Neurological manifestations of Babesiosis

Individuals with babesiosis can experience fevers, chills, myalgias, anorexia, headache, nausea, and vomiting. According to the authors, “The least common are shortness of breath, sore throat, neck stiffness, emotional lability, photophobia, and dark urine.”

In their study entitled “Atypical Presentation of Babesiosis With Neurological Manifestations as Well as Hematological Manifestations,”  the authors summarize two cases which presented with stroke-like/transient ischemic attack (TIA)-like signs and symptoms.

Both patients were in their 70’s with multiple co-morbidities. They were admitted to the hospital “with similar symptoms of confusion/cognitive impairment, slurred speech, ataxia, fever, myalgias and chills, urinary frequency, and urgency,” the authors wrote. They had no history of travelling outside the country or having noticed a tick bite.

Two cases of babesiosis with neurological symptoms

The first patient was treated successfully for babesiosis, Anaplasma, and Lyme disease with a combination of atovaquone, azithromycin, and doxycycline for a total duration of 10 days.

The second patient with babesiosis was “initially started on broad-spectrum antibiotics, vancomycin and piperacillin-tazobactam, for suspicion of sepsis,” wrote the authors. He also received a blood transfusion along with fluid resuscitation and maintenance fluids and required pressor support along with midodrine for hypotension. The patient was treated successfully for Babesiosis, Lyme disease, and Mycoplasma pneumoniae with a combination of atovaquone, azithromycin, and doxycycline for a total duration of 10 days.

According to the authors, there are few reports in the literature of neurologic manifestations associated with babesiosis involving cognitive and motor dysfunction. Published studies involving neurologic manifestations have been typically attributed to Lyme disease and anaplasmosis rather than with babesiosis.

“There is a huge gap in knowledge about tick-borne infections, especially babesiosis, which is grossly under-studied and underdiagnosed,” the authors concluded.

“This is a diagnosis associated with complete recovery on prompt diagnosis and treatment, and it could be fatal if left undiagnosed or with a delayed diagnosis.”

Editor’s note: The authors’ cases were well documented. It is harder to publish cases involving  babesiosis with neurologic involvement if the parasites are not seen on a red blood smear and testing is negative.