Archive for the ‘Babesia’ Category

New Study: The Hidden Ways Microbes Control Tick Behavior

New Study: The Hidden Ways Microbes Control Tick Behavior

New Study: The Hidden Ways Microbes Control Tick Behavior

by Jenny Lelwica Buttaccio
Posted 9/17/20

We’ve heard a lot of late about an increase in Lyme disease cases, but tick-borne diseases of all kinds — including babesiosis, anaplasmosis, rickettsiosis, and others — are on the rise throughout the United States, reports the Centers for Disease Control and Prevention (CDC). At least part of the increase in tick-borne illnesses can be traced to an expanding tick population, caused by several factors including changes in climate patterns and the development of housing into wooded areas, creating closer interactions between people, animals, and ticks.

But what if there’s also an unseen force at work compelling ticks to act out or present with certain behaviors that give them a leg up when it comes to their own survival — and that of the microbes they carry? New research suggests that perhaps there’s more to this story than we know.

First, a Basic Overview of Ticks On the Hunt

More than four decades after the first cases of Lyme disease were diagnosed, we’re still learning about tick behavior and why they operate in the way they do. We know that blood hosts like humans and animals are critical for tick survival, so ticks are regularly on the prowl.

A tick’s vision isn’t very good, so they rely on other sensory components to find food sources. Located on the first pairs of ticks’ legs are tiny structures called Haller’s organs. These organs are found only on ticks, and it is believed that they function somewhat like antennae and utilize the sense of smell to detect odors wafting through the air to find unsuspecting hosts.

Using their Haller’s organs, ticks detect the carbon dioxide (CO2) that comes from human respiration and breathing — they can sense other chemicals like ammonia and pheromones, too. While certain ticks, like the Lone Star tick, can aggressively charge potential human hosts, most prefer a more subtle approach: Waiting patiently on blades of grass or areas of brush until you approach them, an activity known as “questing.”

diagram of tick biology

When a tick quests, they grip the blade of grass or brush with their back legs and stretch their front legs into the air. In due time, a human or animal walks past, and they latch on, using the front legs to ascend their new host and search for a suitable spot to begin feeding.

As weird and as sci-fi as all this sounds, emerging research from Giovanni Benelli, PhD, Senior Research Entomologist at the University of Pisa in Pisa, Italy, has begun to shed light on microscopic agents that exert influence upon ticks’ hunting behavior. Interestingly, it’s the very microbes we work so hard to avoid that play puppeteer to their tick hosts.

6 Microbes that Manipulate Tick Behavior

In August 2020, Benelli published a new review in the journal Pathogens investigating whether microbes Anaplasma, Borrelia, Babesia, Bartonella, Rickettsia, and tick-borne encephalitis virus (TBEV) were involved in influencing tick behavior and adaptive significance (traits that affect a tick’s reproductive success). Pathogenic manipulation — such as an increase in biting frequency and duration and changing host-borne odors to make them more appealing meals for other arthropods like mosquitos and sand flies — has already been noted in scientific literature.

In regards to ticks, Bellini’s data suggests modes of pathogen-tick manipulation may include physiological changes, tolerance to extreme temperatures, and enhanced survivability, among others. Here, we’ll take a look at some of the key highlights of Benelli’s research, a wealth of further insights into tick behavior that could be a crucial factor in helping to curtail the bugs’ proliferation and their ability to spread chronic illnesses.

1. How Borrelia Impacts Tick Behavior

Borrelia is the bacteria implicated in Lyme disease. In the United States, Borrelia burgdorferi is the species that’s found in black-legged ticks (Ixodes scapularis) or deer ticks. However, in Europe, the predominant Lyme disease-carrying tick is the castor bean tick (Ixodes ricinus).

Borrelia infection in the blood. Borrelia bacteria cause borreliose, transmitted by ticks and by lice.

