Fast Five Quiz: Tick Bites

Michael Stuart Bronze, MD


March 11, 2022

The spectrum of babesiosis manifestations is broad, ranging from a silent infection to a fulminant malarialike disease with fever and chills that results in severe hemolysis and, occasionally, death. Symptoms are thought to be related to the degree of red blood cell parasitemia, but this is not always the case. In the United States, infection with Babesia microti in otherwise healthy individuals often remains subclinical; however, symptomatic infection is common in asplenic, elderly, and immunocompromised patients. In Europe, because bovine babesiosis due to Babesia divergens and Babesia bovis mostly occurs in patients who are asplenic, infections are generally clinically overt and frequently fatal.

Initial symptoms begin gradually and are nonspecific. Common symptoms include:

  • Malaise

  • Fatigue

  • Anorexia

  • Shaking chills

  • Fever

  • Diaphoresis

  • Headache

  • Myalgias

  • Arthralgias

  • Nausea

  • Vomiting

  • Abdominal pain

  • Depression and emotional lability

  • Dark urine

  • Neck stiffness

  • Altered sensorium

  • Shortness of breath

Photophobia, conjunctival injection, sore throat, and cough are less common. Petechiae may be present in a few patients, and ecchymoses have been noted occasionally. A rash similar to erythema migrans has been described, but this probably represents intercurrent Lyme disease.

Learn more about the presentation of babesiosis.


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