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Tuesday, December 2, 2008

Babesia Herxheimer reactions?

I haven't seen anything written about this phenomenon. When I learned about the Jarish Herxheimer reaction the literature indicated that it was limited to an exclusive club of microbes. It was associated with syphilis, leptospirosis, relapsing fever, rate bite fever, Lyme disease, anthrax and very few other infections. The reaction was related to two things: 1) the infection was disseminated and 2) the germ antigens, released when the germ was killed, caused an exaggerated immunological response associated with an unusually exuberant cytokine response.

Now the term Herxheimer reaction seems to be associated with a whole host of other infections. My clinical experience confirms that when patients are placed on anti-Babesia therapy they experience massive Herxheimer reactions. The sweating increases. Pain and fatigue increase. Even cognitive dysfunction- brain fog and memory loss increases substantially. These reactions can be much more intense than those associated with initial anti-Borrelia (Lyme) therapies.

Let's take a look. We are told that Babesia is associated with specific symptoms. These include: recurrent chills and sweats- the sweats are frequently drenching, neck pain and air hunger. We are told that it is a clinical diagnosis and that lab tests are inaccurate and cannot be relied upon. Babesia is a malaria like parasite, and resides in red blood cells. Malaria is associated with a parasitic infection of the red blood cells associated with hemolysis, rupture of the red blood cells. The afflicted individuals experience sever chills, sweats and fevers and are frequently very ill. It is diagnosed when the parasites are observed in the red cells under the microscope. The blood smears for Babesia are generally negative. We are told it is because the parasites infest a very small percent of red blood cells.

PCR tests, antibody tests and a wide variety of special diagnostic assays searching out confirmation of Babesia are usually negative. There is no evidence of ruptured red blood cells. Occasionally antibodies for a Babesia strain may be present. This indicates exposure to the organism- not active infection. If IgM antibodies are present active infection is more likely. For the most part there is no confirmation whatsoever. The standard wisdom (mainstream medicine) is that Babesia is generally a self limited infection which is cleared by the immune system.

Let me play Devil's advocate. Lyme can cause sweats, flu symptoms, breathing problems and pains of all sorts. The same symptoms frequently clear when only Lyme therapy is given. Is Babesia really present at all? Or is a case of the emperor without any clothes. If we have invisible "Bartonella like organisms," perhaps we should have "Babesia like organisms." or Babesia syndrome associated with Lyme disease. Perhaps the anti-Babesia therapy is really killing a form of Lyme via some unsuspected mechanism. If the Babesia organisms are rare and hard to find then why does killing them cause a Herx reaction? Is there any precedent for the treatment of parasitic (piroplastic) infection associated with a described Herxheimer response?
I believe it is important to question all the assumptions of what has now become the new orthodoxy of Lyme literate dogma.

Let's put this argument aside. When I treat patients for Babesia they do have dramatic Herx reactions. The reactions can be disabling and cause serious setbacks.
Patients may Herx with a single dose of Artemesia or Malarone. Frequently Mepron cannot be tolerated due to excessive Herxing. The dose of anti-Babesia therapy must be gradually ramped up based on individual tolerances. One can start with Artemesia/Artemesin or Malarone/Mepron. When the second agent is added it must be done gradually. The clinical response is that the sweating and associated symptoms increase for a period of time and then gradually wane and disappear. It works.

For now I do believe in chronic, persistent Babesiosis, despite the lack of supporting evidence, as part of the Lyme disease complex; but my mind is open to other possibilities.


choosingtohaveagoodday said...

I recently read an article by Dr. Schaller in the Public Health Alert newspaper in which he said that he had discovered that 1500 mg of Mepron for Babesia was doing no more than suppressing the infection and as soon as the treatment was stopped the infection would return. Do you have any thoughts on what a more current dosage for Babesia treatment would be. Dr. Schaller said he would tell me for $560. Sorry trying to keep my house for my family right now is more important. I have had 3 courses of 750 mg of Mepron 2X day with a zithromax chaser. My LLMD sent me to a ND who did bio-imaging to see what my infection concentration was after all this time (2 yrs) and the Babesia tripled in three months even after that treatment and lyme, bartonella, erlichiosis, naella=F )sorry on that one), candida, mercury and silver poisoning. I have had 8 months of IV rocephin and ended up with pernicious anemia and my hemoglobin was 3.5 and my iron count was 2 (yes 2) when it was discovered,not being able to stay upright was there first clue, about a year later I had a new line put in and was given 900 mg clindymyacin 3X per week and would get stroke-like symptoms, numb on left, uncontrollable jerking on the right side and I couldn't talk. Seemed a bit harsh but hung in there for several weeks. So yes I have been digging holes but not in the same spot, I must have covered a couple of acres by now and still haven't struck crude oil and gone to Beverly.

