Sweats may be a sign of Babesia
Sweats have been reported in patients with Babesia.  This finding is no surprise given that Babesia is related to Malaria, a vector-borne disease, well-known to cause sweats. Nearly half (46%) of the patients in a New England study, who presented with a combination of Babesia and Lyme disease (LD), reported having sweats. 
by Daniel J. Cameron, MD MPH
The study by Krause and colleagues, published in the Journal of the American Medical Association, did not break down the time of day the patients exhibited sweats.  The authors noted, however, additional symptoms their patients suffered including fatigue (81%), headaches (77%), fevers (58%), chills (42%), myalgias (38%), anorexia (31%), arthralgia (27%), emotional lability (23%), and neck stiffness (23%).
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 from whom follow-up data were available (P<.001).”
- “Patients co-infected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n=10) experiencing babesial infection alone.”
- “Circulating spirochetal DNA was detected more than 3 times as often in co-infected patients as in those with Lyme disease alone (P=.06).”
They were also more likely to manifest clinical symptoms than those patients infected by either pathogen alone. “Of subjects infected by both pathogens from 1991 to 1994, 1 (5%) of 19 was asymptomatic,” according to Krause.  “The presence of both agents tends to synergize a variety of other symptoms as well, especially headache, chills, and 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.” 
Furthermore, treatment for Babesia is typically delayed. “No therapy for Babesiosis was administered to any of the subjects; diagnosis generally was delayed,” according to Krause. 
As Krause points out, 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 in the study.” 
The number of cases of Babesia is on the rise, particularly in Northeastern U.S.
“Epidemiologic studies have documented that up to 40% of patients with Lyme disease experience concurrent Babesiosis,” according to Diuk-Wasse and colleagues from Columbia University. 
Clinicians, therefore, should be particularly cognizant 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.
“Physicians caring for patients with moderate to severe Lyme disease should consider obtaining diagnostic tests for babesiosis and possibly other tick-borne pathogens in regions where these diseases are zoonotic, especially in patients experiencing episodes of ‘atypical Lyme disease’ or patients in whom the response to antibiotic treatment is delayed or absent,” urges Krause.
Clinicians are also advised to not rely on blood smears in making a diagnosis. “As is common in the case of babesial infection, parasites frequently cannot be seen in blood films.”  In a New England study, the serologic tests for Babesia pathogens were negative in 67% of patients by microscopic evaluation, in 29% of patients by specific amplifiable DNA, and 22% of patients by antibodies. 
Identifying Babesia is critical since treatment is different than for Lyme disease. “For the treatment of babesiosis, a regimen of atovaquone and azithromycin is as effective as a regimen of clindamycin and quinine and is associated with fewer adverse reactions,” writes Krause. 
While sweats may be helpful in diagnosing Babesia, it is not a symptom physicians can rely fully on. Sweats can also be absent. In the Krause study, 46% of Babesia patients reported sweats; 42% did not have sweats. Furthermore, sweats have been reported in other tick-borne illnesses. Studies by Krause and Ramsey found 22% of patients with Lyme disease and 37.5% of patients with Anaplasmosis complained of sweats. [3,5]
When evaluating patients suspected of having Babesia, the physician’s clinical judgment is still the best diagnostic tool.
Note: Sweats may also be reported in a variety of other conditions. “Nighttime sweating has been associated with menopause, malignancies, autoimmune diseases, and infections,” according to Mold from the College of Medicine, University of Oklahoma Health Sciences Center. 
- Homer MJ, Aguilar-Delfin I, Telford SR, 3rd, Krause PJ, Persing DH. Babesiosis. Clin Microbiol Rev, 13(3), 451-469 (2000).
- Krause PJ, Telford SR, 3rd, Spielman A et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. Jama, 275(21), 1657-1660 (1996).
- Krause PJ, McKay K, Thompson CA et al. Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease. Clin Infect Dis, 34(9), 1184-1191 (2002).
- Mold JW, Holtzclaw BJ, McCarthy L. Night sweats: a systematic review of the literature. J Am Board Fam Med, 25(6), 878-893 (2012).
- Ramsey AH, Belongia EA, Chyou PH, Davis JP. Appropriateness of Lyme disease serologic testing. Ann Fam Med, 2(4), 341-344 (2004).
- Krause PJ, Lepore T, Sikand VK et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med, 343(20), 1454-1458 (2000).
- Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. Trends Parasitol, (2015).
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 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??
It would be wonderful if you had a practice in maryland
Where do you live in Maryland?
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
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.