Symptoms, Diagnosis & Treatment
UPDATE- Babesia duncani (aka WA1) has been detected in patients on the west coast (USA) where it was first discovered. However, doctors have been finding WA1 infected patients across the USA and overseas. Some of these patients are also infected with the Babesia microti strain.
Babesia duncani can not be detected using the standard Babesia microti tests. Doctors should initiate treatment and order both the Babesia duncani test along with the Babesia microti test if Babesiosis is suspected.
UPDATE 9/12/14- In Maryland, the WA1 strain (Babesia duncani) is being detected in human patients approximately 5 times more often than the B. microti strain.
General Information: Many Lyme disease patients have one or more tick borne infections. One study indicates over 1/2 of Babesiosis patients also have Lyme disease.
Babesiosis Symptoms: The parasite that causes Babesiosis invades and then destroys red blood cells and can cause a malaria-like (relapsing) illness which can become chronic and/or can be fatal (10%- 28% fatality rate).
Symptoms may appear as a sudden onset, but also may take months to years to fully develop. There can be "flares" of symptoms every four to six days.
Symptoms can include dizziness, depression and suicidal tendencies, intermittent fevers, fatigue that worsens with exercise, anxiety, chills, waves of sweats at night and also can occur during the day, mood swings, soreness or pain on the top of the head, numb spots on head, drenching night sweats, feelings of being off-balance, memory and cognitive disorders, non-typical symptoms related to the head, muscle pains, temperature intolerance, racing heart and/or irregular heart beat (often worse at night), breathing difficulties (air hunger- need to sigh and take a deep breath), appetite swings, sensitivity to light, disturbances in autonomic nervous system, enhanced senses, headaches (often pressure headaches- behind the eyes- can feel like head is in a vise), headaches that feel like moving sensations, and malaise.
Patients with Babesiosis may also experience orthostatic hypotension, episodes of vomiting, panic disorder, hypercoaguable states (thick blood), severe insomnia, obsessive compulsive disorder (OCD), wrist and hand pain, dehydration or swelling, pain in feet/ankles, bleeding tendencies, acute respiratory distress syndrome, severe fluctuation of temperature, unexplained weight gain or loss, dark colored urine (blood in urine), anemia, swollen spleen (can rupture in some cases), enlarged liver, attention deficit disorder (ADD), vivid dreams and nightmares, congestive heart failure, respiratory failure, renal failure, bruising, jaundice, pulmonary edema, myocardial infarction, anorexia, evidence of shock and encephalopathy.
Symptoms can range from mild to severe. Some feel babesiosis is more dangerous than Lyme disease. To see more information on symptoms, please refer to Dr. James Schaller’s Checklists for Bartonella, Babesia and Lyme Disease by clicking here.
*Supplementation with glutathione and glutamine can increase the number of babesia parasites and if taken it should be used slowly to prevent increased symptoms and anxiety.
Babesia Testing: Babesia tests like Lyme tests are unable to detect the infection in all patients. Therefore, you should treat the patient, not the test. Many experienced doctors will diagnose and treat patients based on exposure, history and symptoms due to the failure of many tests to detect the infection.
It is recommended doctors run multiple tests to improve the chance of detecting the infection. Antibody tests from Quest Lab (includes two strains) and PCR tests from IGeneX Lab for babesiosis are useful if positive, but a negative result does not rule out the disease. The Babesia organism is rarely detected in blood smears. Try to have blood drawn for testing early in the week so it is not delayed in transport and does not sit over the weekend.
Some advanced experts use indirect laboratory testing such as VEGF, TNF-a, IL-6, IL-1B, ECP, and sudden drops in MSH (LabCorp) or natural killer cell numbers such as CD57, CD56, CD3 and CD4 in response to a malaria or Babesia medication. Some feel increased symptoms caused by patients being given low doses of pure Babesia medications is highly suspicious for Babesia.
Babesia Treatment: A combination of high dose Atovaquone/Mepron, 2-4 T per day (1-2 T, 2x per day), and Zithromax or Biaxin, is a common treatment for Babesiosis. This combination is reported to have less serious side effects than quinine and clindamyacin. Eating fatty foods (bacon, ice cream, etc) while taking Mepron has been reported to increase absorption of the drug.
The cost to treat babesiosis with Mepron/Zithromax can range from approximately $1,800- $3,600 per month. If you have little or no insurance and have a modest net income, $30,000 as a single person or $40,000 as a couple, you may qualify for free Mepron or Malarone through the Bridges to Access program. You can learn more about the program by clicking here.
Recently a generic for Mepron came on the market. Prices vary greatly, so please contact different sources to determine the best prices. Patients have reported the ITunes App has been helpful in locating pharmacies in their area with the lowest prices. To learn more about the App, click here.
The duration of treatment has recently been increased to a minimum of 4 months, often requiring 9 months to eradicate the organisms in early cases. In some patients recovery was not seen until five years into treatment and relapses are fairly common.
