Let me clarify this confusing post: It is based on a true clinical scenario. I was drawn into a hole chasing Babesia; the symptoms were classic, especially the profound night sweats. The "Babesia" stubbornly wouldn't go away, with everything thrown its way: Mepron, malarone, Artemesia, Coartem and Larium.
I was willing to treat Babesia as a clinical diagnosis with aggressive, long term therapy; positive lab confirmation is rare. I convinced myself that resolution was just around the corner.
I was reluctant to treat Lyme with intravenous therapy(I had been treating Lyme with oral antibiotics) If the clinical picture had been more "Lyme flavored," I may have pulled the trigger for IV therapy more quickly.
The patient had clear symptoms of neuroborreliosis including hallucinations at one point. Still, the clinician could rationalize the marked neuropsychiatric manifestations were the product of cerebral babesiosis.
Over a period of several months the patient requested (stridently) that she needed a PICC and IV therapy.
The diagnosis of tick borne disease is still made clinically. Still, in borderline situations the clinician sometimes turns to laboratory results, as I did here, to help justify the more dangerous step up in therapy.
The patient's mantra for some time was: I need a PICC.
I acquiesced after 9 months of oral therapies.
Incredible improvements with resoltion of both cognitive and physical symptoms were seen within the first month. The so-called classic Babesia symptoms also melted away.
This raises many interesting clinical questions.
I am not offering any clinical advise here. Please do not misinterpret. Every case is different.
In this case, the patient had insights about her care which turned out to be true.