Babesia: Common Lyme Disease Co-infection

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Babeisiosis, or infection with the protozoan Babesia, has been around for hundreds of years in wild and domestic animals such as cattle, horses, and sheep. But it wasn’t identified in humans until the 1960’s.

Babesia lives in many of the same animals as the Lyme disease bacteria, Borrelia. The same tick species that transmit Lyme can also pass Babesia to humans through a bite. Because of this similarity in hosts and transmission, babesiosis tends to occur in the same geographic areas as Lyme disease. Reservoir animals include deer, cattle, horses, dogs, cats, and mice. Of the over 100 Babesia species, only a few cause disease in humans, namely, Babesia microti, Babesia divergens, and to a lesser extent, Babesia bovis. B. microti is common in the United States. B. divergens occurs more often in Europe.

Infection Cycle

White-tailed deer and field mice are most responsible for supporting Babesia infections in humans. The deer host the Ixodes ticks in all its stages: larva, nymph, and adult. White-footed mice carry the protozoa. In other words, Ixodes ticks grow on deer and Babesia thrive in mice. When the two species intermingle, humans can be infected. Typically, an Ixodes tick nymph feeds on a field mouse infected with the protozoa. The infected nymph then bites a human. The longer an infected nymph feeds on a human, the more likely the protozoa are passed from the tick into the human bloodstream. Less common, blood transfusions can also transmit the protozoa.

Pathogenesis

Babesia has a particular fondness for red blood cells. Once inside a red blood cell, the protozoa split in half to form two new protozoa. This splitting continues until there are too many protozoa inside the cell. The cell then bursts and releases the micro-organisms into the blood. These free protozoa seek out new red blood cells to continue reproducing.

Having an infection that destroys red blood cells does a few particularly damaging things to the body:

  • Babesia leaves the blood with too few red blood cells and therefore decreased oxygen., which red blood cells carry.
  • A burst red blood cell also releases hemoglobin into the blood plasma. Too much hemoglobin floating around causes jaundice, or yellowing of the skin.
  • Broken blood cell fragments can accumulate in the bloodstream faster than the spleen can eliminate them. When cell fragments travel through small blood vessels like capillaries, they can get stuck and block blood flow.

Symptoms of Babesiosis

An incubation period of one week to eight weeks elapses between the tick bite and the onset of Babesia symptoms.  Almost everyone who contracts this disease gets flu-like symptoms of fever and chills.

Nonspecific symptoms include:

  • generalized weakness
  • intermittent fever
  • fatigue, often with inability to sleep
  • gastrointestinal (GI) symptoms like nausea, vomiting, diarrhea, and belly pain
  • headaches
  • muscle pain
  • joint pain
  • unusual weight gain
  • decreased appetite
  • sensitivity to light, touch, sound, or smells

Specific symptoms of babesiosis (as consequences of ruptured red blood cells) include:

  • jaundice
  • shortness of breath – air hunger
  • night sweats and hot flashes
  • chills
  • arm and leg pain
  • swollen spleen
  • dark urine (rare but can happen)

Diagnosis

Anemia due to a low red blood cell (RBC) count is common in babesiosis. This can be easily detected with a routine blood test called a complete blood count or CBC. However, diagnosis cannot be made on this finding alone since many illnesses can cause anemia. Doctors must first suspect the diagnosis of babesiosis based on history and physical examination. A peripheral blood smear microscopic exam can reveal the microorganisms inside the red blood cell. If the blood smear does not show Babesia, but the physician strongly suspects babesiosis, more specific blood tests can be done. These tests search for proteins or DNA specific to the protozoa.

Note: Babesia’s substantial similarity to the malarial parasite Plasmodium falciparum results in misdiagnosis of many patients suffering from Babesiosis.

Treatment

Since Babesia is a protozoan and not a true bacterium, it can’t be treated with run-of-the-mill antibiotics alone. Usually it’s treated with at least two drugs. The most commonly prescribed drugs are Mepron or Malarone (a combination of Atovaguone and Proguanil).  That’s usually combined with some form of the herb artemesia (artemisiae or artemesinin) and/or the Ghanian root cryptolepis sanguinolenta. Another combination, oral Atovaquone (anti-protozoan drug) and oral Azithromycin (an antibiotic) have also been used successfully. A third combination, oral quinine (anti-malarial drug) and oral and intravenous Clindamycin (an antibiotic) have been used but aren’t well tolerated by some patients.

