Babesia Infection – Signs, Symptoms, and Treatment

Pathophysiology of Babesia Infection

1) Babesiosis is caused by the intracellular protozoan parasite Babesia microti and in Europe B. divergens 2) most severe symptoms occur in immunosuppressed, diabet6ic, splenectomized, and elderly 3) now clinically important in the USA and Candada as a coinfection of Lyme disease, ehrlichiosis, and Bartonella (which are all transmitted via the bite of the Ixodes tick)

Signs and Symptoms

1) acute flu-like symptoms – fever, chills, sweats, muscle pain, fatigue, arthralgias, and headache 2) petechiae 3) jaundice/dark urine 4) if occurs as coinfection with Lyme disease, the clinical symptoms are more severe

Histology/Gross Pathology

1) parasites enter RBCs and resemble malarial organisms 2) Babesia infection causes a ring-like structure in RBCs on Giemasa blood smear 3) sometimes tetrad daughter organisms are seen inside RBCs owing to asexual reproduction

Associated Conditions

1) Lyme coinfection (50%) 2) ehrlichiosis coinfection 3) Bartonella coinfection 4) Anaplasma coinfection 5) Babesia infection can be life-threatening in splenectomized patients


1) vector is the Ixodes tick 2) occurs particularly in northeastern USA (esp. coastal areas) and upper Midwest


1) oral Malarone and azithromycin for 30 days (may have to repeat) 2) Mepron (atovaquone) and azithromycin for 30 days (may have to repeat) 3) treatment of coinfections (Lyme, ehrlichiosis, anaplasma, Bartonella)

B. divergens infection is more serious with fever, hemolysis, jaundice, and hemoglobinuria.

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