Ticks and Malaria-Like Parasites

I have to go to India in a few days so I’ve started taking two drugs called proguanil and

atovaquone. The drugs are used to treat, or in this case, prevent malaria. There are plenty of

malaria-carrying mosquitoes in downtown New Delhi so a daily dose of anti-malarial meds is a

good idea for visitors. Interestingly, these same drugs also may protect me from a malaria-like

infection found here in the U.S.

The infection is babesiosis. It is caused by a parasite (not a virus or a bacterium) called

Babesia microti. Unlike malaria, babesiosis is usually acquired from the lazy bite of a tick, not

the hypodermic sting of a mosquito. The tick is the same slow-feeding, dot-size tick that

transmits Lyme infections. (It is possible to find ticks that carry both Lyme bacteria and Babesia

parasites, and the resulting bite may give you two concomitant infections.)

Where do ticks get Babesia? They get it from local rodents such as deer mice, voles, rats

and chipmunks. Ticks feeding on these common rodents pick up the parasites during a blood

meal and later pass it to humans.

By itself, babesiosis is not a terribly dramatic infection. Most Babesia infections are

probably asymptomatic, which means you may never even notice you had it. Those infections

that are more obvious will produce fever, chills, fatigue, anemia, and myalgia one to four weeks

after being bit by an infected tick. Babesiosis tends to be more severe in elderly and

immunosuppressed populations, and among people who have had their spleens removed.

The severity of the infection may also be caused by delays in diagnosis and treatment.

There are few standardized, high-tech diagnostic tools for babesiosis so blood smears have to be

prepared and examined under a microscope. Like the malaria parasite, Babesia parasites are

found in the blood and nestled inside red blood cells (erythrocytes).

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 Treatment consists of 7-10 days of clindamycin (an antibiotic) and quinine (the original

malaria drug), or antovaquone and azithromycin (another antibiotic).

Babesiosis is not a national reportable infectious disease so it’s hard to know how

common it is in various parts of the country. Tom Mather, who runs the University of Rhode

Island’s Center for Vector-Borne Disease, recently told the Providence Journal newspaper that

it’s a “relatively rare infection, but it’s increasing.” Rhode Island had 43 human cases in 2005.

Mather’s research found that about 12 percent of the state’s Ixodes ticks carried Babesia

parasites.

There are several Babesia hotspots in the Northeast, including Nantucket Island, Martha’s

Vineyard, Shelter Island, Cape Cod, Block Island, and Fire Island. New Jersey, Virginia,

Connecticut and Maryland have also reported cases in recent years.

Sporadic cases of a related Babesia species called WA-1 have been reported in

Washington state and California.

Interestingly, ticks are not the only way to catch babesiosis. Transfusion is another

possible route. In the absence of a quick and accurate test for Babesia, these blood-borne

parasites will sometimes slip through the blood donor screening process. Last year in

Connecticut, a small study of donated blood samples found that 0.9% of 3490 donations were

positive for antibodies to Babesia. That means the donors showed evidence of having had

babesiosis. A small number of those seropositive samples also tested positive for the presence of

Babesia DNA, suggesting their blood was still infectious and likely to transmit Babesia to

transfused patients.

Ticks, transfusions, and even Mom can be sources of this obscure parasitic infection. I

include Mom here because the medical literature contains two documented cases of congenital

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Babesia infection. Both cases involved a maternal tick bite and infection of the mother. Babesia

parasites subsequently infected the fetuses. Both newborns were treated with clindamycin and

quinine, and recovered.

Babesiosis is another example of the many different infections—some life-threatening

and some merely irritating—one can get from the bite of a tick. For more information about

babesiosis and ticks, visit the University of Rhode Island’s Tick Research Laboratory at:

http://riaes.cels.uri.edu/resources/ticklab/babesia.html.