In extremely severe cases, an exchange blood transfusion may be required. In this treatment, the diseased blood is removed and replaced with healthy blood. Exchange transfusion is generally reserved for patients who have a large number of broken red blood cells, have lost the use of their spleen due to trauma or illness, and/or have parasites in greater than ten percent of their red blood cells.

Complications

Severe babesiosis is rare. However, a number of possible complications may arise from severe, untreated, or undertreated disease. While infrequent, the most common complications of babesiosis are:

  • Acute respiratory distress syndrome – a severe lung disease with few effective treatments
  • Severe anemia – Very low numbers of healthy red blood cells, requiring blood transfusion
  • Congestive heart failure – Blood backs up in the lungs and veins when the heart can’t pump effectively
  • Disseminated intravascular coagulation – The blood forms harmful clots some places in the circulatory system and does not clot in others
  • Hypotension/shock – Severely low blood pressure
  • Myocardial infarction – A heart attack
  • Renal failure – Kidneys no longer filter the blood properly

Persistence

Babesia tends to stick around for months. If patients have mild, nonspecific symptoms and don’t receive any Babesia treatment, the protozoa can be detected in the blood for about three months. Those treated with typical drug combinations will still carry Babesia for two to three weeks after treatment ends. Furthermore, evidence of the protozoa can persist in the blood for years, even though the person has no more symptoms.

For recommended articles and books on Babesia, see Babesia Resources.

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123 Responses to “Babesia: Common Lyme Disease Co-infection”

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  1. Nicole Says:

    I have a question. I have babesia, bartonella, rocky mountain, mycroplasma, typhus and most likely borrelia (came back negative). My C4A levels are at 22,000. How severe is this? Or is this normal tohave so many co-infections? I just feel like I can’t get better. How long will I feel horrible? On top of this my 9 year old has Bartonella and Lyme and my 3 year old has Lyme. My 5 year old has shown exposure but it is dormant (we think) and my husband has it. I am seeing a great Dr. But I feel like i need more help or at least more opinions. Especially with the 3 year old. Her inflammtion levels are 11,000. Is this high for a 3 year old and do I need to be worried?

    Reply

    • Pam Dodd Says:

      Nicole, it is unfortunately “normal” to have more infections than just Lyme. Having multiple co-infections makes treatment difficult. It usually takes far longer than most people expect to begin healing from this onslaught. I’m not a doctor and so can’t comment on your C4A questions. But I can say for your children, you should find a Lyme-literate doctor who knows how to treat kids. Thanks for asking.

      Reply

  2. phyllis Says:

    My boyfriend got bit by a tick doing mulching when he was 17….they gave him antibotics to treat the lyme disease of course this was after many poor diagonisis from local doctors who had said it was strept throat at first….his symptoms seemed to go away and nothing more was thought of it that was until may of 2011 he had a pimple under his eye and was trying to pop it and used so much force he hurt himself and soon after began to have symptoms of severe headaches and eye pain….after many CAT scans and MRIs and several different doctors opinions and treatments nothing had worked to make him better it is now august 2012 and he has had the continuing headaches and eye painnon stop everyday the entire time….the lat 2 doctors he has seen seemed to think he had Babesiosis…that the lyme disease he had at 17 has been dormant in his body and when he hurt his eye it became active again….idk if that is right or not but the treatment he has been given have been prednazone arithamicin and tons of homeopathic meds such as monolauren….none of this has helped take this sereve pain and illness away….as days progress he sleeps more and feels worse….i need help can u please help me??!! im scared he will die from this!!!! id appreciate any info or refferals or suggestions u may have please!!!thank you for you time

    Reply

    • Pam Dodd Says:

      Phyllis, tell me where your boyfriend lives and I’ll send you into on how to find a Lyme specialist near him. If his Lyme is back, a steroid like Prednisone is the LAST thing he should be taking. It makes the Lyme worse. A Lyme specialist can test for not only Lyme but also the other Lyme co-infections – Babesia, Bartonella, Ehrlichia, and Anaplasmosis. Most people with Lyme have at least one. Some people have one or more co-infections but not Lyme. Glad you asked.

