Archive for the ‘Babesia’ Category

Detection of Anaplasma phagocytophilum, Babesia odocoilei, Babesia sp., Borrelia burgdorferi Sensu Lato, and Hepatozoon canis in Ixodes scapularis Ticks Collected in Eastern Canada

Scott et al. 2021, 5 pathogens-1

Detection of Anaplasma phagocytophilum, Babesia odocoilei, Babesia sp., Borrelia burgdorferi Sensu Lato, and Hepatozoon canis in Ixodes scapularis Ticks Collected in Eastern Canada

John D. Scott 1,* and Risa R. Pesapane 2,3
Received: 27 August 2021
Accepted: 21 September 2021
Published: 1 October 2021


Tick-borne pathogens cause infectious diseases that inflict much societal and financial hardship worldwide. Blacklegged ticks, Ixodes scapularis, are primary vectors of several epizootic and
zoonotic pathogens. The aim sets forth the pathogens and their prevalence. In Ontario and Quebec,
113 I. scapularis ticks were collected from songbirds, mammals, including humans, and by flagging.
PCR and DNA sequencing detected five different microorganisms:

  • Anaplasma phagocytophilum,1 (0.9%)
  • Babesia odocoilei, 17 (15.3%)
  • Babesia microti-like sp., 1 (0.9%)
  • Borrelia burgdorferi sensu lato (Bbsl), 29 (26.1%)
  • Hepatozoon canis, 1 (0.9%)

Five coinfections of Bbsl and Babesia odocoilei occurred. Notably, H. canis was documented for the first time in Canada and, at the same time, demonstrates the first transstadial passage of H. canis in I. scapularis. Transstadial passage of Bbsl and B. odocoilei was also witnessed. A novel undescribed piroplasm (Babesia microti-like) was detected. An established population of I. scapularis ticks was detected at Ste-Anne-de-Bellevue, Quebec. Because songbirds widely disperse I. scapularis larvae and nymphs, exposure in an endemic area is not required to contract tick-borne zoonoses. Based on the diversity of zoonotic pathogens in I. scapularis ticks, clinicians need to be aware that people who are bitten by I. scapularis ticks may require select antimicrobial regimens.

Single Tick Bite Leads to 3 Diseases in Elderly Woman

Single tick bite leads to 3 diseases in elderly woman

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

In their article “Triple Tick Attack,” doctors describe the case of a 74-year-old woman living in Connecticut who developed three tick-borne diseases as the result of a single tick bite. While Lyme disease is the most common tick-borne illness, ticks can transmit other bacterium, causing various “co-infections,” which can be difficult to diagnose.

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 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.”

The Case of An Untreated Babesia Infection

The case of an untreated Babesia infection

Woman with untreated Babesia infection holding her head.

Babesia can be a severe and life-threatening tick-borne illness. In a recent article, Dr. Gary Wormser described a 61-year-old female with an untreated Babesia microti infection.¹ The woman’s IgM test for Lyme disease was positive, but it was dismissed as a false positive test.

In his article, Wormser discusses the case of a 61-year-old woman who went untreated for a Babesia infection, despite positive test results. The patient, who lives in Westchester, NY, a highly endemic area for Lyme disease, reportedly removed an unidentified tick from her left wrist at the end of March 2020, wrote Wormser.

In June, she developed intermittent fevers, joint pain, anorexia, and fatigue and was evaluated at the Lyme Disease Diagnostic Center (LDDC) in New York State.

Unfortunately, the patient did not have an erythema migrans rash. And, as a result was not treated for a tick-borne infection.

On July 30, 2020, the woman tested positive by PCR for Babesia but was not treated.

Two weeks later, she had a positive Lyme disease EIA and one IgM Western blot band. But she was still not treated for either Lyme disease or Babesia.

On August 26, 2020, her Lyme disease tests were positive by the CDC’s two-tier diagnostic criteria. She had a positive EIA and positive IgM Western blot test. Still, she was not treated for either Lyme disease or Babesia.

On December 11, 2020, the woman’s PCR test for Babesia and IgM Western blot test for Lyme disease were negative.  Her Lyme EIA remained positive.

I. scapularis ticks recovered from the environment that are infected with B. microti may be co-infected with B. burgdorferi.

The woman never developed more than two IgM Western blot bands for Lyme disease. And she never exhibited an erythema migrans (or Bull’s-eye) rash. If she had, it would have allowed Dr. Wormser to make the diagnosis of Lyme disease in a patient with Babesia.

As he states, “Diagnosing Lyme disease co-infection in patients with active babesiosis, as in patients with human granulocytic anaplasmosis, is more convincingly accomplished if objective clinical features of Lyme disease are present, such as an erythema migrans skin lesion.”

