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Diseases

Babesiosis

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

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Key Highlights
  • Babesiosis is transmitted to humans through the blood meal of Ixodes ticks, the same vector as for Lyme disease and human granulocytic anaplasmosis. 

  • Peak transmission occurs from May to September in the upper midwestern and northeastern US. The disease is rare in other countries.

  • Transfusion-related transmission is emerging as an important secondary mode of transmission; therefore, transmission can occur anywhere and at any time of year.

  • Usually asymptomatic or presents as a mild viral-type illness in young and healthy people. May cause more serious disease or be fatal in asplenic or immunocompromised patients and in older people.

  • Diagnosis is made by visualization of parasites on a peripheral blood smear or by molecular testing.

Thin blood smear, Babesia microti, with triad form in center
Thin blood smear, Babesia microti, with triad form in center
From the collection of Sarah Hochman, Albert Einstein College of Medicine; used with permission

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

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        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Thin blood smear, Babesia microti, with ring forms

            Thin blood smear, Babesia microti, with ring forms

          • Thin blood smear, Babesia microti, with triad form in center

            Thin blood smear, Babesia microti, with triad form in center

          Citations

            Key Articles

            • Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers, sixth edition. Aug 2022 [internet publication].[Full Text]

            • Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis. Clin Infect Dis. 2021 Jan 27;72(2):e49-64.[Abstract][Full Text]

            Other Online Resources

            • CDC: tickborne disease surveillance data summary​
            • ​CDC: tick bite guide
            • CDC: about babesiosis
            • ​CDC: what to do after a tick bite
            • National Organization for Rare Disorders (NORD): babesiosis

            Referenced Articles

            • 1. Vannier E, Krause PJ. Human babesiosis. N Engl J Med. 2012 Jun 21;366(25):2397-407.[Abstract]

            • 2. Hunfeld KP, Hildebrandt A, Gray JS. Babesiosis: recent insights into an ancient disease. Int J Parasitol. 2008 Sep;38(11):1219-37.[Abstract]

            • 3. Häselbarth K, Tenter AM, Brade V, et al. First case of human babesiosis in Germany: clinical presentation and molecular characterisation of the pathogen. Int J Med Microbiol. 2007 Jun;297(3):197-204.[Abstract]

            • 4. Conrad PA, Kjemtrup AM, Carreno RA, et al. Description of Babesia duncani n.sp. (Apicomplexa: Babesiidae) from humans and its differentiation from other piroplasms. Int J Parasitol. 2006 Jun;36(7):779-89.[Abstract]

            • 5. Hatcher JC, Greenberg PD, Antique J, et al. Severe babesiosis in Long Island: review of 34 cases and their complications. Clin Infect Dis. 2001 Apr 15;32(8):1117-25.[Abstract]

            • 6. Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers, sixth edition. Aug 2022 [internet publication].[Full Text]

            • 7. Dumic I, Madrid C, Rueda Prada L, et al. Splenic complications of Babesia microti infection in humans: a systematic review. Can J Infect Dis Med Microbiol. 2020 May 27:2020:6934149.[Abstract][Full Text]

            • 8. Gelfand JA, Vannier E. Babesia species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's principles and practice of infectious disease. 6th ed. Philadelphia, PA: Elsevier; 2005:3209-15.

            • 9. Karshima SN, Karshima MN, Ahmed MI. Global meta-analysis on Babesia infections in human population: prevalence, distribution and species diversity​. Pathog Glob Health. 2022 Jun;116(4):220-35.[Abstract][Full Text]

            • 10. Swanson M, Pickrel A, Williamson J, et al.Trends in reported babesiosis cases - United States, 2011-2019. MMWR Morb Mortal Wkly Rep. 2023 Mar 17;72(11):273-7.[Abstract][Full Text]

            • 11. ​​Centers for Disease Control and Prevention. Table 2c. annual reported cases* of notifiable diseases, by region and reporting area, United States, U.S. territories and non-U.S. residents, 2023. 2023 [internet publication].[Full Text]

            • 12. Public Health England. News story: rare tick-borne infections diagnosed in England. Jul 2020 [internet publication].[Full Text]

            • 13. Vannier E, Gelfand JA. Babesia species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:3400-9.

