The case of an untreated Babesia infection

Woman with untreated Babesia infection holding her head.

Babesia can be a severe and life-threatening tick-borne illness. In a recent article, Dr. Gary Wormser described a 61-year-old female with an untreated Babesia microti infection.¹ The woman’s IgM test for Lyme disease was positive, but it was dismissed as a false positive test.


In his article, Wormser discusses the case of a 61-year-old woman who went untreated for a Babesia infection, despite positive test results. The patient, who lives in Westchester, NY, a highly endemic area for Lyme disease, reportedly removed an unidentified tick from her left wrist at the end of March 2020, wrote Wormser.

In June, she developed intermittent fevers, joint pain, anorexia, and fatigue and was evaluated at the Lyme Disease Diagnostic Center (LDDC) in New York State.

Unfortunately, the patient did not have an erythema migrans rash. And, as a result was not treated for a tick-borne infection.

On July 30, 2020, the woman tested positive by PCR for Babesia but was not treated.

Two weeks later, she had a positive Lyme disease EIA and one IgM Western blot band. But she was still not treated for either Lyme disease or Babesia.

On August 26, 2020, her Lyme disease tests were positive by the CDC’s two-tier diagnostic criteria. She had a positive EIA and positive IgM Western blot test. Still, she was not treated for either Lyme disease or Babesia.

On December 11, 2020, the woman’s PCR test for Babesia and IgM Western blot test for Lyme disease were negative.  Her Lyme EIA remained positive.

I. scapularis ticks recovered from the environment that are infected with B. microti may be co-infected with B. burgdorferi.

The woman never developed more than two IgM Western blot bands for Lyme disease. And she never exhibited an erythema migrans (or Bull’s-eye) rash. If she had, it would have allowed Dr. Wormser to make the diagnosis of Lyme disease in a patient with Babesia.

As he states, “Diagnosing Lyme disease co-infection in patients with active babesiosis, as in patients with human granulocytic anaplasmosis, is more convincingly accomplished if objective clinical features of Lyme disease are present, such as an erythema migrans skin lesion.”

The woman’s fever resolved without treatment. But Dr. Wormser did not state whether the patient’s joint pains, anorexia, or fatigue had resolved. Neither did Dr. Wormser report whether there were any long-term sequelae from an untreated tick-borne illness.

Editor’s perspective:

I would have been uncomfortable leaving the woman untreated particularly since she had evidence of at least one tick-borne infection – Babesia.

  1. Wormser GP. Documentation of a false positive Lyme disease serologic test in a patient with untreated Babesia microti infection carries implications for accurately determining the frequency of Lyme disease coinfections. Diagn Microbiol Infect Dis. May 16 2021;101(1):115429. doi:10.1016/j.diagmicrobio.2021.115429

10 Replies to "The case of an untreated Babesia infection"

  • Amy Morgan
    08/30/2022 (10:38 pm)

    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?

    • Dr. Daniel Cameron
      08/31/2022 (7:42 am)

      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.

  • L.Jennings
    08/08/2022 (5:11 pm)

    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.

  • Anita Pandolfi
    07/18/2022 (4:13 pm)

    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?

    • Dr. Daniel Cameron
      07/20/2022 (9:10 am)

      I have patients who are failing other treatment until they add treatment for Babesia.

    • Dr. Daniel Cameron
      07/21/2022 (7:38 am)

      I would not be able to rely on a blood smear from a Health Food Store. I have patients in my practice who have done well with treatment for Babesia despite negative tests.

  • Linda Lane
    08/16/2021 (2:37 am)

    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.

    • Dr. Daniel Cameron
      08/16/2021 (8:23 am)

      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.

  • Jennifer Johnson
    08/05/2021 (5:21 pm)

    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.

  • Kathleen
    08/05/2021 (9:47 am)

    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.

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