Babesia sweats are a common symptom — but they’re just one piece of the puzzle. When patients have both Babesia and Lyme disease, they’re sicker for longer. A landmark study found that 50% of co-infected patients were symptomatic for 3 months or more, compared to just 4% of those with Lyme disease alone.
Babesia Sweats and Other Symptoms
The study by Krause and colleagues, published in the Journal of the American Medical Association, found that 46% of Babesia patients reported sweats. However, 42% did not have sweats — so absence of this symptom doesn’t rule out infection.
Additional symptoms reported included:
- Fatigue (81%)
- Headaches (77%)
- Fevers (58%)
- Chills (42%)
- Myalgias (38%)
- Anorexia (31%)
- Arthralgia (27%)
- Emotional lability (23%)
- Neck stiffness (23%)
While babesia sweats may be helpful in diagnosis, sweats have also been reported in other tick-borne illnesses. Studies found 22% of patients with Lyme disease and 37.5% of patients with Anaplasmosis complained of sweats.
Why Coinfection Makes Babesia Sweats Patients Sicker
Krause and his team found that co-infected patients were sicker for a longer period of time. Thirteen (50%) of 26 co-infected patients were symptomatic for 3 months or longer compared with 7 (4%) of the 184 patients with Lyme disease alone. Patients co-infected with Lyme disease experienced more symptoms and a more persistent episode of illness than those experiencing Babesia infection alone. Circulating spirochetal DNA was detected more than 3 times as often in co-infected patients as in those with Lyme disease alone.
Co-infected patients were also more likely to manifest clinical symptoms. Of subjects infected by both pathogens from 1991 to 1994, only 1 (5%) of 19 was asymptomatic, according to Krause. The presence of both agents tends to synergize a variety of symptoms, especially headache, chills, and babesia sweats.
“Although not all patients experience severe illness, co-infection generally results in more intense acute illness and a more prolonged convalescence than accompany either infection alone.”
Delayed Diagnosis Is Common
Treatment for Babesia is typically delayed. No therapy for Babesiosis was administered to any of the subjects in the study — diagnosis was generally delayed, according to Krause.
Importantly, the Babesia patients were typically not immunocompromised. Although 3 of the Babesia-infected subjects had a history of pre-existing malignancy, no other evidence of immunosuppression was noted in any of the other subjects.
This mirrors findings from the Mayo Clinic study where 2 out of 3 hospitalized patients were not immunocompromised.
How Common Is Babesia Coinfection?
Up to 40% of patients with Lyme disease experience concurrent Babesiosis, according to Diuk-Wasser and colleagues from Columbia University.
The number of cases of Babesia is on the rise, particularly in the Northeastern U.S.
Clinicians should be particularly aware of the disease and consider Babesiosis in patients with an atypical presentation of Lyme disease or in those who do not respond adequately to treatment.
Krause urges physicians caring for patients with moderate to severe Lyme disease to consider obtaining diagnostic tests for babesiosis and possibly other tick-borne pathogens in regions where these diseases are endemic — especially in patients experiencing atypical Lyme disease or delayed response to antibiotics.
Testing Challenges
Clinicians are advised not to rely on blood smears in making a diagnosis. Parasites frequently cannot be seen in blood films, as is common with Babesia infection.
In a New England study, serologic tests for Babesia pathogens were negative in:
- 67% of patients by microscopic evaluation
- 29% of patients by specific amplifiable DNA
- 22% of patients by antibodies
When evaluating patients suspected of having Babesia, the physician’s clinical judgment remains the most important diagnostic tool. For more on testing limitations, see Babesia Testing: Why False Negatives Delay Treatment.
Treatment Differs from Lyme Disease
Identifying Babesia is critical since treatment is different from Lyme disease.
A regimen of atovaquone and azithromycin is as effective as clindamycin and quinine and is associated with fewer adverse reactions, according to Krause.
Patients with Babesia and early Lyme coinfection need both Lyme treatment (doxycycline or amoxicillin) AND Babesia treatment (atovaquone plus azithromycin).
Babesia Sweats Are Not the Only Clue
While babesia sweats may point toward diagnosis, they are not a symptom physicians can rely on fully. Sweats can be absent in nearly half of patients.
