Babesia Positive Test But No Treatment: What This Case Shows
Can Babesia be left untreated?
One patient had a positive PCR test.
But treatment was not started.
Babesia positive test no treatment is a clinical concern when patients have compatible symptoms but therapy is delayed or withheld.
This question often comes up when patients test positive for Babesia but are told to wait, watch, or assume the infection will resolve on its own.
In an article by Wormser, a case was described involving a 61-year-old woman from Westchester County, New York, who tested positive for Babesia but did not receive treatment.
The patient had removed an unidentified tick from her wrist and later developed intermittent fever, joint pain, anorexia, and fatigue.
Quick Answer: Should Babesia Be Treated If the Test Is Positive?
In many cases, treatment should be considered when Babesia testing is positive and symptoms are compatible with infection.
Some mild cases may improve without treatment, but the long-term outcome of untreated Babesia infection is not always clear.
Positive Babesia PCR but No Treatment
On July 30, 2020, the woman tested positive for Babesia by PCR.
Despite the positive result, treatment was not started.
Two weeks later, she had a positive Lyme disease enzyme immunoassay and one IgM Western blot band.
By August 26, 2020, Lyme disease testing met CDC two-tier diagnostic criteria, yet treatment was still withheld.
For more on diagnostic uncertainty, see Babesia testing.
Why This Case Matters
Ticks carrying Babesia microti are often found in the same regions as ticks carrying Borrelia burgdorferi, the bacterium that causes Lyme disease.
Coinfection can complicate diagnosis and treatment decisions.
However, the patient did not have an erythema migrans rash, and Lyme coinfection was considered less certain.
This illustrates the challenge of interpreting test results when clinical signs are incomplete or evolving.
What Happened to the Patient?
The woman’s fever eventually resolved without treatment.
However, the report did not clarify whether her joint pain, anorexia, or fatigue resolved.
It also did not address whether untreated Babesia infection led to any long-term consequences.
This uncertainty matters because persistent symptoms may follow untreated or incompletely addressed tick-borne infections.
Why Untreated Babesia Can Be Concerning
Babesia infection can range from mild to severe.
Some patients experience fever, fatigue, sweats, chills, anemia, or worsening symptoms over time.
Older adults and immunocompromised patients may be at higher risk for complications.
When symptoms and positive testing align, clinicians should consider whether treatment is appropriate.
Clinical Perspective
I would have been uncomfortable leaving this patient untreated, particularly given laboratory evidence of Babesia infection and compatible symptoms.
When a patient has a positive PCR test and symptoms such as fever and fatigue, treatment should be strongly considered.
Waiting for symptoms to resolve despite evidence of infection raises important clinical and ethical questions.
For treatment considerations, see Babesia treatment protocol.
Frequently Asked Questions
Can Babesia resolve without treatment?
Some mild cases may improve without treatment, but outcomes are not always well documented.
What are the risks of untreated Babesia?
Untreated Babesia may lead to persistent fatigue, ongoing symptoms, anemia, or more serious complications in higher-risk patients.
Why was this patient not treated?
The report suggests treatment was withheld despite a positive Babesia PCR, partly because Lyme coinfection was considered uncertain without objective clinical findings such as a rash.
Would you have treated this patient?
With a positive Babesia PCR and symptoms including fever and fatigue, I would have strongly considered treatment.
Clinical Takeaway
A positive Babesia test should not be dismissed when symptoms are compatible with infection.
When Babesia PCR is positive and patients have fever, fatigue, or other compatible symptoms, treatment should be carefully considered rather than automatically withheld.
References
- Wormser GP. Documentation of a false positive Lyme disease serologic test in a patient with untreated Babesia microti infection. Diagn Microbiol Infect Dis. 2021.
Related Reading
- Babesia and Lyme: What Patients Need to Know
- Babesia Testing: Why Negative Results Don’t Always Mean Negative
- Babesia Negative Tests: Why I Still Treat When Symptoms Fit
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
Thankfully my family doctor saw positive based on clinical observations, for Lyme and started me on antibiotics before the blood work came back proving that. It was caught and treated early, and I’ve been in remission since late 2012. Get rid of the bands, and the rash method and detect by CLINICALLY ASKING about and LISTENING TO PATIENTS symptons. Catch it sooner and treat aggressively!! I would not be alive today by the methods discussed in this article.
Unbelievable. Babesia (with Lyme, mycoplasma & toxoplasma) was responsible for my continued decline even though I received treatment for Lyme within 72 hours of exposure. It culminated in encephalitis, cognitive decline & constant fevers. Some symptoms resolved with IV antibiotics but UNTIL BABESIA WAS TREATED 2 YEARS LATER, I didn’t significantly improve. Now, 11 years later I still require oral Lyme & Babesia meds.
