Abstract
Babesiosis is caused by a tick-borne hemoparasite that, like malaria, can cause fever, hemolysis, and anemia. Typically self-limited, in the asplenic, immunocompromised, or elderly, disease can be severe or deadly. US cases have been primarily due to Babesia microti; WA-1, which may be related to Babesia gibsoni; and MO-1, related to Babesia divergens. European infections are usually due to B. divergens. North American cases are treated either with quinine and clindamycin or with atovaquone and azithromycin. The latter regimen appears less toxic.
Similar content being viewed by others
References and Recommended Reading
Dammin GJ: Babesiosis. In Seminars in Infectious Disease. Edited by Weinstein L, Fields B. New York: Stratton; 1978:169–199.
Quick RE, Herwaldt BL, Thomford JW, et al.: A new species of Babesia? Ann Intern Med 1993, 119:284–290.
Persing DH, Herwaldt BL, Glaser C, et al.: Infection with a babesia-like organism in northern California. N Engl J Med 1995, 332:298–303.
Persing DH, Conrad PA: Babesiosis: new insights from phylogenetic analysis. Infect Agents Dis 1995, 4:182–195.
Herwaldt B, Persing DH, Precigout EA, et al.: A fatal case of babesiosis in Missouri: identification of another piroplasm that infects humans. Ann Intern Med 1996, 124:643–650.
Thompson C, Spielman A, Krause PJ: Coinfecting deer-associated zoonoses: Lyme disease, babesiosis, and ehrlichiosis. Clin Infect Dis 2001, 33:676–685. Makes the important point that babesiosis may coexist with both Lyme disease and human granulocytic ehrlichiosis. Reviews key points for diagnosing each, eg, leukopenia, lymphopenia, granulocytopenia with HGE, throbocytopenia, and anemia with babesiosis.
Dammin GJ, Spielman A, Benach JL, et al.: The rising incidence of clinical Babesia microti infection. Hum Pathol 1981, 12:398–400.
Herwaldt BL, Springs FE, Robert PP, et al.: Babesiosis in Wisconsin: a potentially fatal disease. Am J Trop Med Hyg 1995, 53:146–151.
Mintz ED, Anderson JF, Cabel RG, et al.: Transfusion-transmitted babesiosis: a case report from new endemic area. Transfusion 1991, 31:365–368.
Spielman A, Etkind P, Piesman J, et al.: Reservoir hosts of human babesiosis on Nantucket Island. Am J Trop Med Hyg 1981, 39:560–565.
Spielman A, Wilson ML, Levin JF, et al.: Ecology of Ixodes dammini-borne human babesiosis and Lyme disease. Ann Rev Entomol 1985, 30:439–460.
Smith RP, Rand PW: Role of bird migration in the long distance dispersal of Ixodes dammini, the vector of Lyme disease. J Infect Dis 1996, 174:221–224.
Brasseur P, Gorenflot A: Human babesial infections in Europe. Rocz Akad Med Bialymst (Poland) 1996, 41:117–122.
Popovsky MA, Lindberg LE, Syrek AL, et al.: Prevalance of Babesia antibodies in a selected blood donor population. Transfusion 1988, 28:59–61.
Esernio-Jenssen E, Scimeca PG, Benach JL, et al.: Transplacental/ perinatal babesiosis. J Pediatr 1987, 110:570–572.
Raoult D, Soulayrol L, Toga E, et al.: Babesiosis, pentamidine, and cotrimoxazole. Ann Intern Med 1987, 104:944.
Ruebush TKI, Juranek DD, Chisholm ES, et al.: Human babesiosis on Nantucket Island: evidence for self-limited and subclinical infections. N Engl J Med 1977, 297:825–827.
Ruebush TKI, Juranek DD, Spielman AM, et al.: Epidemiology of human babesiosis on Nantucket Island. Am J Trop Med Hyg 1981, 30:937–941.
Benach JL, Habicht GS: Clinical characteristics of human babesiosis. J Infect Dis 1981, 144:481.
White DJ, Talarico J, Chang HG, et al.: Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors. Arch Intern Med 1998, 158:2149–2154. The authors review 139 hospitalized cases of babesiosis; age more than 50 years and comorbitities predicted a poorer outcome. Significant inpatient morbidity was documented.
Iacopino V, Earnhart T: Life-threatening babesiosis in a woman from Wisconsin. Arch Intern Med 1990, 150:1527–1528.