The woman’s fever resolved without treatment. But Dr. Wormser did not state whether the patient’s joint pains, anorexia, or fatigue had resolved. Neither did Dr. Wormser report whether there were any long-term sequelae from an untreated tick-borne illness.

Editor’s perspective:

I would have been uncomfortable leaving the woman untreated particularly since she had evidence of at least one tick-borne infection – Babesia.

  1. Wormser GP. Documentation of a false positive Lyme disease serologic test in a patient with untreated Babesia microti infection carries implications for accurately determining the frequency of Lyme disease coinfections. Diagn Microbiol Infect Dis. May 16 2021;101(1):115429. doi:10.1016/j.diagmicrobio.2021.115429


I’m too angry to comment.  Wormser needs to retire.

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A Tick Bite at Age 6, Followed by More Than 40 Years of Health Problems

A tick bite at age 6, followed by more than 40 years of health problems

Marta Edmisten gave the following as public comments at the August 26 meeting of the federal Tick-Borne Disease Working Group.

Good morning, my name is Marta Edmisten. I am here today to talk about the impact tick-borne disease has had on me.

I had my first known tick bite around age 6, in 1980. I found a bump behind my right earlobe. I vividly remember my mom dropping the wriggling tick into a medicine dosing cup full of rubbing alcohol, which immediately turned red.

That was two years before Borrelia burgdorferi was officially identified and even more years before testing was available.

I am now 47 and currently live with two strains of babesiosis, two strains of Bartonella, active Lyme disease, as well as tick-borne relapsing fever.

My testing is recent and not “borderline.” This is after over five years of treatment. I am here to tell everyone that the adage that tick-borne disease is hard to get and easy to get rid of is simply not true for so many of us.

Within a year of my first tick bite, I developed endocrine issues so worrisome that I was followed by the head of endocrinology at DC’s Children’s Hospital for fourteen months. No cause was ever discovered.

Problems in school

By age 8, I suddenly developed attention and reading issues after having flawless testing results in kindergarten. I also struggled with a sudden onset of allergies and asthma. My joints would swell out of nowhere and ache. I was screened for juvenile rheumatoid arthritis. The results were negative.

By middle school I suffered from anxiety, depression, depersonalization, suicidal ideation, insomnia, memory issues, and confusion.

I was officially diagnosed with ADHD and dyslexia after getting less that 400 on the SATs. My GPA at the time was stellar. I worked really hard.

I got my second known tick bite in Rhode Island while I was in college. I had a bull’s-eye rash all over my neck. I was told it was a spider bite and sent home.

I was diagnosed with  SMI—serious mental illness—soon thereafter. For over two decades, I saw preeminent psychiatrists in Boston and New York City. I took all the pills–nothing worked. I was hospitalized multiple times. I voluntarily underwent electroconvulsive therapy (ECT) treatments.

By the time I was 36, my arms and legs often twitched uncontrollably and soon fatigue and pain made running my successful business impossible. At 40, my vision was so poor I was unable to read, walking was impossible, and I became incontinent. Multiple autoimmune diseases were suspected. I was finally tested for Lyme disease and co-infections in 2016. I started treatment soon thereafter.

I am no longer on psychiatric medications, just things to help me sleep. Physically, I am better, but I’m still extremely disabled. Just last fall, I spent months not recognizing my home or remembering that my closest friend had passed away over a year earlier.

I look perfectly normal — as long as I am seated. I live with extreme mobility issues, drenching sweats, intermittent fevers, neuropathy, immune dysfunction, pain that often makes sleep impossible, and cognitive issues that make my dream of becoming a social worker out of reach at this time. There are so many people with my story.  Please believe us.  Please help us.

Marta Edmisten lives in Maryland.


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The Added Battle For Lyme Patients: Coinfections

The Added Battle for Lyme Patients: Co-infections

Holtorf Medical Group

Lyme disease is slowly gaining the recognition it deserves as a complex and serious illness that can cause severe health problems if not treated early and properly.

Learn more about Lyme disease and its symptoms here

However, it is important to note that oftentimes Lyme disease patients are not just fighting the Lyme bacteria, but also other co-infections. More specifically, part of the complication with Lyme disease is that, when bitten by a tick, people can be exposed to other pathogens that also carry illnesses. These are called co-infections. A survey of chronic Lyme-infected individuals found:

  • 50% had at least one co-infection
  • while almost 30% had at least two

So, if you have Lyme disease, there is a chance some of your symptoms may be due to a co-infection.

