WHAT IS BABESIOSIS?

(BABESIA)
Babesiosis?(Babesia)

Babesiosis is a disease caused by microscopic parasites that infect red blood cells. Many different
species (types) of Babesia parasites have been found in animals, only a few of which have been found in
people. Babesia microti which usually infects white-footed mice and other small mammals is the main
species that has been found in people in the United States. Occasional cases caused by other Babesia
species have been detected.

Babesiosis is caused by microscopic parasites that infect red blood cells and are spread by certain ticks.
In the United States, tickborne transmission is most common in particular regions and seasons: it mainly
occurs in parts of the Northeast and upper Midwest and usually peaks during the warm months.

Although many people who are infected with Babesia do not have symptoms, for those who do effective
treatment is available. Babesiosis is preventable, if simple steps are taken to reduce exposure to tic

Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a genus of Apicomplexa.
Human babesiosis is an uncommon but emerging disease in the Northeastern and Midwestern United
States and parts of Europe, and sporadic throughout the rest of the world. It occurs in warm weather.

Ticks transmit the human strain of babesiosis, so it often presents with other tick-borne illnesses such as
Lyme disease. After trypanosomes, Babesia is thought to be the second-most common blood parasite of
mammals, and they can have a major impact on health of domestic animals in areas without severe
winters. In cattle, a major host, the disease is known as Texas cattle fever, redwater, or piroplasmosis.

Babesia is a malaria-like parasite, also called a “piroplasm,” that infects red blood cells. Scientists believe
Babesia microti is the most common piroplasm infecting humans, but they have identified over twenty
piroplasms carried by ticks. In addition to transmission by a tick, babesia can be transmitted from
mother to unborn child or through a contaminated blood transfusion. Currently, most blood banks do
not screen donated blood for babesia.

The first case of babesiosis was reported from Nantucket Island, Massachusetts, in 1969. Since the late
1980s, the disease has spread from the islands off the New England coast to the mainland. Cases have
also been reported across the United States, Europe, and Asia.

How do people get infected with Babesia?

The main way is through the bite of an infected tick:

 Babesia microti is spread by Ixodes scapularis ticks, which are commonly called blacklegged ticks
or deer ticks. (Although white-tailed deer are the most important food source for the adult stage
of the tick, deer are not infected with B. microti.)
 The parasite typically is spread by the young nymph stage of the tick. Nymphs are mostly found
during warm months (spring and summer) in areas with woods, brush, or grass.
  Infected people might not recall a tick bite because I. scapularis nymphs are very small (about
the size of a poppy seed).

Other possible ways of becoming infected with Babesia include:

 receipt of a contaminated blood transfusion (no tests have been licensed yet for donor
screening); or
 transmission from an infected mother to her baby during pregnancy or delivery.

Where do most of the cases of babesiosis occur in the United States?

Most cases occur in the Northeast and upper Midwest, particularly in parts of New England, New York
state, New Jersey, Wisconsin, and Minnesota. In the Northeast, babesiosis occurs in both inland and
coastal areas, including off-shore islands, such as Nantucket and Martha’s Vineyard (Massachusetts);
Block Island (Rhode Island); and Shelter Island, Fire Island, and eastern Long Island (New York state).

Symptoms

What are the symptoms and signs of Babesia infection?

Many people who are infected with Babesia microti feel fine and do not have any symptoms. Some
people develop flu-like symptoms, such as fever, chills, sweats, headache, body aches, loss of appetite,
nausea, or fatigue. Because Babesia parasites infect red blood cells, babesiosis can cause hemolytic
anemia (from the destruction of red blood cells).

Symptoms of babesiosis are similar to those of Lyme disease but babesiosis more often starts with a
high fever and chills. As the infection progresses, patients may develop fatigue, headache, drenching
sweats, muscle aches, chest pain, hip pain and shortness of breath (“air hunger”).

Babesiosis is often so mild it is not noticed but can be life-threatening to people with no spleen, the
elderly, and people with weak immune systems. Complications include very low blood pressure, liver
problems, severe hemolytic anemia (a breakdown of red blood cells), and kidney failure.

A Babesia infection most often starts with a high fever and chills. Common symptoms include:

 fatigue
 severe headache
 muscle aches
 joint pain
 abdominal pain
 nausea
 skin bruising
 yellowing of your skin and eyes
 mood changes
Complications

As the infection progresses, you may develop chest or hip pain, shortness of breath, and drenching
sweats.

It’s possible to be infected with Babesia and not have any symptoms. A relapsing high fever is
sometimes a sign of undiagnosed babesiosis.

Complications can include:

 very low blood pressure

 liver problems
 breakdown of red blood cells, known as hemolytic anemia
 kidney failure

Causes of babesiosis?

Babesiosis is caused by infection with a malaria-like parasite of the species Babesia. The Babesia parasite
can also be called Nuttalia.

The parasite grows and reproduces inside the red blood cells of the infected person or animal, often
causing intense pain.

There are more than 100 species of the Babesia parasite. In the United States, Babesia microtiis the
most common strain to infect humans, according to the Centers for Disease Control and Prevention
(CDC).

Other strains can infect:

 cattle
 horses
 sheep
 pigs
 goats
 dogs
 Diagnosis

Babesiosis can be difficult to diagnose.

In the early stages, Babesia parasites can be detected by examination of a blood sample under a
microscope. However, this method is reliable only in the first two weeks of the infection.
If you or your doctor suspects babesiosis, your doctor can do further testing. They may order an indirect
fluorescent antibody test (IFA) on the blood sample. Molecular diagnostics, such as polymerase chain
reaction (PCR), may also be used on the blood sample.

Sometimes, babesia can be detected in blood examined under a microscope. However, this method is
reliable only in the first two weeks of the infection. Commercial tests currently detect only two strains of
Babesia and there are likely many strains yet to be discovered.

The PCR (polymerase chain reaction) test can detect babesia DNA in the blood. The FISH (Fluorescent In-
Situ Hybridization) assay can detect the ribosomal RNA of Babesia in thin blood smears. The lab can also
test the patient’s blood for antibodies to Babesia. It may be necessary to run several different tests, and
negative results should not be used to rule out treatment.

Babesiosis is typically treated with a combination of anti-malarial drugs and antibiotics. Relapses
sometimes occur after treatment and must be retreated.

Treatment

Babesia is a parasite and won’t respond to antibiotics alone. Treatment requires antiparasitic drugs,
such as those used for malaria. Atovaquone plus azithromycin is used to treat most cases and is usually
taken for 7 to 10 days.

Clindamycin plus quinine is used in more severe cases. With severe illness, additional supportive
measures may be taken.

It’s possible for relapses to occur after treatment. If you have symptoms again, they must be retreated.

How to reduce your risk

Avoiding contact with ticks is the best prevention against both babesiosis and Lyme disease. If you go
into wooded and meadow areas where deer are present, take preventive measures:

 Wear clothing treated with permethrin.

 Spray repellent containing DEET on your shoes, socks, and exposed areas.
 Wear long pants and long-sleeved shirts. Tuck your pant legs into your socks to keep ticks out.
 Inspect your whole body after spending time outdoors. Have a friend look at your back and the
backs of your legs, especially behind your knees.
 Take a shower and use a long-handled brush on areas you can’t see.

A tick must attach to your skin before it can transmit the disease. Attaching usually takes some hours
after the tick has contacted your skin or clothing. Even if the tick attaches, there is some time before it
can transmit the parasite to you. You may have as long as 36 to 48 hours. This gives you time to look for
the tick and remove it.
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