Treating Babesia and Lyme Disease

Welcome! Today, we're discussing the treatment of Babesia and Lyme disease, focusing on real patient experiences and effective treatment strategies.

I had a patient who remained chronically ill six months after treating for Lyme disease. Despite exhaustive evaluations, she was still symptomatic. Her antibody tests came back positive for Babesia, although her thick smear and PCR were negative. She believed Babesia was asymptomatic since it wasn’t seen in her red blood cells, but she was very symptomatic.

 Babesia is a parasite transmitted by the same deer ticks that carry Lyme disease. Some patients have Babesia parasites visible in their red blood cells under a microscope, usually seen at the onset of the illness for one to two weeks. In some cases, especially in the elderly or immunocompromised, the parasite can persist longer, leading to severe illness requiring intensive care."

 Some Babesia patients don't experience acute, life-threatening illness and might not have visible parasites in blood smears. Instead, positive antibody tests for Babesia, such as IgM and IgG for Babesia microti or Babesia duncani, can indicate the presence of the infection. I've seen positive Babesia duncani tests even on the east coast, suggesting the need for further research.

 I've had patients who, despite negative tests, improved after Babesia treatment. These patients often failed treatments for Lyme disease, Anaplasmosis, Ehrlichia, and Bartonella for months or years, unaware that Babesia could be a co-infection.

 For Babesia treatment, I avoid quinine and clindamycin due to their higher rate of side effects. Instead, I recommend atovaquone combined with azithromycin, which is more tolerable. Atovaquone is marketed as Malarone and Mepron in the USA. Malarone is a pill, while Mepron is a thick yellow liquid. Malarone is generally less expensive and more convenient.

 Malarone also comes in a pediatric dose, making it easier to tolerate for patients with an upset stomach or those concerned about a Herxheimer reaction. I usually prescribe 30 days of atovaquone, longer than the 10 days suggested by some studies, as my patients often aren't treated at the onset of their Babesia infection."

 I combine atovaquone with azithromycin and discuss the risks of azithromycin versus untreated Babesia. If necessary, I consult a cardiologist to rule out prolonged QT interval and treat for the same duration as atovaquone."

 If a patient can't take azithromycin or if there's a possibility of co-infection with Anaplasmosis or Ehrlichia, I may substitute doxycycline. For patients failing atovaquone with azithromycin, tafenoquine (Arakoda) has been introduced as an alternative. Although it's currently difficult to obtain, it has shown some success in persistent Babesia cases."

 Atovaquone is often covered by prescription plans, and services like GoodRx can reduce the cost to less than $80 in some communities. This makes it a viable option for many patients.

 Conclusion

 Treating Babesia is often overlooked in patients with recurrent or prolonged illnesses. With ongoing research and new treatments, there's hope for better management and outcomes for patients with Babesia and Lyme disease. Thanks for watching, and stay tuned for more insights on managing tick-borne diseases."