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Babesiasis is usually transmitted by tick bites although there is some non-tick transmission. This is one of the illness that can still be transmitted by transfusion from people who are infected babesiasis, babesia. It is transmitted by the same tick that transmits Lyme and Ehrlichia, so you can have a triple infection with Babesia, Ehrlichia and Lyme. There is some suggestion that the ongoing fatigue in people with Lyme disease may be due to co-infection with Babesia. Most cases occur in the summer and in the Northeastern United States. One of the areas that was initially described was in Martha's Vineyard off of Massachusetts.

The clinical presentation of babesiasis is that symptoms usually occur a week after the bite, people don't recall the bite and again, it is a flu-like syndrome, but this is a flu-like syndrome like malaria. People have fevers, sweats, myalgias and headache. It can be mild and asymptomatic, but it also can lead to renal failure and death. This is one of the diseases that is more severe.

The diagnosis is made by demonstrating the organism in peripheral blood smear. This can look like malaria when you look at it on a blood smear. It tends to be low parasitemia, so you don't see many of them. There are serologies for babesia, but titers can persist for months, so if you have an isolated serology, it may reflect past infection and as I mentioned, co-infection.

Lyme can occur in up to twenty percent of individuals, so in someone with Lyme disease with persistent symptoms or an unusual presentation, this is one of the things you think about.

Treatment is not incredibly well worked out for this disease, but in general the recommendations are quinine plus clindamycin. These are both anti-protozoal agents which will kill the organism. You generally treat for seven days and similar to Lyme disease, symptoms here can persist for months after treatment and it doesn't mean that you need to re-treat them, it just means that you need to follow them over time and tell them that the symptoms may persist. In splenectomized patients with severe disease, exchange transfusion has been used to get rid of and basically lower the level of parasitemia.

I wanted to mention something about tick paralysis. Again, there can be a very dramatic recovery from what appears to catastrophic illness. Tick paralysis is due to a neurotoxin that is produced in the saliva of a tick. Symptoms can occur within two to seven days of exposure. Most cases from the United States have been reported from the Pacific Northwest, but they can occur anywhere in the United States. The typical mimic here is Guillain-Barre. This is someone who presents with a symmetric