Avid hiker ends up with babesiosis

Dear Dr. Roach: I am an avid hiker, and I live in an area with lots of Lyme disease. I recently developed some fever, headache, shaking chills and dark urine, and just felt awful. My doctor did some blood tests and said I had Babesia and/or Anaplasma. Are these related to Lyme disease? — I.J.M.

Like Lyme disease, babesiosis and anaplasmosis can be spread by the bite of the deer tick, Ixodes scapularis, but neither bacteria species are related to Borrelia burgdorferi, the cause of Lyme disease. These diseases are not wellknown by most people, nor even by many general doctors outside the areas where they are common.

Babesiosis causes fever as high as 105.6 F, fatigue and feeling unwell. Dark urine is occasionally present. There are nonspecific lab findings, such as anemia and low platelet counts, but the diagnosis is confirmed by seeing the bacteria inside the red blood cells or by sophisticated blood testing (PCR). Treatment is with azithromycin and atovaquone.

Anaplasmosis has a generally lower fever, muscle aches, headache, chills and the same feeling of being unwell. Blood counts frequently show low white blood cell counts. The diagnosis is made by antibody or PCR testing, but treatment is usually started in the appropriate setting even before positive results. Treatment is with doxycycline.

Tickborne diseases may exist at the same time, so consideration must be given to people having both anaplasmosis and babesiosis, with or without Lyme disease. Doxycycline treatment for anaplasmosis also treats early Lyme disease, but does not treat babesiosis.

Both anaplasmosis and babesiosis can be very severe in people with immune system disease, such as HIV or an organ transplant. Older people are also at higher risk for severe disease.