Seibertneurolyme said...


When you describe your patients as having a certain set of diagnostic markers it always seems like hubby falls outside of that box.

He has had positive blood smears for babesia from the old Bowen lab and from the Fry lab. Waiting on Clongen results. All other babs testing negative.

When his babs is active, his RDW increases as does bilirubin. If treatment is therapeutically effective then those 2 numbers go back to normal.

Also has occasional RBC's in urine during treatment, elevated Urobilinogen and the CPK isoenzymes related to destruction of RBC also become elevated. These markers also return to normal following treatment.

Bryan Rosner said...

This is a fantastic question and I think you are among the few physicians who think appropriately "outside the box" on this topic. I have asked the same question many times, regarding the Babesia orthodoxy that just doesn't "add up" when analyzed. Since Lyme is a very complex and elusive bug, I think it is quite possible that the "Babesia symptoms" and "Babesia herx" are really just a different manifestation of Lyme symptoms and die off.

Bryan Rosner

Shawn B. said...

This is an interesting blog post, because it comes just a week after my LLMD (Dr. P in CT) told me he thinks improvement on mepron may actually be a result of mepron killing lyme. You may not be alone in your suspicions.

seibertneurolyme- what are you treating babesia with? I ask because if artemisinin or a derivative are part of the treatment, and it acts by promoting free radical production within the RBC's, it seems logically possible that the signs of damaged/destroyed RBC's you are detecting are simply a result of the treatment itself, and not necessarily babesia.

Michele said...

I know that I had/have Babesia and have gotten better on Mepron, Zithromax, artemesia treatment but I have always known that something else was being treated with this regimin also. Symptoms were relapsing fever with bronchitis like cough every 4 weeks, drenching sweats, swollen lymph nodes, blood in urine, leg muscle pain. I do believe Babesia exists and many people are infected with it. I believe I had it and still do as I continue to pee blood and have relapsing fever & cough but again, I also know that the treatment protocal has helped me with Lyme symptoms especially unrelenting leg pain so it remains another mystery that hopefully will come to light some day. I've had recent positive PCR test for Lyme and have had it for over 2 years.

jenbooks13 said...

I'm sorry, I said I wouldn't comment, but I won't go into alt med and annoy your patients.

Nick Harris told me some years ago that two babesia patients who were willing to have bone marrow biopsies had it in their bone marrow. I also wonder if it resides in the liver like malaria does.

A doctor friend of mine, a Harvard/Stanford trained woman who was quite smart, and who had run a large emergency room before deciding to live a "quieter" life and treat brain trauma with EEG neurofeedback and hyperbaric oxygen at a clinic in a huge house on a wooded property in the northeast, where lymies descended upon her begging for her to treat them as well and where, you guessed it, most of her family got lyme on the wooded, deer-tick infested property, so that she was treating it and then got it along with babesia...anyway she learned enough microscopy to examine her and her daughter's blood after a hyperbaric session. She would see lots of dead babesia in the extracellular space after a session. But recrudescence was fairly quick. I guess in the cell it is visible as a maltese cross?

She also tested the blood of a couple who were taking Riamet (a European drug for malaria that contains two meds, including an artemisia derivative) for babesia, and though it seemed to take care of it, recrudescence again occured in a few weeks.

There may be forms beyond the maltese cross we don't understand. "Malaria like" is a vague word. Just because it infects red blood cells, it may be quite a different organism. It hasn't been studied enough.

Perhaps both facts are true. Perhaps mepron/zith treats lyme or other coinfecting organisms, along with babesia.

You don't necessarily get rid of babesia anyway. Mepron helps but your immune system has to hold it in check ultimately and it can't do that if immunosuppressed by BB.

Peter Krause told me of a babesia patient who got "well" with the standard course of mepron/zith but "relapsed" years later when he got cancer (and I assume, had chemo and became immunosuppressed during treatment).

There is no definitive treatment for babesia, ie one that rids it in more than its active form.

Seibertneurolyme said...


Hubby had an allergic reaction to Mepron after 10 days. Could not tolerate Larium. Took artemesinin for 15 months straight with no effects on RBC -- did not know that it should have been pulsed.

Anyway -- results I was discussing happened during 2 different treatments with low dose quinine/clindamycin (4 months each time). Also from Primaquine/Chloroquine to a lesser extent. More recently with Alinia and currently with the herb Cryptolepsis at a very low dose.

SO ... is it babs destroying red blood cells or something else?