Borrelia may manipulate tick behavior in both tick species, according to Bellini’s review. Here are some of his key findings:

Key Findings:

  • Black-legged nymph ticks infected with B. burgdorferi showed enhanced movement toward or away from light sources (phototaxis).
  • Nymph ticks infected with B. burgdorferi demonstrated an affinity for vertical surfaces such as the top layers of leaf litter piles or plant vegetation like blades of grass, which may provide them with more opportunities to come into contact with hosts.
  • B. burgdorferi stimulated tick histamine release factor (tHRF), the chemical that regulates vascular permeability and improves blood flow to the site of the bite for feeding.
  • Infected adult black-legged ticks had slower mobility than their non-infected counterparts. However, research is unclear whether this is a behavior adaptation resulting from B. burgdorferi.
  • Castor bean nymph ticks exposed to extremely dry conditions showed they were more active and more resistant to harsh conditions than those that were not carrying the pathogen.
  • Nymph ticks carrying a strain of Borrelia known as Borrelia afzelii (a European strain known for its ability to affect the central nervous system) had increased rates of mobility, including duration and speed of movement, over non-infected ones.

The Takeaway

Indeed B. burgdorferi may manipulate tick behavior in several ways, but Bellini acknowledges that further research is needed to determine how these behaviors contribute to disease and how the data can be used to slow the spread of ticks and prevent the transmission of Lyme disease.

2. How Anaplasma Affects Tick Behavior

All ticks, including the black-legged tick, carry multiple disease-causing microbes known as coinfections. One such microbe is Anaplasma phagocytophilum, previously called human granulocytic ehrlichiosis (HGE). When a tick is infected with A. phagocytophilum, it may demonstrate behavioral changes that influence survival, questing, and feeding.

Anaplasma microbe, microscope view

The following three are important points to note from Bellini’s research:

Key Findings

  • A. phagocytophilum-infected black-legged ticks create heat shock proteins in response to stressful environmental circumstances. This makes them more resilient to extremely dry environments and boosts their survivability rates.
  • In the non-infected tick population, cold temperatures can raise the tick mortality rate. But ticks that have been infected with A. phagocytophilum have an advantage — they manufacture an antifreeze glycoprotein that guards them against the cold.
  • A. phagocytophilum is present in the salivary glands of ticks, and it inhibits cellular death to allow for the infection to be transmitted from the tick’s vector to the host, fostering more effective feeding and greater survival.

The Takeaway

The relationship between A. phagocytophilum and tick manipulation is a better-researched interaction than that of other ticks and pathogens. The mechanisms by which A. phagocytophilum alters the behavior of the tick are more apparent in terms of how it augments tick reproduction and survivability. However, when it comes to other species of Anaplasma that may impact humans or animals, more research is needed.

3. How Babesia Affects Tick Behavior

Babesia is a distant cousin of malaria and a less virulent microbe, comparatively. Babesia may occur in up to 40% of people infected with Lyme disease, indicates a report in Trends in Parasitology, making it a relatively common coinfection. The species of Babesia that are most likely to pose a disease risk to humans are Babesia microti, Babesia divergins, and Babesia ducani (WA-1).

Babesia microbe, zoomed view, round

Regarding Benelli’s review, only a few studies have looked at the effects Babesia may have on tick behavior, but he noted the following:

Key Findings

  • B. microti maximized the success of feeding and strengthened the survival of shrew ticks (Ixodes trianguliceps), but these modifications didn’t correlate with the strain’s infection rates.
  • In animal studies, B microti delayed the amount of time it took for a tick to become engorged.
  • Nymph ticks that fed on infected hosts had a higher body weight than those that fed on non-infected ones.
  • Larvae who fed on infected hosts shed their skin more quickly (a process known as molting) than those that fed on non-infected ones.

The Takeaway

At present, the research on Babesia species and their ability to manipulate tick behavior is scant. The processes that encourage feeding, development, and the survival of ticks infected with Babesia have yet to be determined.