      Reply

  3. Theresa Says:

    I have hypothyroidism since late 02 .. I have gotten tested for lyme almost yearly sometimes twice in one year.I was diagnosed last June with Lyme… besides my “NORMAL” fatigue, brain fog, muscle/body aches.. I was getting cold sweats at night, 6 wks Doxycycline. I was re-tested on two more occasions and once again my levels where high and back on 6 weeks of Doxycycline. Looking for Help in hudson valley (ulster county) ny area. I once again had a goose bump, sweat filled night :(

    Thanking you advance
    Theresa

    Reply

    • Theresa Says:

      is there any herbs or something that will help I have no insurance at this time. I am not big on antibiotics since i tend to have low tolerance or allergic.

      Reply

      • Pam Dodd Says:

        Cat’s Claw (Samento, Saventaro) works for Lyme. Cryptolepis Sanguinolenta, a Ugandan herb long used for malaria, works for Babesia.

    • Pam Dodd Says:

      Theresa, I’m sending NY Lyme info. Cold sweats could be Babesia. Besides a good Lyme test, you should also be tested for Babesia and the other common Lyme co-infections – Bartonella, Ehrlichia, and Anaplasmosis. Most people with Lyme have at least one. Thanks for asking.

      Reply

  4. zandra Says:

    Are there any medical experts in Colorado, Arizona, Utah or New Mexico in this disease? Thank you for your response

    Reply

  5. Carla Says:

    My 5 year old son has been bitten by 2 deer ticks (one when he was ~10 mos old, and another when he was 4 yrs old). He suffers from eczema & GI issues (both of which are somewhat managed on a GFCF diet) and neurological issues. He seems chemically sensitive and just overall fragile. He used to be very sensitive to light at age 1, but that resolved very suddenly at one point when he was 2. Last summer, when he was starting to show signs of Asperger (with OCD/anxiety/auditory processing delays/sensory issues/etc), we discovered air quality issues in our house (mold, faulty HVAC, etc). Upon fixing those, he almost miraculously stopped showing signs of Asperger. But he still has other pretty regular neurological issues (anxiety, signs of hyperactivity, forgetting how to get dressed properly, etc.) He has just been a biomedical mystery for us! Most recently, he had pneumonia and had to go on antibx. We were bracing ourselves because of all his gut issues (he’d never taken ANY drugs before, except for IV antibx at birth in the NICU). However, a very unexpected thing occurred…only days into the cefprozil, we witnessed him having SOLID stools (no straining) for the first time in his life! Sure enough, within 2 days of stopping the meds, his bowels were back to the usual loose stools, straining, etc. His behavior was noticeably improved on the meds — pleasant, balanced, able to give appropriate gentle affection for the first time, etc. We were marveling at him on antibx. So as much as we never wanted to consider the possibility of Lyme for him (my husband had an awful case of Lyme 2 years ago; he is still not right), we can no longer ignore it after this unexpected eye opener on antibx. With that, we’re looking for a PEDIATRIC lyme doc in the NJ area (central/southern NJ or PA [Philadelphia area] preferred). Thanks so much for your time!

    We’ve had our son tested for Lyme twice…LabCorp test was neg, and IGeneX was not a conclusive negative (41 and 58 bands were + and 39 was INDeterminate).

    Reply

    • Pam Dodd Says:

      What a ride you’re on, Carla! It sounds very frustrating. NJ/PA info coming up. You may have to search a bit but should be able to find a doctor who knows how to diagnose Lyme and the co-infections that often come with it correctly and treat it in children. Thanks for asking.

      Reply

    • Laura Says:

      You should know that the diagnosis for Lyme is clinical. Meaning that the tests are not the defining factor. You can test negative but still have the disease. There is a movie on Hulu called Under Our Skin. It is about Lyme. Pediatric cases are a little different. I also suggest a book called Coping with Lyme Disease by Lang. Good luck on your journey.

      Reply

  6. Jerry Says:

    I was diagnosed with lyme 14 months ago. We started with 3 months of Doxy, 2 months off, then went to 3 months of Zithromax, 2 months off, and now 4 months of Zithromax again. Most of my symptoms seem to be under control or tolerable except for the lightheadedness and buzzy feeling in my head. Sometimes it is to the point where I don’t want to move so I just lay on the couch for days at a time. When it is bad it is really hard to consentrate or focus and some of the time I will get dizzy. We are now considering IM Penicillin. My concern is that we are not really fighting lyme any more and it is something else. Ever heard of symptoms like this?
    Would you please send me LLMD info for the Kansas City area, I am considering getting a second opinion.
    Thank you

    Reply

    • Pam Dodd Says:

      KS Lyme info coming up, Jerry. A second opinion is a good idea. Have you been tested for Babesia, Ehrlicia, Bartonella, and Anaplasmosis, common co-infections that often come with Lyme? Most of us with Lyme have at least one other infection that also needs to be treated. Thanks for asking.

