Babesiosis: Causes, Symptoms & Treatment

Babesiosis is the name for an infectious disease that occurs worldwide. It is caused by babesia, which is a parasite.

What is babesiosis?

Babesiosis is a relatively rare infectious disease that occurs throughout the world. It is transmitted by ticks, through which the actual causative agents, babesia, enter the body of humans or animals. These intracellular small parasites, which belong to the genus Babesia, infect the red blood cells (erythrocytes) of affected individuals. The name babesiosis is derived from Romanian-born pathologist Victor Babes (1854-1926), who first described babesia in 1888 when it caused hemoglobinuria in Romanian cattle. The infection resulted in tens of thousands of dead cattle. In 1889, the genus Babesia bigemina was identified by the American pathologist Theobald Smith (1859-1934) as the causative agent of the cattle disease Texas fever. He later found that the protozoan was transmitted by ticks. It took until 1956 for the first human case of Babesia to be recorded, and in that year a patient died in Yugoslavia who had no spleen left and suffered from an infection with a fulminant course. Since further cases of Babesia were repeated in people who no longer had a spleen, doctors initially assumed that only such patients were at risk of contracting the disease. While the Babesia divergens genus is primarily responsible for illnesses on the European continent, in the USA infections are mostly caused by Babesia microti. Overall, babesiosis is a rare disease. It is considered particularly dangerous for people who suffer from immunodeficiencies such as AIDS or who have undergone splenectomy. Because the course and symptoms of babesiosis resemble malaria, the disease is also called malaria’s little sister.

Causes

Babesiosis is caused by babesia, which are single-celled spore animals. The parasites are transmitted to humans by ticks belonging to the genus Ixodes, such as the common wood tick (Ixodes ricinus). This species of tick is particularly widespread in Central Europe. In some cases, however, the transmission of babesia also took place through blood transfusions. These were infected with the babesia. Thus, there is a risk that people who suffered from babesiosis still carry the pathogen via a blood donation even after their disease has been cured and pass it on to other people in this way. For several decades, doctors erroneously assumed that babesiosis could only break out in people who had their spleens surgically removed. Therefore, people without a spleen were considered more susceptible to infection. However, over the years, infections have shown up in people who still had a spleen. Normally, however, there is resistance to Babesia when the spleen is still present. Just like the pathogens that cause malaria, babesia belong to the protozoa. They infect the red blood cells in the human organism, causing hemolysis, the severity of which depends on the density of the parasites. Babesia can reproduce asexually within the erythrocytes. However, only duplications occur in this process.

Symptoms, complaints, and signs

The symptoms that occur in babesiosis have similarities with the symptoms of malaria. Thus, they last for a certain period of time, then slowly recede and reappear later. The incubation period of babesiosis is between one and four weeks. Typical first signs are loss of appetite, fatigue, nausea, malaise and loss of weight. After a few days, patients suffer from continuously increasing high fever, severe sweating, chills, intense headache and aching limbs. Jaundice, severe anemia, and even kidney failure are also possible.

Diagnosis and course

The diagnosis of babesiosis takes place through the detection of the pathogens. For this purpose, the physician takes a blood smear from the patient, which is then examined microscopically. Babesia can be visualized within the infected red blood cells. Due to the high number of pathogens, the diagnosis is not considered difficult. As an alternative, cultivation of the parasites is also possible.This method can be used to detect infections that often remain undetected in the blood smear due to an insufficient pathogen density. Due to the low number of cases in humans, an exact prediction of the course of babesiosis is not possible. Thus, no systematic studies could be performed so far. Severe or even fatal courses are rarely seen and predominantly affect people whose immune system is weakened.

Complications

The complications of babesiosis are similar to the symptoms of malaria disease. Here, in the worst case, the patient may also die if the disease is not treated. Therefore, in the case of babesiosis, immediate medical treatment is necessary to prevent secondary damage and serious complications. In most cases, the transmission of babesiosis is followed by a very high fever. The temperature of the patient can reach up to 42 degrees Celsius and thus rises to a life-threatening state. In addition to the high fever, there is a loss of appetite, fatigue, diarrhea and headache. Often there is also a severe weight loss, which has a generally negative effect on the health of the body. In addition to these symptoms, there is also inflammation of the skin, which can be painful and spread throughout the body. In the process, limbs become paralyzed, so that the patient is severely limited and in many cases can no longer move. Antibiotics are used in the treatment. These do not cause any further discomfort and in most cases the treatment proceeds without complications.

When should you go to the doctor?