Boustani MR, Lepore JT, Gelfand JA, Lazarus DS: Acute respiratory failure in patients treated for babesiosis. Am J Respir Crit Care Med 1994, 149:1689–1691.
Krause PJ, McKay K, Thompson CA, et al.: Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease. Clin Infect Dis 2002, 34:1184–1191. Complete bloodcount with thin smear, PCR, and immunoglobulin M antibody tests distinguished these infections: babesiosis, human ehrlichiosis, and Lyme disease. Of 192 patients with confirmed infection, 39% were coinfected, three of 192 with all three pathogens.
Krause PJ, Telford SRI, Spielman A, et al.: Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA 1996, 275:1657–1660.
Pancholi P, Kolbert CP, Mitchell PD, et al.: Ixodes dammini as a potential vector of human granulocytic ehrlichiosis. J Infect Dis 1995, 172:1007–1012.
Telford SRI, Dawson JE, Katavolos P, et al.: Perpetuation of the agent of human granulocytic ehrlichiosis in a deer tickrodent cycle. Proc Natl Acad Sci U S A 1996, 93:6209–6214.
Spach DH, Liles WC, Campbell GL, et al.: Tick-borne diseases in the United States. N Engl J Med 1993, 329:936–947.
Magnarelli LA, Dumler JS, Anderson JF, et al.: Coexistence of antibodies to tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in human sera. J Clin Microbiol 1995, 33:3054–3057.
Krause PJ, Spielman A, Telford SR 3rd, et al.: Persistent parasitemia after acute babesiosis. N Engl J Med 1998, 339:160–165. Despite treatment, babesial DNA could be detected in the circulation for a mean of 41 days; for untreated patients, the mean was almost 9 months, even in the absence of symptoms. Implications are that from the blood supply to immunosuppressive therapy, prior infection and recrudesence of babesial infection should be considerations.
Hatcher JC, Greenberg PD, Antique J, Jimenez-Lucho VE: Severe babesiosis in Long Island: review of 34 cases and their complications. Clin Infect Dis 2001, 32:1117–1125. Additional documentation of the severity of this disease in some. Twenty percent required exchange transfusions; 10% died.
Gupta P, Hurley RW, Helseth PH, et al.: Pancytopenia due to hemophagocytic syndrome as the presenting manifestation of babesiosis. Am J Hematol 1995, 50:60–62.
Falagas ME, Klempner MS: Babesiosis in patients with AIDS: a chronic infection presenting as fever of unknown origin. Clin Infect Dis 1996, 22:809–812.
Persing DH, Mathiesen D, Marshall WF, et al.: Detection of Babesia microti by polymerase chain reaction. J Clin Microbiol 1992, 30:2097–2103.
Pruthi RK, Marshall WF, Wiltsie JC, et al.: Human babesiosis. Mayo Clin Proc 1995, 70:853–862.
Wittner M, Rowin KS, Tanowitz HB, et al.: Successful chemotherapy of transfusion babesiosis. Ann Intern Med 1982, 96:601–604.
Krause PJ, Lepore T, Sikand VK, et al.: Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 2000, 343:1454–1458. This is a seminal paper on therapy; while the power of the study did not conclusively prove atovaquone plus azithromycin was more effective than quinine plus clindamycin, the former regimen was clearly less toxic.
Centers for Disease Control and Prevention: Clindamycin and quinine treatment for Babesia microti infections. MMWR 1983, 32:65–71.
Machtinger L, Telford SRI, Inducil C, et al.: Treatment of babesiosis by red blood cell exchange in an HIV-positive splenectomized patient. J Clin Apheresis 1993, 8:78–81.
Jacoby GA, Hunt JV, Kosinski KS, et al.: Treatment of transfusion-transmitted babesiosis by exchange transfusion. N Engl J Med 1980, 303:1098–1100.
Gelfand JA, Poutsiaka DD: Babesiosis. In Principles and Practice of Clinical Parasitology. Edited by Gillespie SH, Pearson RD. West Sussex: John Wiley & Sons; 2001:100–102.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Gelfand, J.A., Callahan, M.V. Babesiosis: An update on epidemiology and treatment. Curr Infect Dis Rep 5, 53–58 (2003). https://doi.org/10.1007/s11908-003-0065-z
Issue Date:
DOI: https://doi.org/10.1007/s11908-003-0065-z