4 & 5. How Bartonella and Rickettsia Affect Tick Behavior

Rickettsia microbe, zoomed in microscope view

Although Bartonella, a common coinfection found in people with Lyme, and Rickettsia, a highly virulent and life-threatening microbe, can pose serious health risks to humans, little is known about the behavioral changes these infections may have on tick behavior. A few points worthy of consideration include:

Key Findings

  • Bartonella-infected castor bean ticks had an increase in a component called Ixodes ricinusserine protease inhibitor (IrSPI). This enzyme inhibitor is involved in such biological processes as inflammation, blood clotting, wound healing, constricting blood vessels, and altering hosts’ defense systems.
  • Rickettsia-infected ticks demonstrated a greater inclination towards electromagnetic fields than non-infected ones.

The Takeaway

Like Babesia, the research on Bartonella- and Rickettsia-infected ticks is minimal. However, because annual incidences are on the rise, continued investigation in this area has the potential to bring about crucial information for the benefit of public health.

6. How Tick-Borne Encephalitis Virus Affects Tick Behavior

Tick-borne encephalitis (TBEV) is a viral infection spread through the bite of an infected tick. The virus resides throughout Europe and Asia, according to the CDC, making the infection relatively unknown in the U.S.

Encephalitis microbe, zoomed in microscope view

Between 20% and 30% of people who acquire the infection develop symptoms that affect the nervous system. Evidence for two hypotheses suggest the virus can manipulate tick behavior in the following ways:

Key Findings

  • TBEV intensifies tick movement and the ability to find a host.
    Feeding results in higher concentrations of TBEV.
  • When a TBEV-infected tick is unfed, the concentration of the virus remains low. But when the tick feeds, the TBEV titers raise to reach detectable levels.
  • A percentage (6%) of TBEV-infected adult castor bean ticks can navigate DEET-covered areas with a 1% formulation. In contrast, uninfected ticks were unable to cross these areas.


In general, ticks infected with TBEV demonstrated enhanced tick mobility, including walking speed and duration, and a proclivity toward higher questing heights. These changes may lead to greater outcomes when it comes to tick and microbe survivability.

Putting It All Together

There’s no doubt that’s an incredible amount of information to take it in. But this valuable data sets the stage for the urgent need for ongoing research when it comes to understanding how pathogens affect and modify tick behavior.

There is a wide array of tick species worldwide, and countless disease-causing pathogens that pose a threat to human health. Tracking behavioral changes in infected and non-infected ticks could one day lead to positive, new developments for halting the spread of tick-borne diseases.

In the meantime, your best bet is to practice good tick-prevention strategies like doing regular tick checks when coming in from the outdoors, wearing permethrin-treating shoes and clothing, and promptly removing attached ticks with a pair of fine-pointed tweezers. 


1. Alberdi P, Espinosa PJ, Cabezas-Cruz A, de la Fuente J. Anaplasma phagocytophilum Manipulates Host Cell Apoptosis by Different Mechanisms to Establish Infection. Vet Sci. 2016;3(3):15. Published 2016 Jul 15. doi: 10.3390/vetsci3030015
2. Benelli G. Pathogens Manipulating Tick Behavior-Through a Glass, Darkly. Pathogens. 2020;9(8):E664. Published 2020 Aug 17. doi: 10.3390/pathogens9080664
3. Blisnick AA, Šimo L, Grillon C, et al. The Immunomodulatory Effect of IrSPI, a Tick Salivary Gland Serine Protease Inhibitor Involved in Ixodes ricinus Tick Feeding. Vaccines (Basel). 2019;7(4):148. Published 2019 Oct 12. doi: 10.3390/vaccines7040148
4. Carr AL, Mitchell RD III, Dhammi A, Bissinger BW, Sonenshine DE, Roe RM. Tick Haller’s Organ, a New Paradigm for Arthropod Olfaction: How Ticks Differ from Insects. Int J Mol Sci. 2017;18(7):1563. Published 2017 Jul 18. doi: 10.3390/ijms18071563
5. Dai J, Narasimhan S, Zhang L, Liu L, Wang P, Fikrig E. Tick histamine release factor is critical for Ixodes scapularis engorgement and transmission of the lyme disease agent. PLoS Pathog. 2010;6(11):e1001205. Published 2010 Nov 24. doi: 10.1371/journal.ppat.1001205
6. Lyme and Other Tickborne Diseases Increasing. Centers for Disease Control and Prevention website.,59%2C349%20reported%20cases%20in%202017.
7. Tick-borne encephalitis. Centers for Disease Control and Prevention website.,headache%2C%20nausea%2C%20and%20vomiting
This explains a lot – if only mainstream medicine/research will listen instead of conducting more climate data. It also makes sense.
It is commonly known that parasites affect behavior:

Parasites are a whole new fantastical frontier. I’ll never forget this information on how parasites affect human behavior by Dr. Klinghardt, which I found here:

  • Parasite patients often express the psyche of the parasites – sticky, clingy, impossible to tolerate – but a wonderful human being is behind all of that.

  • We are all a composite of many personalities. Chronic infections outnumber our own cells by 10:1. We are 90% “other” and 10% “us”. Our consciousness is a composite of 90% microbes and 10% us.

  • Our thinking, feeling, creativity, and expression are 90% from the microbes within us. Patients often think, crave, and behave as if they are the parasite.

  • Our thinking is shaded by the microbes thinking through us. The food choices, behavioral choices, and who we like is the thinking of the microbes within us expressing themselves.

  • Patients will reject all treatments that affect the issue that requires treating.

  • Patients will not guide themselves to health when the microbes have taken over.

It only follows that parasites will affect tick behavior as well.

Have You Heard of the Tick-Borne Disease Babesiosis?

deer tick on grass


Babesiosis, a tick-borne infection caused by the parasite Babesia (most commonly, Babesia microti, though there are other species like Babesia duncani and Babesia divergens), is a malaria-like infection of the red blood cells. A 2019 report by the American Academy of Pediatrics states,

“Although cases of tickborne babesiosis have been diagnosed in the U.S. since 1966, this disease only became nationally notifiable in 2011. A report of the first five years of babesiosis surveillance from the Centers for Disease Control and Prevention (CDC) shows an alarming increase in incidence.[i]

In his book Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease, Richard I. Horowitz, M.D. speaks to this alarming prevalence: “Other studies are now showing evidence of a worldwide epidemic of babesiosis: It is now spreading to parts of the United States, Europe, and Asia…the scientific literature has shown that the number of positively diagnosed cases of babesiosis in New York state alone has increased twenty times.”[ii]

While increased Lyme literacy has improved awareness of babesiosis, many people still look at me like I have three heads when I say I have this infection. The name is indeed strange and difficult to pronounce; one of my graduate school professors said, “Can we just call it babelicious? That’s easier.” Whether you refer to it as babesiosis, Babesia, babelicious, or, as my friends have adopted, babs, it’s important that you understand what this illness is, how it is transmitted, what the symptoms are (and what they actually feel like), and what treatment options are available.

Babesia microti as seen in infected red blood cells via microscope

The tiny parasite Babesia is most commonly transmitted by a tick bite—meaning you can get Lyme and babesiosis, as well as other co-infections, all from the same tick. However, you do not have to have Lyme disease to get Babesiosis. Babesia can also be transmitted via blood transfusion or from mother to fetus. It depletes the red blood cells of oxygen, causing patients to experience air hunger, lightheadedness, weakness, shortness of breath, and post-exertional fatigue akin to what marathon runners describe as “hitting a wall”. Other common symptoms include high fever, night-sweats, headaches, chills, and hypoglycemia. Dr. Horowitz writes that babesiosis can also cause “a hemolytic anemia (due to red blood cells breaking down), jaundice, thrombocytopenia (low platelet count), congestive heart failure, and renal failure.”ii

What does it actually feel like to have babesiosis? While every case is different and not all patients experience every symptom, I can share my own 20+ year battle with this infection. After finding a splotchy red rash on my arm in the summer of 1997, the first symptom I experienced was hypoglycemia. After a busy morning teaching water-skiing, swimming, and canoeing at the summer camp where I worked, I collapsed in the dining hall from what I thought was dehydration but was actually low blood sugar. Beyond testing for diabetes, no one thought to look into the cause of my sudden hypoglycemia or to test for tick-borne infections. Instead, I continued to suffer low blood sugar reactions and sudden lightheadedness for years, and learned to always carry a snack with me.

