Babesia Testing in Lyme Disease: Why Coinfections Are Missed
Babesia coinfections are common
Testing may be overlooked in Lyme disease patients
Missed diagnosis can affect treatment decisions
Babesia testing in Lyme disease remains inconsistent despite evidence that coinfections are common in endemic regions.1,4
A recent study published in Vector-Borne and Zoonotic Diseases examined the seroprevalence of B. microti infection in individuals who tested positive for Lyme disease (LD). The authors found that nearly 30% (28.6%) of serum samples taken from individuals with Lyme disease tested positive for Babesia.1 However, since the study was retrospective, the authors could not determine whether individuals already knew they had Babesia or had previously been treated.
The high prevalence of Babesia found in these serum samples is not new. Reported coinfection rates of B. microti with B. burgdorferi vary greatly and can range from 10% to 32%, according to Curcio and colleagues.1 In the 2015 issue of Trends in Parasitology, Diuk-Wasser and colleagues reported that up to 40% of patients with Lyme disease experienced concurrent babesiosis.4
Identifying Babesia is critical since treatment differs from Lyme disease treatment alone. “Doxycycline is the preferred oral treatment because it has activity against other tick-borne illnesses such as human granulocytic anaplasmosis, whereas treatment for babesiosis is generally a combination of atovaquone and azithromycin,” explains Curcio.1
The clinical presentation and outcomes for serum samples positive for Babesia were not examined. “We presumed that these individuals were symptomatic because they were being tested for Lyme disease; however, we have no clinical information regarding previous tick exposure or diagnoses,” according to Curcio.1
Why Babesia Testing in Lyme Disease May Be Overlooked
Babesia testing in Lyme disease may be overlooked because symptoms overlap with Lyme disease, testing practices vary, and clinicians may focus primarily on Lyme disease. Patients with fatigue, sweats, dizziness, air hunger, or symptoms that seem disproportionate to Lyme disease alone may prompt consideration of coinfections.2,4
Patients with Babesia may report fatigue, sweats, dizziness, or air hunger, though symptoms often overlap with Lyme disease.2
Another study indicates that doctors may be reluctant to order tests for non-Lyme tick-borne diseases, including Babesia. When data were collected from seven large commercial laboratories, results indicated that out of nearly 3 million specimens tested for tick-borne diseases, only 3% involved testing for Babesia.5
More than 2 million Lyme disease tests were ordered during the same period, compared with 85,323 Babesia tests.5
Concern for Blood Banks?
Curcio and colleagues expressed concern over transmission through blood banks if patients are not evaluated for Babesia. “B. microti is the highest ranking pathogen transmitted by blood transfusion in the United States for which there was no FDA-approved donor screen currently implemented.”1
“Transfusion transmitted babesiosis has high fatality in transfusion recipients with 28 deaths attributed to complications from 1979 to 2009,” she adds, along with additional reported deaths afterward.1
Babesia has already been reported in the blood supply. Tonnetti and colleagues found that among 2,150 blood donations tested in Minnesota between October 2010 and November 2011, 42 donors (2.0%) were positive by IFA.6
“It could be expected that the number of tested blood donors in New York State would be higher,” explains Curcio, “as it represents 37.2% of the total number of CDC-reported babesiosis cases.”1
The authors suggest babesiosis screening for the nearly 5 million recipients who undergo blood transfusions annually in the USA. “Thus, the implementation of an FDA-approved screening has the potential to save many lives.”1
Babesia microti in the blood supply
Frequently Asked Questions
Can you have Babesia and Lyme disease together?
Yes. Babesia coinfection with Lyme disease is well described in endemic regions and may complicate diagnosis because symptoms overlap and illness severity may increase.2,4
Why is Babesia testing important in Lyme disease?
Babesia treatment differs from Lyme disease treatment. Missing coinfections may contribute to persistent or unexplained symptoms in some patients.1
What symptoms may raise concern for Babesia?
Symptoms can overlap with Lyme disease but may include fatigue, sweats, dizziness, air hunger, fever, and anemia-related symptoms.2
Clinical Takeaway
Babesia coinfections remain an important consideration in Lyme disease, particularly when symptoms appear disproportionate or atypical. Under-recognition may affect both diagnosis and treatment decisions.
Testing decisions for Babesia may matter because coinfections can alter both clinical presentation and management.
Related Articles
Tick-borne coinfections
Air hunger in Lyme disease
Babesia overview
Persistent Lyme disease
References
- Curcio SR, Tria LP, Gucwa AL. Seroprevalence of Babesia microti in Individuals with Lyme Disease. Vector Borne Zoonotic Dis. 2016;16(12):737-743.
- Krause PJ, Telford SR III, Spielman A, et al. Concurrent Lyme disease and babesiosis: Evidence for increased severity and duration of illness. JAMA. 1996;275(21):1657-1660.
- Johnson L, Wilcox S, Mankoff J, Stricker RB. Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ. 2014;2:e322.
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. Trends Parasitol. 2016;32(1):30-42.
- Connally NP, Hinckley AF, Feldman KA, et al. Testing practices and volume of non-Lyme tickborne diseases in the United States. Ticks Tick Borne Dis. 2016;7(1):193-198.
- Tonnetti L, Thorp AM, Deisting BM, et al. Babesia microti seroprevalence in Minnesota blood donors. Transfusion. 2013;53(8):1698-1705.
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