I have identical Lyme Carditis, I had a positive test but was never treated properly. I am left to die. 24 years of suffering and treated twice. Last time put on anibiotics I was resistant too. I had Babiesia diagnosis but I didn’t have Lyme Carditis symptoms until after improperly treated. Now I am dying. How do we get help.
I am sorry to hear you are still sick. Your story highlights how difficult it can be to be sure there is not an unresolved tick borne infection. I face this all the time in my practice. I also lean on other specialists to make sure there is not an underlying illness.
I was infected with Lyme Disease here in Asheville North Carolina a year ago. Fortunately, I had the rash behind my knee. I was treated and refused the short course of 10 days of doxycycline. I then saw an infectious disease doctor and was given a month of doxycycline. When I realized I had a nymph tick on the back of my knee I removed it and accidently dropped it on a patterned carpet. I vacuumed and remained concerned that it was in the apartment. My strictly indoor cat became ill and with great difficulty I got my vet to test him for Lyme. His test as she put it was only ‘mildly positive”. I then had difficulty getting him treated. I lived in Connecticut for years and Lyme was epidemic. I didn’t want to see him suffer from Lyme in his declining years. I don’t think people think of the fact that their dog can bring in an infected tick. The county health dept called to interview me regarding my case of Lyme. The nurse after hearing my story said “Oh yes, we had a diagnosis of Lyme and we treated the whole family and the dog.” I had Babiosis in Connecticut and was quite ill but didn’t have a diagnosis until a blood smear was taken through a Health Food Store. My question is does the Babesiosis remain in your body like Lyme?
I have patients who are failing other treatment until they add treatment for Babesia.
Why are doctors not treating this as a life threatening illness. I was just hospitalized for 5 days due to Babesia. I’ve never been so I’ll. For 3 days I was sleeping , fever, feeling paranoid, nightmares, nausea, headache, loss of balance, walking was affected, headache, loss of fine motor skills, my speech was declining like I was intoxicated. Finally went to the E.R. and had antibiotic I.V.and 5 other antibiotics. I am now having weekly blood tests and my platelets are being monitored ( total of 5 tests). If I had waited another couple days I would not be here. I thank my University of Penn professionals in Chester County, Pa.for getting me through this.
My mom has been extremely sick since 6 August. She developed the red rash on her arm the morning she went to urgent care (9 Aug) and was notified on 12 Aug that she tested positive for Lyme. The doctor, thankfully, was proactive and started her on doxycycline at the visit on the 9th. However, she continues to be very sick. After her second visit to the ER, we asked for testing for bartonella and Babesia, which both came back negative today. She has a headache (temples and eyes), extreme fatigue, body tremors, nausea, extreme loss of appetite with a weight loss of 16 pounds in the last 10 days, a chronic dry cough, shortness of breath upon exertion, gastrointestinal problems, short-term memory loss, and a CT shows she has some fluid around her heart. She sees her cardiologist tomorrow. My questions are, could she have those co-infections despite the tests being negative? Is it possibly the lyme bacteria has caused carditis which would be the reason for the cough? The doctor who tested for babesia and bartonella put her on a long and high tapered dose of prednisone (50 mg X 3 days, 40 mg X 3 days etc, down to 5 mg X 3 days) for the cough which seemed to make her get worse rather quickly. He agreed she could stop when it didn’t stop the cough after 4 days. We are at a loss and her PCM refuses to refer her anywhere for the lyme. We requested a referral to infectious disease at WVU Medical in Morgantown, WV but again, her said no. Any resources anyone can recommend so we can get mom the help she needs?
I have worked with patients who remain ill despite standard therapy for a tick borne illness. The tests for co-infections have not been as good as I would like. My patients also see other doctors to rule out other diseases including pulmonary and cardiac disease. Keep working on all fronts until she gets better.
I was exposed to mold at work for 8 years, diagnosed initially with Lyme through Igenex and clinically diagnosed with Babesia and Bartonella. Before being diagnosed with mold I had treated the lyme and co. For almost 2 years and many symptoms resolved but I had still persistent slurred speech and off balance and loss of fine motor skills that led to the testing for mold.
Although I treated with binders for over a year I didn’t have any resolution to these symptoms and then got Covid. All of my balance, slurred speech and motor skills have been exasperated and some new ones added. Could these symptoms be from babesia or from mold still although out of that exposure since I was diagnosed 12/4/20
I have had success with treating Lyme diseases and Babesia again. Others have reported success with mold treatment.