As the tick-borne infections Lyme, babesiosis, and ehrlichiosis ran through my body unchecked over the next eight years, I developed smashing migraines that left me nauseous and crying on the bathroom floor. I now know that my brain was not getting properly oxygenated, causing my extreme pain. I lived in Colorado at the time, so doctors told me I had altitude sickness.

Babesiosis can exacerbate Lyme and other infections; not knowing I had any of them, they all were getting worse, the symptoms overlapping and manifesting more frequently. Flu-like symptoms, coupled with intense bouts of fatigue, came on-and-off for years. Despite being a gym rat and a life-long skier, I could no longer keep up with my friends on the slopes, experiencing low blood sugar, dehydration, and fatigue that would sometimes send me to bed for a day or two afterwards. By the end of my second year in Colorado, I’d developed asthma and needed to use an inhaler.

In 2003, I got mononucleosis that slipped into chronic Epstein-Barr virus—I couldn’t fight it because of the underlying tick-borne diseases—and in 2005 those diseases were finally diagnosed. By that point I was experiencing fevers that could have been associated with any of those illnesses, and occasional nightsweats.

Once I started treatment for babesiosis (along with antibiotics for Lyme and ehrlichiosis), those nightsweats increased, but that was a good sign. It was a form of Jarisch-Herxheimer reaction; my body was sweating out the dead parasites. I often woke in a puddle, my pajamas fully soaked, and sometimes had to change sheets twice a night. At my worst point, I couldn’t ride thirty seconds on a stationary bike without “hitting a wall”.

While Lyme Literate Medical Doctors (LLMDs) have varying opinions about the treatment and prognosis of babesiosis infections, the general consensus I heard at the International Lyme and Associated Diseases Society (ILADS) conference in 2019 was that there is no cure. Some doctors are having great luck, with patients reporting complete eradication of symptoms for both babesiosis and Lyme disease, with the antimicrobial drug Disulfiram (commonly known as Antabuse); however, more research is needed, and the drug has serious side effects. More commonly, doctors use anti-malarial drugs such as Mepron, Malarone, or Coartem to treat babesiosis, often pulsing these treatments over weeks or even months as the patient’s Babesia load decreases. Still others supplement these medications with homeopathic remedies such as artemisinin or cryptolepsis.

This is not a complete list of babesiosis treatments; Dr. Horowitz talks about others in his book, and your LLMD may have other ideas. I have been on different anti-malarial medications, paced at different intervals, and on different homeopathic drops, throughout my journey. Unfortunately, it doesn’t help for me to share my protocol, because it is ever-changing, and because no two cases of tick-borne illness are alike. Here’s what I can tell you for sure: babesiosis symptoms can get better. If you are being treated for Lyme disease and haven’t been tested for babesiosis or other co-infections, you may only be fighting half the battle. Whether you have a known or suspected case of Lyme, it’s critical that you talk to your doctor about other tick-borne diseases, too.


[ii] Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease. Horowitz, Richard I., MD. New York: St. Martin’s Press, 2013 (135, 136).

Related Posts:
Differentiating Between Babesia and COVID-19 Air Hunger
New test for Babesia approved by the FDA
What is Air Hunger, Anyway?
Tainted Transfusions: Why Screening Blood is More Important Than Ever

jennifer crystal_2

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at





Another great example that Lyme is just the “tip of the spear” for many patients and the CDC’s mono therapy of doxycycline will NOT work for many, particularly if you are coinfected and/or have had Lyme for any length of time.

For more on Babesia:

More on Disulfiram:

Human Babesiosis: Recent Advances & Future Challenges

doi: 10.1097/MOH.0000000000000606. Online ahead of print.

Human babesiosis: recent advances and future challenges

Affiliations expand

Purpose of review: As human babesiosis caused by apicomplexan parasites of the Babesia genus is associated with transfusion-transmitted illness and relapsing disease in immunosuppressed populations, it is important to report novel findings relating to parasite biology that may be responsible for such pathology. Blood screening tools recently licensed by the FDA are also described to allow understanding of their impact on keeping the blood supply well tolerated.

Recent findings: Reports of tick-borne cases within new geographical regions such as the Pacific Northwest of the USA, through Eastern Europe and into China are also on the rise. Novel features of the parasite lifecycle that underlie the basis of parasite persistence have recently been characterized. These merit consideration in deployment of both detection, treatment and mitigation tools such as pathogen inactivation technology. The impact of new blood donor screening tests in reducing transfusion transmitted babesiosis is discussed.

Summary: New Babesia species have been identified globally, suggesting that the epidemiology of this disease is rapidly changing, making it clear that human babesiosis is a serious public health concern that requires close monitoring and effective intervention measures. Unlike other erythrocytic parasites, Babesia exploits unconventional lifecycle strategies that permit host cycles of different lengths to ensure survival in hostile environments. With the licensure of new blood screening tests, incidence of transfusion transmission babesiosis has decreased.


Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018

David Ingram; Tonya Crook

Emerging Infectious Diseases. 2020;26(8):1703-1709. 


Babesiosis is an emerging infection in the state of Pennsylvania, and clinicians need to be made aware of its clinical manifestations as well as the risk factors associated with severe disease. Before 2010, our tertiary academic center in central Pennsylvania previously saw zero cases of babesiosis. We saw our first confirmed case of Babesia infection acquired in Pennsylvania in 2011; we recorded 2 confirmed cases in 2017 and 4 confirmed cases in 2018. All 4 cases from 2018 were thought to be acquired in southcentral Pennsylvania counties, whereas prior reports of cases were predominately in the southeast and northeast counties of the state.



Out of 352 patients in the second study, some of which were duplicates, they reviewed patient charts and only identified 8 cases using CDC criteria.  This continues to be a problem as CDC testing misses many cases, and many do not meet the stringent criteria which in many cases is arbitrary.  The study also noted that there were inconsistencies in the way blood smears and PCR testing were ordered.  

Important to note: most were immunocompetent.

Symptoms(numbers in parenthesis show how many patients had it):

  • fever (6/8) 
  • malaise (5/8)
  • myalgias or arthralgias (2/8)
  • anorexia (2/8),
  • rash (1/8),
  • headache (1/8),
  • nausea or vomiting (1/8)
  • diarrhea (1/8)
  • respiratory failure (1/8)

The most common laboratory abnormalities:

  • anemia (seen in all patients)
  • thrombocytopenia (7/8)
  • transaminitis (7/8) – high liver counts can lead to liver damage
  • hyperbilirubinemia (7/8) excess bilirubin can cause jaundice
Importantly: concurrent Lyme disease was noted in half (4/8) of patients.

Patients were screened for Lyme disease by using ELISA; if the result was positive, then a Western blot was performed. Patients had Lyme disease diagnosed if they had positive ELISA results and positive IgM or IgG results on Western blot.

I can guarantee you more patients had Lyme but were omitted due to abysmal testing. This has been going on for over 40 years.

Six of the 8 patients were classified as having severe infection with parasitemia >10%. Four of the 6 patients with severe infection had co-infection with Borrelia burgdorferi (Lyme disease). The 2 nonsevere patients did not have co-infection.

This agrees with previous findings that concurrent infection makes for more severe disease for a longer duration of time:

  • Most (7/8) patients received a combination of azithromycin and atovaquone 
  • 3 received clindamycin and quinine.  Of these 3 patients, 1 patient received clindamycin and quinine alone for the duration of their therapy, and 2 patients were switched to azithromycin and atovaquone because of persistent parasitemia. Two of the patients who received clindamycin and quinine (1 of whom was switched to azithromycin and atovaquone) also required blood or platelet transfusions. Five patients underwent red cell exchange transfusions.
  • Average duration of treatment was 18.1 days. The average duration of parasitemia was 9 days.
  • They only had exact date of clearance for 3 of the 8 patients

The authors admit that due to focusing on specific Babesia-related codes, they probably missed patients that were co-infected.  

Once again they erroneously bring up the climate as a factor in tick expansion (therefore disease expansion).  This has been proven to be a faulty assumption:

They correctly state there is a steady rise in Babesia throughout the U.S.  They also state that the geographic spread could be favored by prior establishment of Lyme disease and that coinfection in mouse reservoirs increases Babesia transmission.

They also rightly maintain:

clinicians must maintain a high index of suspicion in patients with a nonspecific febrile syndrome despite absence of tick bite history or lack of an immunocompromising condition. Evaluation for co-infections, particularly co-infection with B. burgdorferi, should be considered given patients with co-infection appear to have more severe disease.

Herein lies the problem.  Testing for all of this remains abysmal.  Without accurate tests most doctors are just going continue to say, “It’s all in your head.”  And they will continue to get away with it.  

Most mainstream doctors are not even considering coinfection and continue to view this through a myopic tunnel-vision where they believe people are only infected with one pathogen.  






Babesia and Tick-borne Encephalitis Diagnosed in England

Rare tick-borne infections diagnosed in England

PHE calls for people to be tick aware as the first case of a babesiosis is diagnosed in England.
Tick on a leaf

Public Health England (PHE) can confirm the diagnosis of a case of babesiosis and a probable case of tick-borne encephalitis (TBE) in England. This is the first record of a UK-acquired case of babesiosis and the second case of TBE being acquired in the UK.

Babesiosis is caused by a parasite which infects red blood cells whilst TBE is a viral infection that affects the central nervous system. Both are rare infections spread by the bite from an infected tick.

Both patients have been transferred to hospital, where they are receiving appropriate treatment and supportive care.

PHE regularly undertakes work to understand the potential risks of tick-borne infections in England. This year, PHE has surveyed sites in Devon close to where the person with babesiosis lives, collecting and testing hundreds of ticks – all tested negative for the parasite which causes babesiosis.

PHE has tested deer blood samples from Hampshire in areas near to where the person with probable TBE lives and they have shown evidence of likely TBE virus infection, which matches similar results found in 2019.

The risk of babesiosis or TBE for the general public is very low. However, a number of infections can develop following a tick bite, including Lyme disease, and there are things we can all do to reduce our risk of being bitten by ticks while enjoying the outdoors this summer.

It is important to ‘be tick aware’ and take precautions to reduce your risk of being bitten by ticks when enjoying green spaces this summer including:

  • keeping to footpaths and avoiding long grass when out walking
  • wearing appropriate clothing such as a long-sleeved shirt, and trousers tucked into your socks makes it less likely that a tick will bite and attach
  • considering the use of repellents containing DEET
  • making it a habit to carry out a tick check regularly when you’re outdoors and when you get home
  • if you have been bitten by a tick, it should be removed as soon as possible using fine tipped tweezers or a tick removal tool which is sold by many outdoor stores, vets and pharmacies. Grasp the tick as close to the skin as possible and pull upwards slowly and firmly. Once removed, wash your skin with water and soap, and apply an antiseptic cream to the skin around the bite
  • contact your GP promptly if you begin to feel unwell, remembering to tell them you were bitten by a tick or recently spent time outdoors

Dr Katherine Russell, Consultant in the Emerging Infections and Zoonoses team at PHE, said:

It is important to emphasise that cases of babesiosis and TBE in England are rare and the risk of being infected remains very low. Lyme disease remains the most common tick-borne infection in England.

