Babesiosis/Lyme disease co-infection

From WikiProjectMed
Jump to navigation Jump to search
Babesiosis/Lyme disease co-infection
Other names: Lyme disease co-infection[1]
  • Top:Babesiosis occurs within Lyme disease endemic areas in U.S.[2]
  • Bottom: Prevalence of babesiosis coinfections[3]
SpecialtyInfectious disease
SymptomsFatigue, headache, sweats, chills, anorexia, emotional lability, nausea(are more severe[4])[5][6][1]
CausesBabesia microti and Borrelia burgdorferi[7]
Diagnostic methodPCR, FISH(Babesiosis)[8]
Serological test(Lyme disease)[9]
TreatmentCo-infection needs simultaneous treatment with medication that target bacterial and parasitic pathogens(without harmful interactions)[10][4]

Babesiosis/Lyme disease co-infection demonstrates that when both infections occur together, symptoms can be more severe and prolonged. Babesiosis can worsen Lyme disease symptoms, making recovery more difficult. Treatment typically involves antibiotics for Lyme disease and anti-malarial drugs for Babesiosis, sometimes requiring a combination approach[4][11]

Globally, co-infection with babesiosis and Lyme disease, transmitted by the same tick species, is relatively common, with studies indicating that a significant percentage of patients with babesiosis also test positive for Lyme disease antibodies[3]

Signs and symptoms

In terms of presentation, they are more severe and prolonged, studies suggest that co-infected individuals often experience more intense symptoms and a longer duration of illness compared to those with Lyme disease alone.As to the presentation we find the following:[3][11][8]

Cause

As to the cause we find that Babesiosis is a parasitic infection; Babesia microti is the most prevalent protozoa that causes the infection[8]

In Lyme disease we find that in the U.S. it is caused by bacterial spirochete Borrelia burgdorferi. While in Eurasia, B burgdorferi, Borrelia afzelii, and Borrelia garinii are predominant[9]

  • Borrelia burgdorferi

    Borrelia burgdorferi

  • Blood smear Babesia microti

    Blood smear Babesia microti

Transmission

Babesiosis and Lyme disease can both be transmitted by the same tick, the black-legged tick(deer tick). These ticks carry multiple pathogens, which can infect the individual with more than one disease in a single bite[12]

Mechanism

Model explains the effect of B. microti and Bo. burgdorferi coinfection[7]

As to the mechanism that may play out in this coinfection we find that the combination of bacterial infection and parasitic infection can place a significant burden on the human immune system. It is possible that the suppression of immune system caused by one of the infections, can make the other infection more severe.[4]

We find in a review by Diuk-Wasser, et al that, "coinfection with B. burgdorferi and B. microti may create an immunological conflict as the adaptive immune response to B. burgdorferi, an extracellular bacterium, hinders the adaptive immune response to B. microti, an obligatory intracellular parasite . This conflict may increase B. microti fitness, resulting in higher parasitemia".[4]

However we also find that a 2019 review by Parveen, et al indicates that, " increased survival of B. burgdorferi in coinfected mice[with B. microti], compared to mice infected with Borrelia alone, enhances inflammatory Lyme arthritis in coinfected mice. Reciprocally, B. burgdorferi infection triggers TLR2-based signaling that increases pro-inflammatory cytokines, and activates macrophages and polymononuclear neutrophils. These innate immune responses diminish B. microti parasitemia in coinfected mice."[7]

Diagnosis

PCR machine

As to the diagnosis involves a combination of clinical evaluation, patient history, and laboratory testing such as:[13][14][2]

Treatment

As to management we find that Babesiosis and Lyme disease co-infections can complicate treatment due to overlapping symptoms, plans to address the specific symptoms and severity of each is important. Monitoring for relapses and adjusting treatment as needed so there are no adverse reactions, as management involves resolving both infections simultaneously[15][10] Treatments are:

  • Babesiosis is often treated with a combination of anti-malarial drugs such as atovaquone and antibiotics(azithromycin). Severe cases may require clindamycin and quinine.[16]
  • Lyme Disease is treated with antibiotics like doxycycline, amoxicillin, or cefuroxime.[17]

