The local newspaper reported this week that there has been a huge increase in the number of Lyme cases in the area. This is no surprise. The same article stated that only one case of Babesia has been reported. The reports of Lyme are based on CDC surveillance criteria. So how does Babesia become reportable? Here the IDSA (discredited?) protocol is followed. Positive antibodies in the blood do not count. By the way, most LLMDs believe there are about 12 Babesia strains which are Lyme co-infections. The antibody test available in Maryland only tests for B. microti. It fails to test for B. duncati, which can only be tested by labs like IgeneX, and appears to be as common as B. microti. To make the IDSA cut, for reporting Babesiosis as a bonafide case, the blood sample of patients with positive antibodies also need to meet one of two other criteria. There has to be a positive PCR: this only works if you are testing for the right strain, or: you have to demonstrate a positive blood smear showing parasites inside red blood cells. The problem here is that Babesia frequently infects only 1% of red blood cells. Some texts report that study of blood smears can take up to two hours. The average tech at Labcorp or Quest has only a few minutes, at best, to study the smears. The smears are microscopically magnified to the 400 power. Many experts believe that 1000 magnification power with oil immersion is required to identify the pathogens. No wonder only one case of Babesia has been "reported."
Despite all this bad news, I think the patient I saw today might make the cut for reportable Babesia. This young man in his mid 20's had a tick bite about two months ago. Incidentally he had a severe case of Lyme, associated with pericarditis about 3 years ago which appears to be in remission. He had planned to see me for a routine check up today. He had no idea that I treated many patients with Lyme and tick borne illness. Our encounter today was serendipity.
The physical was cancelled. For 6 weeks he had been experiencing episodes of fever, chills and soaking sweats, which had been recurring in cycles. He had experienced a sore throat, mild cough, weight loss, profound weakness and fatigue and some memory loss. In my office today he had an oral temperature of 102.9.
I believe this patient likely has a case of severe active Babesiosis. If I am correct his blood smear should be dramatically positive. Perhaps I am hoping too much. At any rate, I will shortly have lab results and find out how he responds to Mepron and Zithromax.
I will keep you posted.