Sweats may also be reported in a variety of other conditions. Night sweats have been associated with menopause, malignancies, autoimmune diseases, and infections, according to Mold from the University of Oklahoma Health Sciences Center.
For more on the relationship between night sweats and Babesia, see my detailed article on this symptom. When night sweats are accompanied by air hunger, crushing fatigue, and temperature swings, Babesia coinfection should be strongly considered.
Frequently Asked Questions
Are babesia sweats common?
Yes — 46% of Babesia patients report sweats. However, 42% do NOT have sweats, so absence of this symptom doesn’t rule out infection.
How is Babesia coinfection different from Lyme alone?
Co-infected patients are sicker longer. 50% were symptomatic for 3+ months compared to just 4% with Lyme disease alone. Spirochetal DNA was also detected 3 times more often.
How common is Babesia with Lyme disease?
Up to 40% of patients with Lyme disease in endemic areas may have concurrent Babesiosis, according to Columbia University researchers.
Why doesn’t Lyme treatment work for Babesia?
Doxycycline and amoxicillin treat Lyme disease but not Babesia. Babesia requires different medications — typically atovaquone and azithromycin.
Can healthy people get severe Babesia coinfection?
Yes. In the Krause study, most Babesia patients were not immunocompromised. Co-infection can cause severe illness in otherwise healthy individuals.
References
- Homer MJ, Aguilar-Delfin I, Telford SR 3rd, Krause PJ, Persing DH. Babesiosis. Clin Microbiol Rev. 2000;13(3):451-469.
- Krause PJ, Telford SR 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis: Evidence for increased severity and duration of illness. JAMA. 1996;275(21):1657-1660.
- Krause PJ, McKay K, Thompson CA, et al. Disease-specific diagnosis of coinfecting tickborne zoonoses. Clin Infect Dis. 2002;34(9):1184-1191.
- Mold JW, Holtzclaw BJ, McCarthy L. Night sweats: a systematic review of the literature. J Am Board Fam Med. 2012;25(6):878-893.
- Ramsey AH, Belongia EA, Chyou PH, Davis JP. Appropriateness of Lyme disease serologic testing. Ann Fam Med. 2004;2(4):341-344.
- Krause PJ, Lepore T, Sikand VK, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. 2000;343(20):1454-1458.
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens. Trends Parasitol. 2015.
My husband was diagnosed with Lyme disease about 3 years ago…….although a bulls eye was never noticed on him, we feel he had it for considerable time before being diagnosed. He had one month of antibiotics and did well for about 4 months……He has had occasional night sweats and high debilitating fevers. Now he is dealing with body sweats throughout the day. His physician did a repeat testing for Lyme and it was negative. I am at my wits end as to how to help him….soo many doctors insist he is cured and he is not! I notice mood swings….memory loss…concentration issues….At 71 he still works a full 60 hours per week, but I do not know how he does it…..he was tested for coinfections and the test also was negative…..where do we turn?
Doctors are divided over whether to use clinical judgement when testing negative. You may need to consider treatment for Babesia given the sweats. You should also rule out other illnesses.
Same thing happened to me. My Lyme doctor told me I was cured, but I was having crazy heat flashes in the middle of the day, exhaustion, stiff neck, etc. I contacted dr. Zhang in nyc and went on their herbal protocol and it changed my life for the better. They told me immediately that I had Babesiosis and they could tell because a key symptom is it does not allow you to regulate your body temperature! You can do one in person consult with him or his assistant Phyllis and he/she will put him on an herbal
Protocol that costs about 300-400 a month and he will be cured within a year. Only hard part is the diet they put you on, but it’s worth having your health back. If you don’t want to go to nyc then you can also get the book “healing Lyme” by Stephen Buhner and it tells you some of the herbs that Zhang would recommend and he can order them online and self medicate. That will work too, but the diet actually speeds up the process and zhang has pharma grade herbs so I would go that route. Last piece of advice is make sure his iron count is good if he goes on the herbs..the herbs need the iron to kill the Babesiosis, I was anemic so it took a lot of extra time until I found that out..Babesiosis loves to eat the iron in the body too, so you need to take liquid supplements while killing it! That’s it..good luck and god bless.
