GENERAL INFORMATION

It had been thought that Babesia microti is the only significant piroplasm affecting humans. Now it is believed

that many of the over two dozen known species of piroplasms can be carried by ticks and potentially be

transmitted to the human. Unfortunately, we have no widely available tests for these non-microti species.

That

is why, again, a clinical diagnosis is required.

Piroplasms are not bacteria, they are protozoans. Therefore, they will not be eradicated by any of the

currently used Lyme treatment regimens.

Therein lies the significance of co-infections- if a Lyme patient has

been extensively treated yet is still ill, and especially if they are experiencing atypical symptoms, suspect a

co-infection. From the literature:

• “Co-infection generally results in more intense acute illness, a greater array of symptoms, and a more

prolonged convalescence than accompany either infection alone.”

• “Spirochete DNA was evident more often and remained in the circulation longer in co-infected

subjects than in those experiencing either infection alone.”

• “Co-infection might also synergize spirochete-induced lesions in human joints, heart and nerves.”

• “Babesia infections may impair human host defense mechanisms…”

• “The possibility of concomitant Babesia infection should be considered when moderate to severe

Lyme Disease has been diagnosed.”

Babesia infection is becoming more commonly recognized, especially in patients who already have Lyme

Disease. It has been published that as many as 66% of Lyme patients show serologic evidence of coinfection

with Babesia microti. It has also been reported that Babesia infections can range in severity from

mild, subclinical infection, to fulminant, potentially life threatening illness.

Subclinical infection is often missed

because the symptoms are incorrectly ascribed to Lyme.

Babesia infections, even mild ones, may recur even

after treatment and cause severe illness. This phenomenon has been reported to occur at any time, including

up to several years after the initial infection!

Furthermore, such Babesia carriers pose a risk to the blood

supply as this infection has been reported to be passed on by blood transfusion.

SYMPTOMS

Clues to the presence of Babesiosis include a more acute initial illness- patients often recall a high fever and

chills at the onset of their Lyme. Over time, they can note night sweats, air hunger, an occasional cough,

persistent migraine-like headache, a vague sense of imbalance without true vertigo, encephalopathy and

fatigue. The fulminant presentations are seen in those who are immunosuppressed, especially if asplenic,

and in advanced ages. They include high fevers, shaking chills and hemolysis, and can be fatal.

DIAGNOSTIC TESTS

Diagnostic tests are insensitive and problematic. There are at least thirteen, and possibly as many as two dozen Babesia forms found in ticks, yet we can currently only test for B. microti and WA-1 with our serologic

and nuclear tests.

Standard blood smears reportedly are reliable for only the first two weeks of infection, thus

are not useful for diagnosing later infections and milder ones including carrier states where the germ load is

too low to be detected.

Therefore, multiple diagnostic test methods are available and each have their own

benefits and limitations and often several tests must be done. Be prepared to treat based on clinical

presentation, even with negative tests.

• SEROLOGY- Unlike Lyme, Babesia titers can reflect infection status. Thus, persistently positive titers

or western blots suggest persistent infection.

• PCR- This is more sensitive than smears for B. microti, but will not detect other species.

• ENHANCED SMEAR- This utilizes buffy coat, prolonged scanning (up to three hours per sample!)

and digital photography through custom-made microscopes. Although more sensitive than standard

smears, infections can still be missed. The big advantage is that it will display multiple species, not

just B. microti.

• FLUORESCENT IN-SITU HYBRIDIZATION ASSAY (FISH)- This technique is also a form of blood

smear. It is said to be 100-fold more sensitive than standard smears for B. microti, because instead of

utilizing standard, ink-based stains, it uses a fluorescent-linked RNA probe and ultraviolet light.

The

Babesia organisms are then much easier to spot when the slides are scanned. The disadvantage is

that currently only B. microti is detected.

TREATMENT

Treating Babesia infections had always been difficult, because the therapy that had been recommended until

1998 consisted of a combination of clindamycin plus quinine. Published reports and clinical experience have

shown this regimen to be unacceptable, as nearly half of patients so treated have had to abandon treatment

due to serious side effects, many of which were disabling. Furthermore, even in patients who could tolerate

these drugs, there was a failure rate approaching 50%.

Because of these dismal statistics, the current regimen of choice for Babesiosis is the combination of

atovaquone (Mepron, Malarone), 750 mg bid, plus an erythromycin-type drug, such as azithromycin

(Zithromax), clarithromycin (Biaxin), or telithromycin (Ketek) in standard doses. This combination was initially

studied in animals, and then applied to Humans with good success.

Fewer than 5% of patients have to halt

treatment due to side effects, and the success rate is clearly better than that of clindamycin plus quinine.

The duration of treatment with atovaquone combinations for Babesiosis varies depending on the degree of

infection, duration of illness before diagnosis, the health and immune status of the patient, and whether the

patient is co-infected with Borrelia burgdorferi.

Typically, a three-week course is prescribed for acute cases,

while chronic, longstanding infections with significant morbidity and co-infection will require a minimum of four

months of therapy. Relapses have occurred, and retreatment is occasionally needed.

Problems during therapy include diarrhea, mild nausea, the expense of atovaquone (over $600.00 per bottleenough

for three weeks of treatment), and rarely, a temporary yellowish discoloration of the vision.

Blood

counts, liver panels and amylase levels are recommended every three weeks during any prolonged course of

therapy as liver enzymes may elevate. Treatment failures usually are related to inadequate atovaquone

levels.

Therefore, patients who are not cured with this regimen can be retreated with higher doses (and

atovaquone blood levels can be checked), as this has proven effective in many of my patients. Artemesia (a

non-prescription herb) should be added in all cases.

Metronidazole or Bactrim can also be added to increase

efficacy, but there is minimal clinical data on how much more effective this will be.

http://ilads.org/files/burrascano_0905.pdf

[cave note: since those guidelines were published, IGeneX has now come up with a Babesia duncani test.

Purportedly for west coast patients, but it's been found else where.

Also, my personal observations show that more than 4 months of treatment is often the only way a person might show up as negative.]