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.

1. WHAT IS BABESIOSIS?(BABESIA)
Babesiosis?(Babesia)
Babesiosisisadisease causedbymicroscopicparasitesthatinfectredbloodcells.Manydifferent
species(types) of Babesia parasiteshave beenfoundinanimals,onlyafew of whichhave beenfoundin
people.Babesiamicroti whichusuallyinfectswhite-footedmiceandothersmall mammalsisthe main
speciesthathasbeenfoundinpeople inthe UnitedStates.Occasional casescausedbyotherBabesia
specieshave beendetected.
Babesiosisiscausedbymicroscopicparasitesthatinfectredbloodcellsandare spreadbycertainticks.
In the UnitedStates,tickborne transmissionismostcommoninparticularregionsandseasons:it mainly
occurs inparts of the NortheastandupperMidwestandusuallypeaksduringthe warmmonths.
Althoughmanypeople whoare infectedwithBabesiadonothave symptoms,forthose whodoeffective
treatmentisavailable.Babesiosisispreventable,if simple stepsare takentoreduce exposure totic
Babesiosisisamalaria-like parasiticdiseasecausedbyinfectionwithBabesia,agenusof Apicomplexa.
Human babesiosisisanuncommonbutemergingdiseaseinthe NortheasternandMidwesternUnited
Statesand parts of Europe,and sporadicthroughoutthe restof the world.It occurs inwarm weather.
Tickstransmitthe humanstrainof babesiosis,soitoftenpresentswithothertick-borne illnessessuchas
Lyme disease.Aftertrypanosomes,Babesiaisthoughttobe the second-mostcommonbloodparasite of
mammals,andtheycan have a majorimpacton healthof domesticanimalsinareaswithoutsevere
winters.Incattle,amajor host,the disease isknownasTexascattle fever,redwater,orpiroplasmosis.
Babesiaisa malaria-likeparasite,alsocalleda“piroplasm,”thatinfectsredbloodcells.Scientistsbelieve
Babesiamicroti isthe mostcommonpiroplasminfectinghumans,buttheyhave identifiedovertwenty
piroplasmscarriedbyticks.Inadditiontotransmissionbyatick,babesiacan be transmittedfrom
motherto unbornchildor througha contaminatedbloodtransfusion.Currently,mostbloodbanksdo
not screendonatedbloodforbabesia.
The firstcase of babesiosiswasreportedfromNantucketIsland,Massachusetts,in1969. Since the late
1980s, the disease hasspreadfromthe islandsoff the New Englandcoasttothe mainland.Caseshave
alsobeenreportedacrossthe UnitedStates,Europe,andAsia.
How do people get infected with Babesia?
The main way is through thebite of an infected tick:
 Babesiamicroti isspreadbyIxodesscapularisticks,whichare commonlycalledblackleggedticks
or deerticks.(Althoughwhite-taileddeerare the mostimportantfoodsource forthe adultstage
of the tick,deerare not infectedwithB.microti.)
 The parasite typicallyisspreadbythe youngnymphstage of the tick.Nymphsare mostlyfound
duringwarm months(springandsummer) inareaswithwoods,brush,orgrass.

2.  Infectedpeople mightnotrecall atickbite because I. scapularisnymphsare verysmall (about
the size of a poppyseed).
Other possible waysof becominginfectedwithBabesia include:
 receiptof a contaminatedbloodtransfusion(notestshave beenlicensedyetfordonor
screening);or
 transmissionfromaninfectedmothertoherbaby duringpregnancyordelivery.
Where do most ofthe cases of babesiosisoccur in the UnitedStates?
Most cases occur inthe NortheastandupperMidwest,particularlyinpartsof New England,New York
state,NewJersey,Wisconsin,andMinnesota.Inthe Northeast,babesiosisoccursinbothinlandand
coastal areas, includingoff-shore islands,suchasNantucketandMartha’sVineyard(Massachusetts);
BlockIsland(Rhode Island);andShelterIsland,Fire Island,andeasternLongIsland (NewYorkstate).
Symptoms
What are the symptomsand signsof Babesia infection?
Many people whoare infectedwithBabesiamicroti feel fine anddonothave any symptoms.Some
people developflu-like symptoms,suchasfever,chills,sweats,headache,body aches,lossof appetite,
nausea,or fatigue.Because Babesiaparasitesinfectredbloodcells,babesiosiscancause hemolytic
anemia(fromthe destructionof redbloodcells).
Symptomsof babesiosisare similartothose of Lyme disease butbabesiosismore oftenstartswitha
highfeverandchills.Asthe infectionprogresses,patientsmaydevelopfatigue,headache,drenching
sweats,muscle aches,chestpain,hippainandshortnessof breath(“airhunger”).
Babesiosisisoftensomilditisnotnoticedbutcan be life-threateningtopeople withnospleen,the
elderly,andpeople withweakimmunesystems.Complicationsinclude verylow bloodpressure,liver
problems,severe hemolyticanemia(abreakdownof redbloodcells),andkidneyfailure.
A Babesia infection most often starts with a high fever and chills. Common symptoms include:
 fatigue
 severe headache
 muscle aches
 jointpain
 abdominal pain
 nausea
 skinbruising
 yellowingof yourskinandeyes
 moodchanges