Try to find a llmd doctor that will treat your husband for his symptoms, not blood test results-you could still have lyme desease, babasia ,bartonella with negative blood test results
It would be wonderful if you had a practice in maryland
Where do you live in Maryland?
I went to the University of Minnesota and got 2500 dollars in blood tests that all came back negative. I am at my wits end with this. Pain, Insomnia, sweats, chronic fatigue etc…I messaged my doctor about the results and asked if I should get an appointment as I had returning headaches. He told me he sent me to the specialists because he is unable to help me and to find another doctor. What???I’ve seen everyone already, at great cost to my family for the last 16 months. Tested CDC positive for Lyme. I write this as I didn’t sleep at all tonight, not uncommon anymore, pain and sweats were bad so I gave up. Is there anyone in MN that gets this?? Starting to give up but I can’t. I have to keep going for my kids. Feel so sick. Financially, emotionally and physically can’t keep this up anymore!
I grew up in Minnesota. I realize how hard it include a doctor with experience treating tick borne diseases. I have people who fly to New York reflecting the difficulty finding a doctor. You should work with local support groups or leaders to find a doctor. You may also contact the Lyme Disease Association, ILADS, or Global Lyme Alliance websites for names.
Hi Cathy, perhaps this is far too late as you commented a year+ ago…. my husband has been having the same issues and we have spent tens of thousands of dollars trying to figure out what is wrong with him. He finally went (per recommendation….. after 6+ years of issues) to Restorative Health Solutions in Edina and saw Dr . Warren. He performed a whole panel of very extensive testing for infections and co-infections. We FINALLY got an answer…. Babesia. We are waiting on the co-infection result, but suspected Lyme as well and we have an appointment this Friday…. which can’t come soon enough. In the last week the symptoms have worsened with extreme flushing/sweats during the day accompanied by chills and severe headache.
We recommended a friend to Dr. Warren as well and she has a phone consult on Friday. This has been the most frustrating, anxiety ridden journey we could have ever embarked on. It’s suspected he’s had it since he was bit in 2011. The last 3.5 years have been hell, and progressively worsening— to the point of questioning if a career and residence change is needed.
I do hope you see this and can seek some additional testing at this clinic. The Dr was very committed to finding the cause, but started with the “base” testing…. it was $1450. If additional tests were needed he would do them, but believes in only doing what is necessary to keep costs down for patients.
I often find Babesia to be the missing link in my patients who are finding it difficult to get better with treatment for other tick-borne illnesses. Commonly used antibiotics like doxycycline and amoxicillin are not effective for Babesia.
Am wondering if Cathy found the help she so much needed??
Am wondering if Cathy found the help she so much needed??
Homeopathy may help. Search for Lyme and Homeopathy and go from there.
No, it won’t. That’s a fantasy that keeps people from pursuing serious but challenging treatment.
Lymedisease.org has a Physician Finder link. You can just type your location to find an LLMD nearest to you. They also have free CME courses for physicians and nurses (AND patients!) to better educate medical professionals on current research and treatments. A lot has changed since I was first diagnosed in 2013! I am currently taking advantage of the free CME courses for my license renewal.
I was just diagnosed with Lyme but know nothing about it. Saw the red dot but honestly , if that’s the beginning why have I been getting worse since last year. Can they tell you definitively what stage it is cause I have them all
Do yourself a favor and find a REAL doctor, even remotely. I’ve struggled with it for nearly a decade…
Having almost 100 symptoms(of Lymes disease)for 3 years, the newest symptom of a few months is sweating under the soles of my feet, sweating following drinking a hot drink(also chills and touch) Imagine still no diagnosis and absolutely NOBODY taking me seriously, I mean what has to happen before somebody will DIE
I have babesia, Rocky mountain spotted and lymes for 2 years, the antibiotics are not working, I don’t have any idea what to do. The antibiotics have killed my immune system to where I can’t go out without catching something. I’m at wits end.
I am sorry to hear you are having a problems. I have patients who have benefited from a second Lyme disease opinion doctors vary in their approaches.