      Reply

      • Jerry Says:

        I have requested we rerun the Western Blot for Lyme, CD57, and test for Babesia. I asked the Dr. to also test for anything else he thinks might fit with my current symptoms. Hopefully, there is an answer there somewhere.
        I had an accupuncture session today (my first one). I will let you know if it helps or not.
        Thank you

      • Pam Dodd Says:

        Thanks for checking in, Jerry. You might also want to check the herpes viruses Epstein-Barr, Cytomegalovirus, and HHV-6 and also Mycoplasma pneumoniae and Chlamydia pneumoniae.

  7. linda Says:

    I was clinically dx’d with lyme disease 2 years ago, after searching for 22 years for answers to why I was having all the various symptoms I’ve dealt with since 1988. An outside person all my life, tick bits were numerous thru life, with no thought about rashes or infected sores that developed from their bites. I have been on low dose foxy since Dx, yet know we are barely grazing the surface. Will you please share the names of ANY lyme literate physicians in the Louisville, Ky area that you are aware of? Thanking you in advance, Linda

    Reply

    • Pam Dodd Says:

      I sent you KY Lyme info, Linda. Thanks for asking.

      Reply

    • stephanie Says:

      Hi there,
      30 yr old female just Dx’d with Lyme in Aug. ’11. Since then I’ve been on low dose doxy and 7 day pulses of metronidazole every month. I have Strep D, C. pneumonia and high IgG for mycoplasma (not current). Exposure to several viruses. Tested negative for babesia and bartonella, but want further testing. Question: does one go after Lyme first or coinfections? Does it matter?
      And should I keep testing for babesia/bartonella?
      Live in Cincinnati area, but willing to travel to a GREAT LLMD, if you can recommend!

      Thanks so much,
      Stephanie

      Reply

      • Pam Dodd Says:

        Stephanie: Some LLMDs treat for Lyme first to reduce the bacterial load before tackling other co-infections. Some treat for multiple infections at the same time. As for repeated testing for Babesia and Bartonella, it depends. Just because you get a negative co-infections test doesn’t mean you don’t have one or more of them. For example, I did several IGeneX co-infections tests between 2005 and last summer. Nothing turned up except one barely positive Babesia test in 2008. I wasn’t aware of any Babesia symptoms and my doctor didn’t seem concerned so I passed it off as unreliable testing. Then Fall 2011, I got hit with Babesia big time. Seems it was there all along but masked by the Lyme. I’ve heard of this happening with other people. And Bartonella can also show up following the lessening of Lyme immunosuppression.

        OH Lyme info is on its way. Thanks for asking.

  8. Lowell Gerber MD Says:

    I am a cardiologist in Maine practicing metabolic medicine. I have a patient referred to me with late stage Lyme Disease, who has now been found to have co infection with Babesia.

    Do you have any opinion about the following adjunctive therapies which have been proposed by an integrative physician?:
    IV Glutathione
    Sauna with far infrared
    Ozone

    Thank you for your help, your blog has been very informative for me.

    Reply

    • Pam Dodd Says:

      Dr. Gerber: Many chronic Lyme patients I know have used IV Glutathione. It seems to be a standard adjunctive therapy for Lyme. Some have done Ozone therapy, but I haven’t heard where it has made a big difference in reducing symptoms. Some swear by the far infrared sauna although there is evidence that far infrared increases infection. My husband and I sold our 2-person FIR sauna when we found out we had Lyme 6 years ago.

      You might also want to buy the recent 2011 ILADS conference presentation by well-known Lyme doctor Richard Horowitz, M.D. updating the diagnosis and treatment of Lyme and Babesia. I attended the conference in Toronto in October, have now found out that I also have Babesia, and am using Cryptolepsis, an herbal tincture recommended by Dr. Horowitz that has been used for years in Ghana to treat malaria. It’s been a lifesaver for me!

      Two other cardiology factors that you should consider in patients with Lyme and associated vector-borne illnesses are Chlamydia pneumoniae and Mycoplasma pneumoniae (and possibly other Mycoplasmas, although it’s hard to find testing for them). Many of us with Lyme cardiovascular issues have them too.

      Hope this helps. I can send you info on how to contact Lyme doctors in Maine should you want that information. Thanks for asking.

      Reply

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