Health aid helping old woman in bed who had a tick bite and Lyme disease.

Single tick bite leads to 3 diseases in elderly woman

The woman was an avid gardener who had a history of COPD (chronic obstructive pulmonary disease) and high blood pressure. She was admitted to the hospital with dyspnea, fatigue, and a cough productive of yellowish mucoid sputum.

The patient also had significant altered mental status, pallor, and peripheral edema. A lung examination revealed bibasilar crackles, Kumar explains. ¹

She was treated empirically for community-acquired pneumonia and was prescribed ceftriaxone and azithromycin.

The woman had no history of a rash or tick bite. However, lab tests later revealed the presence of 3 tick-borne pathogens.

“We present a case of triple infection with babesiosis, Lyme disease, and anaplasmosis treated with antibiotics and red blood cell (RBC) exchange (erythrocytapheresis).”¹

1) Babesia − This tick-borne disease is caused by a tiny parasite that infects the red blood cells.

“A peripheral blood smear revealed the presence of intracytoplasmic parasites consistent with Babesia,” writes Kumar. Consequently, the woman was started on azithromycin and atovaquone.

Further testing revealed that she had severe babesiosis. Her parasitic load was so high (9.04%) that she required a red blood cell (RBC) exchange (erythrocytapheresis).

Repeat testing, however, found the parasitic load remained high (6.54%), which required a second round of RBC exchange.

“Antimicrobials were changed to clindamycin, quinine, and doxycycline for a total of 14 days,” writes Kumar.

2) Borrelia burgdorferi − The bacteria that causes Lyme disease. Serologic tests were positive. The patient was prescribed doxycycline.

3) Anaplasma − The bacteria that causes anaplasmosis, formerly known as human granulocytic ehrlichiosis (HGE). The patient’s anaplasma titers were positive.

“Patients presenting with an atypical clinical picture of a single pathogen or a lack of improvement with antibiotics after 48 hours require further testing for the presence of other infections,” the authors suggest. “A delay in the diagnosis can lead to an increased risk of complications and disease duration.”

In another case report, Grant and colleagues describe a 70-year-old man who presented to the emergency room with “fevers, ankle edema and nausea following a presumed insect bite on his ankle 1 month prior.”²

Test results revealed the man was positive for Lyme disease, Babesia microti, and Anaplasmosis.

His symptoms resolved completely following treatment with doxycycline, atovaquone and azithromycin.

The authors suggest, “Co-infection with Lyme disease and another tick-borne illness is common, and testing for co-infection should be performed in patients with >24 hours of symptoms despite appropriate treatment, as well as unexplained laboratory abnormalities.”

References:
  1. Kumar M, Sharma A, Grover P. Triple Tick Attack. Cureus. 2019;11(2):e4064.
  2. Grant L, Mohamedy I, Loertscher L. BMJ Case Rep 2021;14:e241004. doi:10.1136/bcr-2020-
    241004

Comments

4 responses to “Single tick bite leads to 3 diseases in elderly woman”

  1. Sandra McLean Avatar
    Sandra McLean

    I was recently treated empirically with doxy for presumed Lyme disease and anaplasmosis (tests were eventually positive for recent infection with both) complicated by an opportunistic strep infection (treated with penicillin). My symptoms were fever, unbearable headache, mild sore throat, muscle and joint aches, stiff neck, fatigue, and worsening neuropathy.
    Last September, I had a severe concussion followed by a sinus infection and severe covid (October), untreated Lyme and anaplasmosis in late November, and in December, the death of my father and my 95-year-old demented mother’s moving in with me. I have a long history of dysautonomia, migraines, NTM infection (successfully treated, with some residual lung scarring), recurrent pyelonephritis and UTIs, and adrenal insufficiency. However, since this series of fun events, my neuropathy, fatigue, and muscle and joint pain have increased exponentially. My neurologist attributed it to my concussion and stress (without knowing about the tickborne infections), but my question is whether there would be any clinical benefit to another course of doxy or whether I should just accept these changes as the new normal and quit my whining? Thank you.
    For background, I live in an area with a very high rate of tick-borne infections–Lyme, babesiosis, and anaplasmosis–so reinfectiom is doubtless inevitable.

    1. I have patients with co-infection to include Babesia where the tests are negative. I have patients who have benefited from treating a co-infection clinically to include treatment for Babesia.

  2. Linda Loving Avatar
    Linda Loving

    I am Chronic for Lyme. Have suspected Babesia for year as well. One Babesia test was Negative. Lyme tests negative for 30+ years. ( Only positive as of 2021 for Lyme). How and where can I have accurate testing for all TBD’s? What would I expect to pay? Old & sick of this relentless battle. Thank you for any advice.

    1. I have not found local labs or speciality labs as good as I would like. I have had to depend on clinical judgement.

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