Babesiosis

Babesiosis is a malaria-like, parasitic infection that reproduces within red blood cells. The infection is most often transmitted through the bite of the Ixodes tick (deer tick or black-legged tick): the same vector responsible for transmission of Lyme disease. Over 100 distinct species have been identified within the Babesia genus, though only a few of these are currently known to be human pathogens.   Although most Babesiosis cases are tick-borne, in endemic areas transfusion and transplacental transmission have been reported. 

In the United States, the primary agent of human babesiosis is Babesia microti, transmitted by the bite of Ixodes scapularis. Cases of babesiosis caused by B. microti occur in the range of the black-legged tick in the Eastern U.S. and Midwest.  Additional cases of babesiosis caused by Babesia duncani occur primarily in the western U.S.;  cases caused by other strains have also been reported in Missouri and Kentucky. 

Patients co-infected with babesiosis and Lyme disease or with other complicating conditions, such as underlying immunosuppression, usually experience more severe symptoms for a longer duration than those with either disease alone and hence need longer treatment to totally resolve.   

Babesiosis may start with gradual onset of malaise and fatigue as well as flu-like symptoms of fever and chills. Several days later high fever, drenching sweats, muscle pain and headaches may follow. Like malaria, these symptoms can continue over a protracted period or can abate, then recur.  If ineffectively treated, the infection may become chronic. Chronic symptoms may include generalized weakness, fatigue, depression, gastrointestinal symptoms, weight loss, headache, photophobia, neck stiffness, altered sensorium, cough, shortness of breath, muscle and joint pain, dark urine, jaundice, and swollen spleen. This chronic stage is resolved only with persistent treatment.

Since early symptoms are largely non-specific, diagnosis is difficult. Nevertheless, physicians encountering a patient from an endemic area who presents with fever and a viral-like illness, especially in the summer months, should be alert to the possibility that babesiosis may be responsible for the patient’s symptoms.  According to the severity of individual cases, treatment duration varies. Treatment of individuals with severe infection should continue until symptoms have resolved and tests are negative for at least two weeks.  

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