*Update- a recent report from Australia (June 2015) provided a possible reason for the relapses or recurrences of the disease (in animals)...
"parasitised erythrocytes were few or undetectable in peripheral blood samples but were sequestered in large numbers within small vessels of visceral organs, particularly in the kidney and brain, associated with distinctive clusters of extraerythrocytic organisms."
Medications such as Coartem, Malarone and Artesunate are also used to treat in some cases, especially when patients develop Mepron resistance or have a strain that does not respond. Some physicians feel other anti-malarials or antibiotics may play a role in removing residual Babesia, and others feel improvements are seen once Lyme is being killed.
Loading doses with some medications can cause severe symptoms in the beginning of treatment and this method is not advised. Instead, starting with low doses may allow less debris and less added inflammation. The doses can be raised as the negative effects disappear.
Artemisinin has been rejected by all international major malaria organizations as a treatment as of 2014, and was replaced with artesunate in combination with a synthetic anti-malarial medication.
Since Babesia is far harder to kill than malaria, some experts feel using artemisinin, a rejected synthetic form of sweet wormwood or Artemisia that is no longer promoted in malaria care, is unwise. Babesia relapses are fairly common, but do not appear to be caused by a slime protective layer coating the organisms, which is commonly found in bacteria and fungal infections.
In summary, artemisinin is reported to not be as affective as other treatments and can still (rarely) produce some severe side effects. However, if a patient feels worse in the first few days on this medicine, they should inform their doctor. If ear pain is not involved it might be a sign you just killed some Babesia.
Many other medications exist that are proposed to augment the bodies ability to remove Babesia. Some include beta blockers, heparin and perhaps most importantly, quality blood thinners or clot prevention agents-- both natural and synthetic options exist.
Some experts feel Babesia is far more deadly than Lyme disease, and a clot is one way patients are harmed. A TIA, stroke or heart attack in a Lyme patient or someone in a high exposure area should be examined closely for clotting time with a D-Dimer test, PT/PTT and attention to how long you bleed--under one minute is far too fast. Many new lab tests exist to examine clotting function and samples are avaialable at all large national labs.
Cucurmin, an anti-malerial herbal, is reported to improve babesia treatment, and two possible optimal forms may be Enhansa and BCM-95, but we defer this to your health care provider.
Heparin inhibits the growth of babesia and has been shown to eliminate the infection by covering/coating the outer area of red blood cells, preventing the parasites from entering individual cells. (When adrenal function is low, response to treatment can be negatively affected.)
Cryptoleptis is another herbal option that has been noted to help patients who relapse when anti-malerials fail or for those who need milder treatment that can still hinder babesia reproduction and action.
Re-treatment or long term treatment is often needed in chronic or long-standing cases. Patients may experience a worsening of the symptoms while treating babesiosis (reported in some to be during the first two weeks or later). Once this worsening occurs a few times, the patient should enter into a more stable recovery phase, although with each dose increase you may notice more symptoms.
Of special note- this worsening is often accompanied by what patients have dubbed the "Mepron Blues", which can be a deepening depression, emotional instability, insomnia, rages, aches and an increase in anxiety levels.
Additional Babesia Information
After an infectious tick bite (babesia organisms found in salivary glands and guts of ticks), Babesia parasites invade red blood cells.
There are more than 100 known species of Babesia that can infect various small mammals, primates, rats and gerbils. The first Babesia species was discovered in 1888 by Victor Babes, a Romanian pathologist in whose honor the organisms were subsequently named.
Researchers continue to describe new babesial species affecting humans, such as MO1, which was associated with the first reported case of Babesiosis acquired in the state of Missouri. It is unclear where to classify MO-1.
The standard serology for Babesia microti will not detect these species and many other new species and strains in the public genetic data bases. Health care professionals should order tests for multiple strains when available.
PCR testing varies a great deal between labs, and is usually less sensitive than antibody testing. Some practitioners have used 2-3 low dose malaria medications and found the debris of Babesia increases positive PCR or DNA tests for Babesia.
Transfusion-associated babesiosis, transplacental, perinatal and congenital babesiosis have also been described and have caused severe illness and death in fetuses and patients.
After a transfusion with infected blood, the incubation period can be up to nine weeks. The risk factors for the recipient have included donors who have had exposure in endemic areas. Transfusion transmittal is increasing and blood banks have concerns that asymptomatic donors are increasing in numbers.
The typical incubation period of Babesiosis varies from 5 to 33 days; however, most patients do not recall tick exposure. The correlation between the level of the serology titer and the severity of symptoms is poor, and tests may be false-negative in many cases.
If Babesiosis is suspected, treatment should begin immediately to prevent the worsening of symptoms and should continue until all symptoms have been cleared.
Recommended Book on Babesia- Dr. James Schaller's Health Care Professional's Guide Book to the Treatment and Diagnosis of Human Babesiosis, which can be purchased online through Amazon.com
Babesiosis diagnosis and treatment ideas in a video featuring Dr. Horowitz can be seen by clicking here.
Please see subpages below for more information.
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