What is the typical clinical presentation of Babesiosis?

Following an incubation period of 1–6 weeks (usually 1 to 4 weeks) after tick bite or 1 week to 6 months (usually 1 to 9 weeks) after blood transfusion:

• Symptoms:
  • Gradual onset of malaise and fatigue
  • Intermittent fever
  • Fatigue
  • Chills
  • Sweats
  • Anorexia
  • Headache
  • Myalgia
  • Less common symptoms including:
    • Arthralgia
    • Emotional lability
    • Depression
    • Hyperesthesia
    • Neck stiffness
    • Sore throat
    • Nausea
    • Abdominal pain
    • Vomiting
    • Conjunctival injection
    • Photophobia
    • Weight loss
    • Shortness of breath
    • Non-productive cough
• Signs:
  • Fever – the most common finding on physical examination
  • Occasional mild to moderate splenomegaly
  • Hepatomegaly
  • Pallor
  • Jaundice
• Labs:
  • Mild to moderately severe hemolytic anemia due to:
    • Parasite-induced hemolysis
    • Less commonly from autoimmune hemolytic anemia
  • Elevated reticulocyte count
  • Thrombocytopenia
  • The leukocyte count is usually normal-to-slightly decreased; neutropenia may occur in infants and adults.
  • Elevated liver enzyme levels

Severe babesiosis usually is noted in immunocompromised patients, especially those with:

• Advanced age
• Neonatal prematurity
• Asplenia
• HIV/AIDS
• Malignancy
• Immunosuppressive therapy
• Cardiac, hematologic or liver comorbidities

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