When babesiosis turns deadly


In their case report “Fatal Babesiosis in an Immunocompetent Patient,” Selig and colleagues describe a 48-year-old man who died within days of being admitted to the hospital from babesiosis and yet, he didn’t have any significant risk factors for severe presentation of the illness. [1]

The man presented to the emergency department with fatigue, generalized weakness and intermittent subjective fevers. The symptoms had worsened over a 2-week period.

The patient also complained of headaches, vision changes, nausea, vomiting and diarrhea. And had a medical history of type 2 diabetes and intermittent asthma.

“He denied any known recent tick or animal exposures, any recent travel, or previous blood transfusions,” the authors write. 

“On arrival to the ED, the patient was tachycardic, afebrile, and normotensive,” the authors write. “A blood parasite smear returned with small ring-form parasites with 25% [red blood cells] infected, consistent with babesiosis.”

“Human babesiosis is an emerging infectious disease with a progressively rising number of cases in the Northeast over the last few decades.”

The patient was admitted to the intensive care unit and began treatment with azithromycin and atovaquone, along with doxycycline for any co-infections, such as Lyme disease.

However, the next day, the patient’s conditioned deteriorated and he required endotracheal intubation with mechanical ventilation. Several days later, he died.

“A few days following the patient’s death, babesia studies returned with PCR positive for B. microti and positive anti body findings (IgG 1:128 and IgM 1:160) confirming the babesiosis diagnosis,” the authors write.

PODCAST: Delayed onset Babesia

The authors suggest, “Clinicians should be aware that even in patients without the classic risk factors of asplenia, advanced age, and immunocompromised status for severe presentations of babesiosis, a deadly case can present.”

They noted that although their patient suffered from type 2 diabetes, an immunocompromised condition, diabetes has not previously been shown to be a significant risk factor for severe babesiosis.

  1. Selig T, Ilyas S, Theroux C, Lee J. Fatal Babesiosis in an Immunocompetent Patient. R I Med J (2013). 2022 Aug 1;105(6):20-23. PMID: 35881994.

14 Replies to "When babesiosis turns deadly"

  • lou
    08/25/2022 (7:56 pm)

    A man died in a southwest Virginia hospital when they failed to detect and treat his babesia case. He was a known lyme patient with years of treatment and a very knowledgeable wife. I don’t remember now if they tested him for babesia and it was negative and they didn’t follow up with a blood smear, or they just ignored it entirely. When you get into a hospital, they may not listen to even very well informed relatives.

  • Jody B.
    08/24/2022 (4:59 pm)

    My husband was diagnosed with Babesiosis after an initial diagnosis of pneumonia and 48 hours of ineffective treatment. I called 911 when his temp reached 102.6 and he had uncontrollable shakes, rapid HR and low oxygen saturation. His level was 9%. 5 days of Azithromycin and Atovaquone and he was sent home with another 5 days totaling 10 days of treatment. His anemia and other labs are all back to normal. But he’s wiped out.
    Should he be followed by an infectious disease specialist? I’m worried about relapse. He is 71 and has type2 diabetes. We live in Maine. Thank God the ED doc knew to draw the tick panel!
    Thank you!

    • Dr. Daniel Cameron
      08/26/2022 (7:17 am)

      I have had patients with Babesia in my practice who have benefited from more than 10 days of treatment.

  • Alan MacDonald MD
    08/24/2022 (4:11 pm)

    Alan MacDonald MD Comment – Grading the Severity of Babesios based on the percentage of parasitized Red blood cells

    I have personally diagnosed over 100 cases of Babesiosis during my tenure as Pathologist at Southampton Hospital in Long Island New York in the period 1982-92. All cases were confirmed by the NY State Dept of Heatlh laborartory of Dr. Jorge L Benach after my initial “STAT” diagnosis of babesiosis from oil immersion microscopy ( minimum microscope time < 30 minutes per case) of thin smears of peripheral blood or from Bone marrow aspirates

    My personal Grading System for Babesia infections in blood smear examinations is:
    Grade 1 – Mild babesia infection – Less than 1% of RBc parasitized.
    Grade 2 – Moderate babesia infection – up to 5% of RBC parasitized – Hospitalization indicated
    Grade 3 – Severe and life threatening babesiosis – Any Asplenic patient, Any hyposplenic patient ( Lymphoma or Sickle cell dis)
    and any patient with parasitemia greater than 10% of red blood cells.
    These break points are based on data from Falciparum Malaria patients

    • Dr. Daniel Cameron
      08/26/2022 (7:21 am)

      Alan. Thanks for sharing. I am also concerned for my Babesia patients who ill despite the absence of Babesia on their blood smears.

  • Robin
    08/24/2022 (6:05 am)

    Wonderful, diabetes does not run in my family and I have been denying my doctors request to do an all day glucose lab testing for diabetes. And since, I contracted lyme/Babesoa..so many of the lab tests I do, do, I have to retake because they come out abnormal only to be normal when tested again or given a different test. A very disturbing article being Ive been treated for Babesia, Lyme etc etc. And so, this article states diabetes is a risk factor, if one has it or get its from Babesia? And, I still have vision problems.. very disturbing.

  • Stacie
    08/24/2022 (5:23 am)

    Wonder if doctors ever considered the consequences of some of the medications used to treat the infection. I barely survived a round with Zithromax, I thought the issues I was having with the medication was a herxheimer- until I was totally unable to walk, breathe or talk. As it turned out, I have a heart condition called prolong QT syndrome and a result of the Zithromax, my heart went into ventricular fibrillation. It is amazing that I survived.

    • Tessa McCall
      08/25/2022 (10:00 pm)

      I was on the medications for a long time because entrenched infection is hard to get over. I knew other people on the medications as well and none of us had problems. Like everything else it depends on the person’s immune system, other infections and other health issues. Hope your better.

    • Dr. Daniel Cameron
      08/26/2022 (7:24 am)

      I am glad to hear your cardiac problems from Zithromax were recognized by your doctor in time. I have had to couple another antibiotics with atovaquone for some of my patients if I am unable to prescribe Zithromax.

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