Epidemiology

As to the epidemiology of Babesiosis and Lyme disease co-infection, we find it is a common occurrence, particularly in areas where both diseases are endemic. In the United States, serological evidence suggests that about 54 percent of babesiosis patients also test positive for Lyme disease antibodies. Furthermore, a significant portion, about 24 percent, of hospitalizations related to babesiosis also list Lyme disease as co-diagnosis.[3]

Geographic distribution of babesiosis and Lyme disease in U.S.[18]

History

In terms of the history of Babesiosis/Lyme disease co-infection, we find that among the first cases identified where done by Dr Jorge L. Benach, in the 1980's, showed serological evidence for the simultaneous occurance of Lyme disease and babesiosis, hence coinfection.[19]

Notes

1.^ As there are few Pubmed indexed reviews, some sources are a case study

References

  1. ↑ Lacout, Alexis; Thariat, Juliette; Hajjam, Mostafa El; Marcy, Pierre Yves; Perronne, Christian (May 2018). "Lyme disease & co-infections: role of adaptive immune system". Future Microbiology. 13 (6): 613–615. doi:10.2217/fmb-2017-0252. ISSN 1746-0921. PMID 29745726. Archived from the original on 4 February 2025. Retrieved 2 April 2025.
  2. ↑ Kumar, Abhinav; O'Bryan, Jane; Krause, Peter J. (6 November 2021). "The Global Emergence of Human Babesiosis". Pathogens (Basel, Switzerland). 10 (11): 1447. doi:10.3390/pathogens10111447. ISSN 2076-0817. PMC 8623124. PMID 34832603.
  3. ↑ 3.0 3.1 3.2 3.3 Ssentongo, Paddy; Venugopal, Natasha; Zhang, Yue; Chinchilli, Vernon M.; Ba, Djibril M. (October 2024). "Beyond Human Babesiosis: Prevalence and Association of Babesia Coinfection with Mortality in the United States, 2015-2022: A Retrospective Cohort Study". Open Forum Infectious Diseases. 11 (10): ofae504. doi:10.1093/ofid/ofae504. ISSN 2328-8957. PMC 11460071. PMID 39381028.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Diuk-Wasser, Maria A.; Vannier, Edouard; Krause, Peter J. (January 2016). "Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences". Trends in Parasitology. 32 (1): 30–42. doi:10.1016/j.pt.2015.09.008. ISSN 1471-5007. PMC 4713283. PMID 26613664.
  5. ↑ Government of Canada, Public Services and Procurement Canada. "Information archivée dans le Web" (PDF). publications.gc.ca. Retrieved 8 April 2025.
  6. ↑ Bhesania, Siddharth; Arora, Kunwardeep Singh; Tokarski, Michal; Ariff, Madiha; Khan, Fastina; Bhesania, Janki; Haq, Salman A. (August 2021). "A Case of Tick Bite Induced Babesiosis With Lyme Disease". Cureus. 13 (8): e17401. doi:10.7759/cureus.17401. ISSN 2168-8184. PMC 8459803. PMID 34589312.
  7. ↑ 7.0 7.1 7.2 Parveen, Nikhat; Bhanot, Purnima (31 July 2019). "Babesia microti-Borrelia Burgdorferi Coinfection". Pathogens (Basel, Switzerland). 8 (3): 117. doi:10.3390/pathogens8030117. ISSN 2076-0817. PMC 6789475. PMID 31370180.
  8. ↑ 8.0 8.1 8.2 Zimmer, Andrea J.; Simonsen, Kari A. (2025). "Babesiosis". StatPearls. StatPearls Publishing. PMID 28613466. Archived from the original on 2022-12-22. Retrieved 2025-04-08.
  9. ↑ 9.0 9.1 Skar, Gwenn L.; Blum, Marissa A.; Simonsen, Kari A. (2025). "Lyme Disease". StatPearls. StatPearls Publishing. PMID 28613720.