            • 14. Krause PJ. Human babesiosis. Int J Parasitol. 2019 Feb;49(2):165-74.[Abstract]

            • 15. Krause PJ, McKay K, Gadbaw J, et al. Increasing health burden of human babesiosis in endemic sites. Am J Trop Med Hyg. 2003 Apr;68(4):431-6.[Abstract]

            • 16. Tonnetti L, Dodd RY, Foster G, et al. Babesia blood testing: the first-year experience. Transfusion. 2022 Jan;62(1):135-42.[Abstract][Full Text]

            • 17. Food and Drug Administration. Recommendations for reducing the risk of transfusion-transmitted babesiosis: guidance for industry. May 2019 [internet publiction].[Full Text]

            • 18. Gerber MA, Shapiro ED, Krause PJ, et al. The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis. 1994 Jul;170(1):231-4.[Abstract]

            • 19. Gubernot DM, Lucey CT, Lee KC, et al. Babesia infection through blood transfusions: reports received by the US Food and Drug Administration, 1997-2007. Clin Infect Dis. 2009 Jan 1;48(1):25-30.[Abstract]

            • 20. Tang TTM, Tran MH. Transfusion transmitted babesiosis: a systematic review of reported cases. Transfus Apher Sci. 2020 Oct;59(5):102843.[Abstract]

            • 21. Krause PJ, Spielman A, Telford SR 3rd, et al. Persistent parasitemia after acute babesiosis. N Engl J Med. 1998 Jul 16;339(3):160-5.[Abstract][Full Text]

            • 22. Herwaldt BL, Linden JV, Bosserman E, et al. Transfusion-associated babesiosis in the United States: a description of cases. Ann Intern Med. 2011 Oct 18;155(8):509-19.[Abstract][Full Text]

            • 23. Joseph JT, Purtill K, Wong SJ, et al. Vertical transmission of Babesia microti, United States. Emerg Infect Dis. 2012 Aug;18(8):1318-21.[Abstract][Full Text]

            • 24. Weiss LM. Babesiosis in humans: a treatment review. Expert Opin Pharmacother. 2002 Aug;3(8):1109-15.[Abstract]

            • 25. Murase T, Maede Y. Increased erythrophagocytic activity of macrophages in dogs with Babesia gibsoni infection. Nippon Juigaku Zasshi. 1990 Apr;52(2):321-7.[Abstract]

            • 26. Ruebush MJ, Hanson WL. Thymus dependence of resistance to infection with Babesia microti of human origin in mice. Am J Trop Med Hyg. 1980 Jul;29(4):507-15.[Abstract]

            • 27. Igarashi I, Suzuki R, Waki D, et al. Roles of CD4(+) T cells and gamma interferon in protective immunity against Babesia microti infection in mice. Infect Immun. 1999 Aug;67(8):4143-8.[Abstract][Full Text]

            • 28. Benach JL, Habicht GS, Holbrook TW, et al. Glucan as an adjuvant for a murine Babesia microti immunization trial. Infect Immun. 1982 Mar;35(3):947-51.[Abstract][Full Text]

            • 29. Aguilar-Delfin I, Wettstein PJ, Persing DH. Resistance to acute babesiosis is associated with interleukin-12- and gamma interferon-mediated responses and requires macrophages and natural killer cells. Infect Immun. 2003 Apr;71(4):2002-8.[Abstract][Full Text]

            • 30. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. 2008 Feb 1;46(3):370-6.[Abstract]

            • 31. Taiwo B, Lee C, Venkat D, et al. Can tumor necrosis factor alpha blockade predispose to severe babesiosis? Arthritis Rheum. 2007 Feb 15;57(1):179-81.[Abstract][Full Text]

