Babesiasis
Posted by Health articles on May 1st, 2009
Babesiasis is usually transmitted by tick bites although there is some non-tick transmission. This is one of the illness that can still be transmitted by transfusion from people who are infected. It is transmitted by the same tick that transmits Lyme and Ehrlichia, so you can have a triple infection with Babesia, Ehrlichia and Lyme. There is some suggestion that the ongoing fatigue in people with Lyme disease may be due to co-infection with Babesia. Most cases occur in the summer and in the Northeastern United States. One of the areas that was initially described was in Martha’s Vineyard off of Massachusetts. There are also areas in the Midwest, particularly in Minnesota and Wisconsin, where Babesia has been described. There is a newer illness in the far west, in Washington and Oregon, where a babesia-like illness has been described. This is an erythrocytic parasite. Like malaria, is likes to invade red cells.
The clinical presentation of babesiasis is that symptoms usually occur a week after the bite, people don’t recall the bite and again, it is a flu-like syndrome, but this is a flu-like syndrome like malaria. People have fevers, sweats, myalgias and headache. It can be mild and asymptomatic, but it also can lead to renal failure and death. This is one of the diseases that is more severe in splenectomized individuals. So when you see someone in the office who has had a splenectomy and you are warning them about the risks of pneumococcal disease and you should vaccinate them – preferably before their spleen is removed – one of the other things that you need to warn them about is tick bites. If they go to some high-risk area and get bitten by ticks, they can have very severe disease and probably should be evaluated and followed closely.
The diagnosis is made by demonstrating the organism in peripheral blood smear. This can look like malaria when you look at it on a blood smear. It tends to be low parasitemia, so you don’t see many of them. There are serologies for babesia, but titers can persist for months, so if you have an isolated serology, it may reflect past infection and as I mentioned, co-infection with
Lyme can occur in up to twenty percent of individuals, so in someone with Lyme disease with persistent symptoms or an unusual presentation, this is one of the things you think about.
Treatment is not incredibly well worked out for this disease, but in general the recommendations are quinine plus clindamycin. These are both anti-protozoal agents which will kill the organism. You generally treat for seven days and similar to Lyme disease, symptoms here can persist for months after treatment and it doesn’t mean that you need to re-treat them, it just means that you need to follow them over time and tell them that the symptoms may persist. In splenectomized patients with severe disease, exchange transfusion has been used to get rid of and basically lower the level of parasitemia.
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