  10. ↑ 10.0 10.1 Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (1 November 2006). "The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1058-4838. PMID 17029130. Archived from the original on 21 May 2019. Retrieved 8 April 2025.
  11. ↑ 11.0 11.1 Feng, Jie; Lin, Tao; Mihalca, Andrei D.; Niu, Qingli; Oosthuizen, Marinda C. (9 February 2023). "Editorial: Coinfections of Lyme disease and other tick-borne diseases". Frontiers in Microbiology. 14. doi:10.3389/fmicb.2023.1140545. ISSN 1664-302X. PMID 36846796.
  12. ↑ Eisen, Rebecca J.; Eisen, Lars (April 2018). "The Blacklegged Tick, Ixodes scapularis: An Increasing Public Health Concern". Trends in Parasitology. 34 (4): 295–309. doi:10.1016/j.pt.2017.12.006. ISSN 1471-5007. PMC 5879012. PMID 29336985.
  13. ↑ Krause, Peter J.; McKay, Kathleen; Thompson, Charles A.; Sikand, Vijay K.; Lentz, Ronald; Lepore, Timothy; Closter, Linda; Christianson, Diane; Telford, Sam R.; Persing, David; Radolf, Justin D.; Spielman, Andrew (1 May 2002). "Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 34 (9): 1184–1191. doi:10.1086/339813. ISSN 1537-6591. PMID 11941544.
  14. ↑ Kwon, Hea Yoon; Im, Jae Hyoung; Park, Yun-Kyu; Durey, Areum; Lee, Jin-Soo; Baek, Ji Hyeon (31 December 2018). "Two Imported Cases of Babesiosis with Complication or Co-Infection with Lyme Disease in Republic of Korea". The Korean Journal of Parasitology. 56 (6): 609–613. doi:10.3347/kjp.2018.56.6.609. ISSN 0023-4001. PMID 30630283.
  15. ↑ Sanchez, Edgar; Vannier, Edouard; Wormser, Gary P.; Hu, Linden T. (26 April 2016). "Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review". JAMA. 315 (16): 1767–1777. doi:10.1001/jama.2016.2884. ISSN 1538-3598. PMC 7758915. PMID 27115378.
  16. ↑ Krause, Peter J.; Auwaerter, Paul G.; Bannuru, Raveendhara R.; Branda, John A.; Falck-Ytter, Yngve T.; Lantos, Paul M.; Lavergne, Valéry; Meissner, H. Cody; Osani, Mikala C.; Rips, Jane Glazer; Sood, Sunil K.; Vannier, Edouard; Vaysbrot, Elizaveta E.; Wormser, Gary P. (27 January 2021). "Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 72 (2): e49–e64. doi:10.1093/cid/ciaa1216. ISSN 1537-6591. PMID 33252652. Archived from the original on 5 April 2025. Retrieved 16 April 2025.
  17. ↑ Wormser, Gary P.; Nadelman, Robert B.; Dattwyler, Raymond J.; Dennis, David T.; Shapiro, Eugene D.; Steere, Allen C.; Rush, Thomas J.; Rahn, Daniel W.; Coyle, Patricia K.; Persing, David H.; Fish, Durland; Luft, Benjamin J. (1 July 2000). "Practice Guidelines for the Treatment of Lyme Disease". Clinical Infectious Diseases. 31 (Supplement_1): S1–S14. doi:10.1086/314053. ISSN 1058-4838. PMID 10982743.
  18. ↑ Knapp, Kristen L.; Rice, Nancy A. (2015). "Human Coinfection with Borrelia burgdorferi and Babesia microti in the United States". Journal of Parasitology Research. 2015: 587131. doi:10.1155/2015/587131. ISSN 2090-0023.
  19. ↑ Benach, Jorge L.; Coleman, James L.; Habicht, Gail S.; MacDonald, Alan; Grunwaldt, Edgar; Giron, Jose A. (1 September 1985). "Serological Evidence for Simultaneous Occurrences of Lyme Disease and Babesiosis". The Journal of Infectious Diseases. 152 (3): 473–477. doi:10.1093/infdis/152.3.473. ISSN 0022-1899. PMID 4031555. Archived from the original on 19 June 2022. Retrieved 15 April 2025.
Retrieved from "https://mdwiki.org/w/index.php?title=Babesiosis/Lyme_disease_co-infection&oldid=1465213"