3. Complications
As the infectionprogresses,youmay developchestorhippain,shortnessof breath,anddrenching
sweats.
It’spossible tobe infectedwithBabesiaandnothave anysymptoms.A relapsinghighfeveris
sometimesasignof undiagnosedbabesiosis.
Complications can include:
 verylowbloodpressure
 liverproblems
 breakdownof redbloodcells,knownashemolyticanemia
 kidneyfailure
Causes of babesiosis?
Babesiosisiscausedbyinfectionwithamalaria-like parasite of the speciesBabesia.The Babesiaparasite
can alsobe calledNuttalia.
The parasite growsand reproducesinside the redbloodcellsof the infectedpersonoranimal,often
causingintense pain.
There are more than 100 speciesof the Babesiaparasite.Inthe UnitedStates,Babesiamicrotiisthe
mostcommon strainto infecthumans, accordingtothe CentersforDisease Control andPrevention
(CDC).
Other strains can infect:
 cattle
 horses
 sheep
 pigs
 goats
 dogs
 Diagnosis
Babesiosiscanbe difficulttodiagnose.
In the earlystages,Babesiaparasitescanbe detectedbyexaminationof abloodsample undera
microscope.However,thismethodisreliableonlyinthe firsttwoweeksof the infection.

4. If you or your doctorsuspectsbabesiosis,yourdoctorcan dofurthertesting.Theymayorderan indirect
fluorescentantibodytest(IFA)onthe bloodsample.Moleculardiagnostics,suchaspolymerase chain
reaction(PCR),mayalsobe usedon the bloodsample.
Sometimes,babesiacanbe detectedinbloodexaminedunderamicroscope.However,thismethodis
reliable onlyinthe firsttwoweeksof the infection.Commercial testscurrentlydetectonlytwostrainsof
Babesiaandthere are likelymanystrainsyettobe discovered.
The PCR (polymerase chainreaction) testcandetectbabesiaDNA inthe blood. The FISH(FluorescentIn-
SituHybridization)assaycandetectthe ribosomal RNA of Babesiainthinbloodsmears.The labcan also
testthe patient’sbloodforantibodiestoBabesia.Itmaybe necessarytorun several differenttests,and
negative resultsshouldnotbe usedtorule outtreatment.
Babesiosisistypicallytreatedwithacombinationof anti-malarial drugsandantibiotics.Relapses
sometimesoccuraftertreatmentandmustbe retreated.
Treatment
Babesiaisa parasite and won’trespondtoantibioticsalone.Treatmentrequiresantiparasiticdrugs,
such as those usedformalaria.Atovaquone plusazithromycinisusedtotreatmost casesand isusually
takenfor 7 to 10 days.
Clindamycinplusquinine isusedinmore severecases.Withsevere illness, additionalsupportive
measuresmaybe taken.
It’spossible forrelapsestooccuraftertreatment.If youhave symptomsagain,theymustbe retreated.
How to reduce your risk
Avoidingcontactwithticksisthe bestpreventionagainstbothbabesiosisandLyme disease.If yougo
intowoodedandmeadowareaswhere deerare present,take preventive measures:
 Wear clothingtreatedwithpermethrin.
 Spray repellentcontainingDEETon yourshoes,socks,andexposedareas.
 Wear longpantsand long-sleevedshirts.Tuckyourpantlegsintoyoursocksto keepticksout.
 Inspectyourwhole bodyafterspendingtimeoutdoors.Have afriendlookatyourback and the
backs of your legs,especiallybehindyourknees.
 Take a showeranduse a long-handledbrushonareasyoucan’t see.
A tickmust attach to yourskinbefore itcan transmitthe disease.Attachingusuallytakessomehours
afterthe tick has contactedyourskinor clothing.Evenif the tickattaches,there issome time before it
can transmitthe parasite to you.You may have as longas 36 to 48 hours.Thisgivesyoutime to lookfor
the tick andremove it.

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