Lyme report: Montgomery County, MD said...

Babesia, if it active should cause the markers described. If it causes the red blood cells to rupture one would see an increase in RDW (red cell distribution width). This indicates that the red cells have a mixed population of sizes. It indicates that the bone marrow is working hard to make new red blood cells. Bilirubin is a breakdown product of hemoglobin which is being released into the blood stream and metabolized by the liver. This would be increased.Urobilinogen would also be seen in the urine. I would expect a positive uring dipstick test for blood with no cells seen under the microscope. This is due to the release of myoglobin when red cells are lysed. I would not expect CPK (muscle enzyme) elevations unless tissue damage is occuring when sequested Babesia are being killed inside soft tissues. The LDH (an enzyme found in red cells) should be elevated. The reticulocyte count should be elevated- this shows that the bone marrow is cranking out new blood cells. These are the sorts of changes which would be seen in typical malaria cases. I have not seen this sort of active Babesia infection so far. There are many strains- this may be a very nasty one. Malaria is the number one cause of mortality in the world. This sounds like a case which you need to stay on top of. Malaria can be chronic and relapasing as well. Many strains develop resistance to multiple drugs. Good luck.

Lyme report: Montgomery County, MD said...

Despite what the CDC says the most common strainof Babesia seen in the east coast appears to be B. duncani.

Clongen finally added B. duncani to its "Babesia species" PCR. It has a unique genome. We just got a positive PCR. This looks promising.

Lyme report: Montgomery County, MD said...

How do you treat Babesia? If the gate theory is true, then Bb(Lyme) is the primary organism which causes immune suppression. Babesia in most cases can be considered an opportunistic infection. It seems, based on my experience, that very aggressive Lyme therapy should preceed Babesia therapy. The results are better. If the Babesia symptoms are very sever then a touch of of Malarone or Artenesin can be given to cool it off while Lyme is treated. Even this may cause unbearable Herxing and Lyme alone should be treated (my experience). The notion that co-infections should be treated before Lyme doesn't work well for my patients. When a Macrolide such as Zithromax or Biaxin is added to Malarone or Mepron it's purpose is to prevent resistance. These drugs are not anti-malarial. Plaquenil and tetracycalines such as doxycyline, do have malarial effects and can be included in the therapy. Cleocin-clindamycin is a macrolide like drug that also has anti-malarial effects. It can be used in place of Biaxin or Zithromax and this may be more effective. Mepron and Artemesin should be taken with a fatty meal or flax seed supplements can be used. I have many patients with typical Babesia symptoms, some with positive serology for B. microti who are in clinical remission and have never been treated with Babesia specific therapy. Our bodies collect innumerable germs and parasites as we sail through life. They accumulate like barnacles on the hull of a boat. If the immune system is working well- they won't make us sick.

I don't understand pulse therapy. I don't use it.

Patients also have a mystery bacteria which is hard to kill.

Clongen is still working on it.

Dr. Kilani is spending a lot of his own money. At this point the idea is to isolate the organism using a plasmid and clone it. The clones can be grown into colonies which can be sequenced. Apparently this is standard stuff at places like NIH.

It may be related to a very resistant form of a Pseudomonas like bacteria. I can't recommend this but- one patient (only one) seem to do well with Ivanz. I relate this to the patient with severe respiratory symptoms that do not go away.

jenbooks13 said...

I agree with you (does it matter lol) that lyme is the gatekeeper. Dogdoc wrote on here somewhere of lyme as "half aids" which is an interesting description.

However, coinfection with *something* and most likely babesia, really makes it a lot worse. Maybe they are synergistically upregulated or signal to each other to increase virulence (sort of like the quorum theory--bacteria stay quiet until they have a quorum and then turn on virulence factors to aggressively multiply and at that point get the notice of the immune system but have enough soldiers to put up a good fight). Maybe these organisms do something similar in the host--hey, you're here, I'm here, together we can really wreak havoc, I'll upregulate your virulence, you upregulate mine, go to work, you wreck the red blood cell, I'll do a number on the bcells and the collagen--go buddy, go!

Pulsing--like Burrascano suggested--is really just trying to treat active infection, thus outwitting the "latency" tricks.

I hope the mystery bug is not some pseudomonas--at least not some even vaguely ordinary strain, because that would seem to mean its immunosuppression and truly opportunistic infection, not pretty.

I liked your idea of some novel tick gut bug that goes awol in the human host. Some novel discovery, that is treatable, would be interesting.

Anyway, the thing about malaria and babesia is it seems we use malaria as a model and I'm not sure why. Maybe I haven't done enough reading, but it seems to me from memory that babesia does not cleve heme. Just because they like the same cell, at least for part of their lifecycle, should we be looking at malaria as a model? I don't see the reasoning behind that.

lymie said...