Ticks are most active between spring and autumn, so it is sensible to take some precautions to avoid being bitten when enjoying the outdoors. Seek medical advice if you start to feel unwell after a tick bite.


About babesiosis

Most people with babesiosis will have either no symptoms or mild symptoms of infection; people with weakened immune systems can become very ill and present with flu-like symptoms such as fever, chills, muscle ache, fatigue, and jaundice.

About TBE

Around 2 thirds of people with TBE infections will have no symptoms. For those who develop symptoms, there are often 2 phases. The first is associated with flu-like symptoms such as fever, headache and fatigue. This can then progress to a more serious second phase that involves central nervous system, which can lead to meningitis, encephalitis and paralysis.

If you develop flu-like symptoms after being bitten by a tick, visit your GP.

Go to hospital if you:

  • get a stiff neck and a severe headache
  • get pain when looking at bright lights
  • have a seizure (fit)
  • have a change in behaviour – such as sudden confusion
  • develop weakness or loss of movement in part of the body



Authorities really need to stop saying infection is rare.  Many doctors don’t know what to look for and many cases go undiagnosed, and therefore unreported.  They should just state that it’s been found and refrain from telling people anything about numbers when frankly no one has been keeping track.

And it should be a real heads-up that they do need to start looking for it and recording it when it’s found.

Secondly, Babesia, according to Dr. Horowitz is one of the most tenacious coinfections he deals with and necessitates 9 months to a year of solid treatment.  To say that people with Babesia mostly have no symptoms or mild symptoms is asinine because people bitten by a tick and typically getting Lyme in the process CAUSES a weakened immune system.

We know that those infected with multiple things have more severe illness for a longer duration of time.  Authorities need to quit soft peddling their comments.  

For more:

Cipro Derivatives Show Promise Against Babesia In Vitro

. 2020 Jul 16.

doi: 10.1007/s00436-020-06796-z. Online ahead of print.

Inhibitory effects of novel ciprofloxacin derivatives on the growth of four Babesia species and Theileria equi

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The problems of parasite resistance, as well as the toxic residues to most of the commercially available antipiroplasmic drugs severely weaken their effective, curative, and environmental safe employment. Therefore, it is clear that the development of treatment options for piroplasmosis is vital for improving disease treatment and control. Ciprofloxacin is a broad-spectrum antibiotic that targets mainly the DNA replication machinery by inhibiting DNA gyrase and topoisomerase enzymes. As a result, ciprofloxacin is used for treating several bacterial and parasitic infections.

In this study, the efficacy of 15 novel ciprofloxacin derivatives (NCD) that had been developed against drug-resistant Mycobacterium tuberculosis was evaluated against piroplasm parasite multiplication in vitro. The half-maximal inhibitory concentration (IC50) values of the most effective five compounds of NCD (No. 3, 5, 10, 14, 15) on Babesia bovis, Babesia bigemina, Babesia caballi, and Theileria equi were 32.9, 13.7, 14.9, and 30.9; 14.9, 25.8, 13.6, and 27.5; 34.9, 33.9, 21.1, and 22.3; 26.7, 28.3, 34.5, and 29.1; and 4.7, 26.6, 33.9, and 29.1 μM, respectively. Possible detrimental effects of tested NCD on host cells were assessed using mouse embryonic fibroblast (NIH/3T3) and Madin-Darby bovine kidney (MDBK) cell lines. Tested NCD did not suppress NIH/3T3 and MDBK cell viability, even at the highest concentration used (500 μM).

Combination treatments of the identified most effective compounds of NCD/diminazene aceturate (DA), /atovaquone (AQ), and /clofazimine (CF) showed mainly synergistic and additive effects. The IC50 values of NCD showed that they are promising future candidates against piroplasmosis. Further in vivo trials are required to evaluate the therapeutic potential of NCD.


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