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Babesiosis, a parasite that deserves a second look

Thomas Lind, 76, never suspected that a parasite was the cause of mysterious symptoms that left him feverish, weak and eventually hospitalized. It all began in November of 2020 when Lind had a strange itch that dissipated in a hot shower. He didn’t think about it until the next month when he tried to grip the car steering wheel and his hands shook violently.

Like many people afflicted with non-specific symptoms, Mr. Lind immediately took a COVID test—it was negative. The shakes continued and were now accompanied by fever and low blood oxygen as noted during multiple trips to urgent care. Antibiotics for a suspected urinary tract infection and IV fluids did not put a dent in his symptoms. Lind, who worked in law enforcement for 25 years in Westchester County and is a certified lie detector, collapsed in his home.

A trip to the Emergency Department showed he was anemic, but his EKG was fine. He was admitted to stay in the hospital overnight for monitoring. All this time, Mr. Lind, who enjoys long hikes around the woods by his house where he has lived for 40 years wasn’t too concerned.

“I lost my worries in my 20’s while serving in Vietnam.”

Mr. Lind was about to be discharged with a referral to a hematologist, when Arthur Forni, MD, infectious disease specialist, Greenwich Hospital, walked into his room with answers.

“The bad news is you are staying another night, the good news is we know what you have and we can treat you,” said Dr. