:12 pm)

    Do any patients with Lyme/Babesia have to deal with
    Ear and nose cartilage becoming very pain to the touch?
    Mine is not everyday, it just pops up out of the blue.

    • Dr. Daniel Cameron
      10/15/2022 (7:53 pm)

      I have not asked my patients about their ear and nose cartilage. I have patients whose skin is very painful or burning from a tick borne illness. Their symptoms typically clear if there tick borne infection is treated

      • Sydney Hampton
        10/17/2022 (9:02 pm)

        So in searching my records I have cartilage issues in ears, nose, throat stretched twice and DDDiscs throughout cervical and lumbar. My thoracic areas have been hurting close to two months and issues in pubic symposia area.
        I have the blue toes that happen about 2-4 times a week.

    • R
      10/20/2022 (5:51 pm)

      Lyme can cause deterioration of cartilage I’ve read because it hungry for collagen. There’s a fb group that a guy started because he started having serious problems with rib slippage as a result of Lyme

    • Vanessa
      10/26/2022 (3:34 pm)

      This happens to me! I will wake up with an ear that hurts so bad. But the outside part, not like an ear infection.

  • LuRaye Tate
    10/12/2022 (1:26 pm)

    Is there any evidence for kidney damage (CKD) caused by Babesiosis?

  • Jan Offutt
    10/12/2022 (1:03 pm)

    Sydney- I also have what you described. I have tried to explain it to many drs. They just dont seem to understand what I mean. It feels like the inside of my body is boiling. I can touch my skin and know that it is cool to the touch, but I can not feel the cold. I just dont say this well- When in a flare- I am so hot and sweaty that I can hardly stand it- I go outside in winter in short sleeves to cool off. I have been told that my autonomic nervous system is damaged from the long term Lyme and Babesia and I believe that is where this comes from. When treatment works- it goes away. So I know it “isn’t all in my head”. Thanks

    • Dr. Daniel Cameron
      10/12/2022 (8:03 pm)

      I advise my patients not to dismiss ongoing symptoms of Babesia.

    • Sydney Hampton
      10/14/2022 (4:15 pm)

      Hi. Thanks for your response. How about your legs and arms looking mottled?
      Told my psychiatrist once, she said dead people have mottled skin and moved on😀

      • Dr. Daniel Cameron
        10/15/2022 (7:55 pm)

        Some of my patients have recurring blue hands and feet from autonomic problems related to a tick borne illness

  • Sydney Hampton
    10/12/2022 (12:46 pm)

    Good morning,
    I was diagnosed with Babesia in 2007. Doctors treated the Lyme with Docycycline twice. No treatment for the Babesia.
    I am really curious to know if others go through drenching sweats and chills at the same time. It continues daily it’s embarrassing and ruins my clothing.
    I hope someone can enlighten me.
    Thank you

    • Dr. Daniel Cameron
      10/12/2022 (8:01 pm)

      Doxycycline does not work for Babesia. I take ongoing symptoms in patients with a history of Babesia serious in my practice.

      • Sydney Hampton
        10/13/2022 (11:55 am)

        Dr Cameron
        Thank you for the care of your patients
        I need more like you in WA state.

      • Sydney Hampton
        10/17/2022 (9:12 pm)

        What does work? I feel that the upteen symptoms are taking the best of me daily. It affects my husband children can’t play with grand babies as I long for. Friends get tired of me saying no to outings. Writing cards/letters are nil from my end.
        My Dr refuses to touch the nodules that are in my veins or the rashes that pop up wherever they want. Any sexual desire or activity just stopped all the sudden has never returned. These diseases are so horrible and affect all around us.

        • Dr. Daniel Cameron
          10/18/2022 (8:46 am)

          I advise my patients to begin a comprehensive evaluation including a Lyme disease evaluation.

    • Linda Loving
      10/13/2022 (9:28 am)

      I am 74 years old w/ confirmed Lyme disease & suspected Babesia. I am confident I have had these for 30+ years and have chosen not to try to treat w/ antibiotics. Day & night sweats from age 42. Dysautonomia for about 6 years. Blood pressure plummets and I pass out. Urinary hesitancy, nervousness, brain fog. Excessive fatigue, heat & exercise intolerant. Now, throat closing & shortness of breath, very poor digestion. Just accepting, that symptoms will continue to progress and I will be sicker with time. The supplements I take are unaffordable. The care, all out of pocket, undoable. 😑

      • Lynn
        07/08/2023 (11:04 pm)

        Hi Linda, have you tried A-Bab from the Byron White Formulas? May be worth your trying it. Good luck!😊🙏

  • Angela Berry KOCH
    10/12/2022 (8:54 am)

    The case reports are very important since babesia and the neurological manifestations are so hard to validate and recognize in the clinical setting. Excellent work! would be further validated if they made a longer follow up. I am curious to know if the treatment was long lasting. Is babesia a relapsing illness? The symptom characteristics I am familiar with include a dull long lasting headache and what patients refer to as “ air hunger”. Would the dark urine be related to porphyria ? Has anyone investigated the cause of the dark urine?
    It would be interesting to know better how babesia impacts the neurological system and why. Many thanks. ABK

    • Dr. Daniel Cameron
      10/12/2022 (10:33 am)

      I often find that Babesia helps early on but has to be treated longer to resolve the infection.

      • Michael Janket
        10/12/2022 (11:11 am)

        After a full 2 year regimen of atovaquone, proguanil, azithromycin, along with negative diagnostic tests for the organism Babesia, and a full year of these negative test results, I was taken off these medicines. During the 2 year period, my blood values were mostly suboptimal. Very gradually, my blood values improved with the exception of my high bilirubin (6.0), very low haptoglobin, and platelets (100k). A couple weeks ago, I went off the meds I was taking for the Babesia. After a 2 week wait, I had blood work done. All of these 3 values improved greatly! Bilirubin halved, haptoglobin approaching normality, BUT platelets remained at 100k. I can’t figure out these platelets. Urine has shown much less reddish tint, also. I’m guessing the atova was the culprit, but I could be wrong. What say you?
        thanks so much

        • Michael Janket
          10/12/2022 (11:16 am)

          Oops! I said platelets were considerably improved but that was incorrect. They’ve been pretty much the same during the med regimen, low. The lowest they got was 22k, the highest before the recent blood test was 128k. I will be submitting to another round of blood work within 2 weeks and I’ll see how things are going.

          • Dr. Daniel Cameron
            10/12/2022 (7:59 pm)

            I have not seen 22K platelets in my practice. I include a hematologist in any evaluation. All the best.

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