Affected persons with babesiosis should go to the doctor immediately. A medical clarification is recommended here already at the first signs of the infectious disease. Who suffers, for example, from loss of appetite, nausea or an unexplained weight loss, should discuss these complaints with the family doctor. Fever symptoms that appear after a few days indicate an infection that needs to be treated. An immediate visit to the doctor is necessary if severe symptoms such as jaundice, anemia or kidney failure occur. Depending on the severity of the symptoms, an emergency physician may need to be alerted. Although the disease is rarely fatal, secondary symptoms can only be prevented by rapid treatment. People who suffer from the above symptoms after a tick bite should also see a doctor. Babesiosis is usually transmitted by ticks and other parasites. Therefore, if the symptoms occur shortly after a walk in the countryside or contact with animals, it is possibly babesiosis. A doctor must diagnose the disease and, if necessary, initiate treatment directly.

Treatment and therapy

In the early years, treatment of babesiosis took place with common anti-malarial drugs. However, because these were unsuccessful, they were no longer used. Later, a combination of cindamycin and quinine was tried with success, which significantly reduced the number of pathogens. However, more recent studies showed ineffectiveness of quinine against Babesia divergens. Medications for babesiosis are taken for seven days, with close monitoring by the physician. However, even after treatment, the patient may continue to suffer from symptoms such as mild fever, fatigue, and malaise for several weeks or months. If the number of babesia in the blood is high or if immunodeficiency is present, an exchange transfusion is recommended.

Outlook and prognosis

The prognosis of babesiosis depends on the patient’s health status, the time of diagnosis, and the earliest possible start of treatment. Without medical treatment, the pathogens continuously spread throughout the body. They weaken the organism inexorably and trigger various complaints. The risk of organ failure or fatal disease progression increases. In severe cases, kidney failure or immune system breakdown occurs. In both cases, the risk of death is very high. With medical treatment, there is usually relief of symptoms within a few days or weeks. The after-effects of the disease may be present for several months. The patient usually recovers slowly until freedom from symptoms subsequently occurs. During the recovery period, the patient must take sufficient care to avoid overexertion or new illnesses.He risks a relapse and a prolongation of the healing process. The prospects of a cure worsen overall for people with pre-existing conditions and a weakened organism. If there is drug intolerance, the healing process is also significantly prolonged. The alternative agents are less efficient, which leads to a delay in recovery. To improve the outlook, a healthy lifestyle helps. Sufficient sleep, the use of relaxation techniques and the avoidance of harmful substances are considered particularly supportive.

Prevention

The best preventive measure against babesiosis is considered to be protection against tick infestation. Thus, tick bites usually cause the infection.

Aftercare

After treatment of babesiosis, regular follow-up care is important. The ill person must visit the family doctor every two to four weeks in the first weeks after the end of therapy. The physician can monitor the healing process by taking a medical history and drawing blood if necessary. If the progress is positive, the rotation of medical examinations can be reduced. After three months, follow-up care is no longer necessary, provided the babesiosis resolves without further complications. Nevertheless, even in the first months after the end of treatment, the family doctor should be consulted for routine examinations. Especially in cases of severe disease, which is often associated with permanent skin and organ damage, a comprehensive physical examination must take place every two months. Babesiosis requires prolonged antibiotic therapy. During follow-up, the prescribed medication must be slowly phased out. Provided that there are no complications and the babesiosis has completely resolved, follow-up care lasts between one and three months. The patient should consult with the doctor during the therapy and arrange the necessary control appointments early. Babesiosis can occasionally lead to permanent skin changes. To avoid effects on the psychological condition, accompanying therapeutic counseling is recommended.

What you can do yourself

Babesiosis in humans is mainly treated with antibiotics. Accompanying relaxation, drinking plenty of fluids and getting enough sleep are recommended. In the early stages, the disease can be well treated by physical rest and the administration of medicines. Some medicinal plants from nature help against headache and muscle pain. For example, the antiseptic angelica, which is best used directly after the infection, or the decongestant St. John’s wort, which can be used in the later stages, have proven effective. The use of alternative remedies should always be discussed with the responsible physician. Used responsibly, rosemary, juniper and lavender can also help to quickly relieve symptoms. However, mild fever, nausea and fatigue may continue for weeks or months after treatment. Effective antidotes are exercise, a healthy diet, and regular checkups with a doctor. During the medical consultation, not only are the risks of babesiosis explained. The doctor can usually also provide practical precautionary tips against insect bites. If babesiosis occurs in conjunction with Lyme disease, further consultations are sometimes useful. In case of severe physical or mental discomfort, participation in self-help groups is recommended.