Below we outline two of the most common Lyme co-infections, their respective symptoms, and how to receive a proper diagnosis:


First reported in 1990, bartonellosis is caused by an infection of Bartonella bacteria. These harmful bacteria are capable of infecting a wide array of organisms.

Bartonella bacteria are most commonly spread by fleas, ticks, and lice. There are several different types of this bacteria. For instance, sand flies in South America carry one strain of Bartonella while human body lice, globally, carry another. Today, scientists have detected 29 different strains of this bacteria with approximately 15 that are capable of causing bartonellosis in humans.

Once Bartonella has infected the body, they primarily occupy the inside lining of blood vessels, specifically, red blood cells, macrophages, and endothelial cells. Until recently, it was believed that cases of bartonellosis tended to be mild, acute, and had little risk of contributing to further disruption. However, doctors have started finding that Bartonella may result in chronic infection.

Depending on the strain of Bartonella, symptoms may vary slightly. Bartonella henselae causes “cat scratch disease” and is associated with a bump or blister at the point of infection, swollen lymph nodes, fatigue, headaches, fever, and body aches.

Carrion’s disease (Bartonella bacilliformis) is linked to miliary lesions that ulcerate or bleed, fever, joint pain, and liver and spleen enlargement.

Bartonella quintana’s trench fever causes a fever, rash, bone pain (predominantly in the shins, neck, and back), enlarged lymph nodes, encephalitis, and eye infections.

As Bartonellosis commonly affects the skin, a streak-like rash is perhaps the most indicator of this infection. Other indicators of the condition include: tremors, neurological issues, blurred vision, numbness in the extremities, and psychiatric manifestations.

When Bartonella is attacking an immune system weakened by Lyme, it is possible to develop a more severe manifestation of bartonellosis. Bartonellosis can lead to endocarditis (heart infection) and bacillary angiomatosis (tumor-like masses caused by an infection in blood vessels).

Because bartonellosis can affect multiple bodily systems, it is often misdiagnosed or dismissed by standard practitioners. Proper diagnosis of Bartonella can be conducted through a variety of testing measures including Western Blot, IFAs (Indirect Immunofluorescent Assay), and others.


Babesia is a parasite similar to malaria. Both fall into the category of piroplasm, which are organisms that infect red blood cells. Infection of babesia is called babesiosis and is the most common Lyme co-infection as well as the most common piroplasm infection among humans.

The first Babesia species was discovered in 1888 by Hungarian pathologist, Victor Babes. Since then, over 100 distinct strains of Babesia have been identified, but only a few are considered human pathogens. In fact, babesiosis has long been recognized as a disease of cattle and other animals but the first human case was not documented until 1957. A young Croatian farmer was infected with Babesia and died shortly after of kidney failure. By the 1960s, babesiosis cases were documented in North America, and the bacteria is recognized as a serious and potentially harmful human pathogen.

The strain of Babesia that most often affects humans is Babesia microti. Like Lyme, babesia may be transferred via tick. However, it can also be transmitted from mother to unborn child through the transfusion of contaminated blood. This quality makes babesia an exceptionally sinister threat.

Symptoms of babesiosis share several similarities with Lyme. However, it may be distinguished with an initial high fever and chills. Progression of the infection brings with it symptoms including fatigue, headache, sweating, muscle aches, chest and hip pain, and shortness of breath, or air hunger. Fortunately, symptoms of babesiosis tend to be mild and non-life-threatening. However, the mildness of the symptoms also means that the condition is often overlooked until symptoms become more severe.

Because Babesia targets red blood cells, babesiosis is often linked to a condition called hemolytic anemia. Hemolytic anemia is characterized by red blood cells dying at a faster rate than the body can produce new ones. Symptoms include: confusion, dark-colored urine, rapid heart rate, heart murmur, dizziness, fatigue, pale skin, jaundice, and swelling of the spleen and liver.

Unfortunately, when babesia goes untreated, it can lead to more severe complications, especially for immunocompromised individuals.

Because symptoms of babesiosis are largely non-specific, especially early on, it is easily missed by standard practitioners. A blood test is required to check for signs of a Babesia infection. It is also important to check if there are other conditions present with babesiosis such as Lyme disease for optimal treatment.

Final Thought

Patients treated at Holtorf Medical Group have seen an average of 7.2 different physicians prior to their visit to our center, without experiencing significant improvement.

At Holtorf Medical Group, our physicians are trained to utilize cutting-edge testing and innovative treatments to uncover the root cause of your symptoms and treat the source. If you are experiencing symptoms of Lyme disease, a co-infection, or if you have been previously diagnosed, but aren’t getting the treatment you need, call us at 877-508-1177 to see how we can help you!


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