Ms. Y. is a 61‐year‐old salad bar chef with a medical history of dyslipidemia and osteoporosis who was admitted with fever, chills, hot flushes, and extreme fatigue for 2 days. On the day of her admission, she also experienced epigastric pain, shortness of breath, chest pain, diaphoresis for a short duration, and a presyncopal episode. Review of systems was positive for headache and cloudy urine. The patient lives between New Jersey and New York with her children and has no pets. The most recent travel history was a trip to Korea 5 months ago. She takes atorvastatin, and is not allergic to any medications. On physical examination, her maximum temperature was 37.9°C. She appeared apprehensive and had mild epigastric tenderness. The rest of her examination was unremarkable except for dry skin on both hands. The abnormal laboratory results were: white blood cell count 2.6, hemoglobin 9.9, platelets 81, monocytes 18.3%, reticulocytes 2.4%, total bilirubin 2.4, unconjugated bilirubin 2, haptoglobin 4, lactate dehydrogenase 410, erythrocyte sedimentation rate 102. The peripheral smear showed multiple parasitic ring inclusions within the erythrocytes, suggesting babesiosis with a parasitemia level of 0.5%. Malaria was excluded based on negative direct antigen test and smears. On further interview, the patient revealed a weekly hiking history in Bear Mountain and Long Island for the past month. She was treated with a 10‐day course of atovaquone and azithromycin, as well as a 7‐day course of doxycycline empirically for other tick‐borne diseases. Her symptoms improved, and she was discharged home. Subsequently, her Lyme EIA and immunoblot turned out positive, and she was offered an additional 10‐day course of doxycycline.
Babesiosis is a tick‐borne disease transmitted by Ixodes scapularis. The main pathogen found in the United States is Babesia microti. Interestingly, these ticks can carry a number of other pathogens including Borrelia burgdorferi, the agent for Lyme disease. The prevalence of human coinfection depends on geographic location. One study done in New Jersey reported that 5% of Ixodes carried B. microti, 47% carried B. burgdorferi, and 2% carried both pathogens. Coinfected patients tend to have more severe and prolonged symptoms, especially if immunocom‐promised. Our patient had a mild to moderate presentation of babesiosis based on age, state of health, symptoms, and laboratory findings including parasitemia level. Evaluation for coinfection was warranted because she lived between New Jersey and New York, regions endemic for Lyme disease. Although a false‐positive Lyme test was possible in our patient given the diagnosis of babesiosis, coinfection was a much more likely scenario, and treatment with doxycycline was therefore extended.
This case illustrates the importance of taking into consideration geography and travel history in making the correct diagnosis.
V. Zhu ‐ none; J. Shammash ‐ none
To cite this abstract:Zhu V, Shammash J. Coinfection with Babesiosis and Lyme Disease in a 61‐Year‐Old Woman. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 1018. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/coinfection-with-babesiosis-and-lyme-disease-in-a-61yearold-woman/. Accessed April 9, 2020.