            • 32. Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis. Clin Infect Dis. 2021 Jan 27;72(2):e49-64.[Abstract][Full Text]

            • 33. Kim N, Rosenbaum GS, Cunha BA. Relative bradycardia and lymphopenia in patients with babesiosis. Clin Infect Dis. 1998 May;26(5):1218-9.[Abstract]

            • 34. Wang G, Wormser GP, Zhuge J, et al. Utilization of a real-time PCR assay for diagnosis of Babesia microti infection in clinical practice. Ticks Tick Borne Dis. 2015 Apr;6(3):376-82.[Abstract]

            • 35. Wang G, Villafuerte P, Zhuge J, et al. Comparison of a quantitative PCR assay with peripheral blood smear examination for detection and quantitation of Babesia microti infection in humans. Diagn Microbiol Infect Dis. 2015 Jun;82(2):109-13.[Abstract]

            • 36. Sanchez E, Vannier E, Wormser GP, et al. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. JAMA. 2016 Apr 26;315(16):1767-77.[Abstract][Full Text]

            • 37. Smotrys M, Magge T, Alkhuja S, et al. Babesiosis as a cause of false-positive HIV serology. BMJ Case Rep. 2018 Jun 8:2018:bcr2017223738.[Abstract][Full Text]

            • 38. ​Centers for Disease Control and Prevention. Babesiosis 2025 case definition. Sep 2024 [internet publication].[Full Text]

            • 39. ​Centers for Disease Control and Prevention. Clinical overview of babesiosis. Feb 2024 [internet publication].[Full Text]

            • 40. Centers for Disease Control and Prevention. Clinical care of babesiosis. Feb 2024 [interenet publication].​[Full Text]

            • 41. STOP-BABESIOSIS Investigators; Leaf DE, Monson AE, Dias JA, et al. Red blood cell exchange transfusion for severe babesiosis. JAMA Intern Med. 2026 May 1;186(5):597-607.[Abstract]

            • 42. Marcos LA, Wormser GP. Relapsing babesiosis with molecular evidence of resistance to certain antimicrobials commonly used to treat babesia microti infections. Open Forum Infect Dis. 2023 Jul 20;10(8):ofad391.[Abstract][Full Text]

            • 43. Vydyam P, Pal AC, Renard I, et al. Tafenoquine-atovaquone combination achieves radical cure and confers sterile immunity in experimental models of human babesiosis. J Infect Dis. 2024 Jan 12;229(1):161-72.[Abstract][Full Text]

            • 44. Heller HM. Babesiosis in immunosuppressed hosts: pathogenesis, diagnosis and management. Curr Opin Infect Dis. 2024 Oct 1;37(5):327-32.[Abstract]

            • 45. Krause PJ, Rogers R, Shah MK, et al. Tafenoquine for relapsing babesiosis: a case series. Clin Infect Dis. 2024 Jul 19;79(1):130-7.[Abstract][Full Text]

            • 46. Khoury JK, Khoury NC, Schaefer D, et al. A tick-acquired red meat allergy. Am J Emerg Med. 2018 Feb;36(2):341.e1-341.e3.[Abstract]

            • 47. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust. 2018 Apr 16;208(7):316-21.[Abstract]

            • 48. ​Centers for Disease Control and Prevention. ​About alpha-gal syndrome. Jan 2026 [internet publication].[Full Text]

            • 49. Pattanaik D, Lieberman P, Lieberman J, et al. The changing face of anaphylaxis in adults and adolescents. Ann Allergy Asthma Immunol. 2018 Nov;121(5):594-7.[Abstract]

            • 50. Woolley AE, Montgomery MW, Savage WJ, et al. Post-babesiosis warm autoimmune hemolytic anemia. N Engl J Med. 2017 Mar 9;376(10):939-46.[Abstract][Full Text]

            • 51. Leiby P. Transfusion-associated babesiosis: shouldn't we be ticked off? Ann Intern Med. 2011 Oct 18;155(8):556-7.[Abstract][Full Text]

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