Title : Dual tick-borne infection: Severe babesiosis and Lyme coinfection complicated by multisystem organ dysfunction
Abstract:
Objective: To present a 72-year-old gentleman with severe Babesiosis and Lyme disease co-infection complicated by multisystem organ failure.
Background:Babesiosis is a rare parasitic disease transmitted by ticks that affects red blood cells and can cause serious illness in older adults. Concurrent infection with Borrelia burgdorferi (Lyme disease) may accelerate clinical deterioration and complicate treatment.
Design/Methods:The author carefully reviewed the patient’s medical records. The patient was interviewed, examined, and assessed.
Results:A previously healthy 72-year-old gentleman with prior Lyme disease presented with rapidly worsening fatigue, jaundice, fever, and recent tick exposure after working in a Maine forest. His initial lab work showed pancytopenia (WBC 4.1 K/µL, RBC 2.5 million/µL, Hgb 8 g/dL, Hct 23.8%, Plt 91 K/µL), acute kidney injury (Cr 9.66 mg/dL, BUN 119 mg/dL, eGFR <15 mL/min/1.73 m²), transaminitis (AST 437 U/L, ALT 381 U/L), cholestatic injury (ALP 426 U/L), hyperbilirubinemia (Tbili 8.9 mg/dL), and hemolysis (LDH 1887 U/L, Haptoglobin <10 mg/dL). Peripheral blood smear revealed microcytosis, anisocytosis, echinocytes, and vacuolated neutrophils, indicating hemolytic anemia secondary to Babesiosis. Blood parasite microscopy confirmed Babesia microti with a 1.6% parasitemia and characteristic Maltese cross tetrads. Lyme serologies revealed positive IgM bands on Western blot, consistent with acute Borrelia burgdorferi co-infection. First-line oral atovaquone and azithromycin antimicrobials for Babesiosis were initiated, along with oral doxycycline for Lyme disease. However, there was no clinical improvement on this antimicrobial regimen. His condition worsened with hemolysis and renal failure, necessitating tunneled catheter placement, hemodialysis, and exchange transfusion with five units of pRBCs. Due to persistent parasitemia and multisystem organ decline, antimicrobial therapy was escalated to second-line treatment per IDSA guidelines with IV clindamycin and oral quinine. His electrolyte imbalance, renal function, liver function tests, and bilirubin levels continued to improve with escalated antimicrobial and supportive care. Over the next few days, his blood parasite levels dropped to less than 1%. The patient clinically improved, showing no significant weakness and resolving jaundice. After stabilization, he received an additional ten days of step-down atovaquone and azithromycin upon discharge. Continued follow-up with infectious disease, hematology, and nephrology was scheduled, along with outpatient hemodialysis.
Discussion:This case illustrates that Babesiosis and Lyme co-infection can cause severe fulminant multisystem organ dysfunction and clinical decline in older adults. Prompt history-taking, awareness of tick-infested geographies, exchange transfusion, hemodialysis, rapid supportive care, and escalation of Babesiosis treatment from first-line atovaquone and azithromycin to second-line clindamycin and quinine were essential for the patient’s recovery.
Conclusion:Severe Babesiosis with concurrent Lyme infection is rare in the medical literature. This combination can present with life-threatening complications in older adults. Coordinated multidisciplinary management and timely escalation of antimicrobial and adjunct therapy are key to improving clinical outcomes.