I got lyme and babesia from a tick bite. For two years, the only symptom I had was a swollen knee. Then all hell broke loose and there were myriad multisystem symptoms. That was when the babesia finally made itself known. It had nothing to say earlier and was apparently latent.

My interpretation is that it wasn't until more active lyme began that my immune system became unable to hold back the babesia.

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girl mark said...

I've experienced this 'babesia herx' without knowing, when I first started therapy, that this effect exists (so I don't think it's "in my head"). It's really nasty.

Anyway, it drives me nuts that I don't quite know if i'm really treating babesia or if I'm just seeing some kind of effect on my chronic Lyme.

Here's a question: Mepron, artemesinin, and Lariam work using different mechanisms when used to treat malaria and/or babesia, right?

Do they all result in a 'babesia herx'? I don't know anyone who's taken Lariam for it.

Is it likely that all three drugs would cause a synergistic effect that makes a Lyme herx take place?

I've never had a Lyme herx when treating Lyme in the past, by the way. I think this clinically-diagnosed babesia that I'm now treating is from a recent re-infection, though, and it didn't respond to my taking antibiotics as soon as I found the tickbite/signs of infection, so i am probably dealing with a new mix of germs that I haven't had to treat in the past.

girl mark said...

Here's another question for anyone pondering this. Does Lyme western blot response change drastically during babesia therapy of any kind? I know that in my case the antibiotic I'm taking also targets Lyme, but is that the case with ALL babesia therapy- should you expect all the drug combos to target Lyme, and do you in fact see changes in WB results (I know you can't read very much into those changes , but I would expect that if someone was having a babesia herx that was actually an exaggerated Lyme herx, you'd expect to see an elevated immune response to Lyme.

LimeEone said...

Coming late here but...

I think there may be something to LymeMD's idea that the mepron and zith are hitting Lyme, and that it is a Lyme herx patients are experiencing.

Many years ago I was on an extended course of flagyl and zith, and sometime into the sixth or eight week I experienced what would be considered by most to coincide with a babesia herx. I had night sweats that were thick, oily, and heavy, so much so that I'd soak through the bedding and mattress, and would have to shower and change the linens, only to have it happen again and again, all night, with intermittent cycles of shivering. But the consistency of the sweat was the bizarre thing; I've never seen or felt anything like it, almost unworldly.

But the question?

What was I killing? Could the flagyl have been killing babesia? Or was it the Lyme? the cysts? Or like Jen suggested, perhaps there is some symbiosis between organisms, and there is one macro-community of bugs that cannot really be separated out so cleanly to: babs, Lyme, mycoplasma, bartonella, etc...

loshakova said...

Thank you so much for posting this. I have been dxed with Lyme + multiple coinfections (Lyme dx 1/10, others followed). I have been taking Malarone and Artemisinin for Babesia for the past month. Within about 3 days of starting this combo, I started having truly amazing sweats and chills every night with frequent migraines -- all symptoms I had had intermittently with the Babesia, but never this often or regularly. I took Artemesia annua for several months last summer (Buhner dosing protocol) without this reaction. My LLMD said the reaction was not herxing, but did not offer any alternative explanation.

I very much appreciate your blog and your thoughtful and questioning approach to these diseases. I continue to learn new things here each time I visit.

Anonymous said...

I have a positive test for Lyme and babesia from Igenex. I started having symptoms in January, 2011 after starting a drug called dapsone for hives I got from Celiac disease. I blamed the drug for my migraines, air hunger and neck and shoulder pain. These severe symptoms haven't gone away despite taking mepron, zith, omnicef and a plethora of natural remedies. I am not doing a course of coartem which is for malaria. I haven't seen any changes except that now I am experiencing night sweats. Does anyone have any ideas for me. It is so difficult to get through the day with the exhaustion and trying to breathe!

Swift said...

Has anyone experienced weird blood clotting in the lungs, shortness of breath, but otherwise mild symptoms associated with Babesia?

Anonymous said...

I think the persistence of babesia is due to cellular function. Babesia is an intracellular infection so getting the remedies into the cells is important. I'm using artemisinin and cryptolepis as treatments but i also take lecithin to promote healthy cell walls and use a product called Oxylift. Oxylift is an ionic oxygen formula that includes the respiratory enzymes that cells use to process oxygen. it also uses minerals to sneak the ionic oxygen into the cells.

Anyway I did a lot of reading and that is my strategy so far. Been getting the night sweat herx so hopefully it wanes.

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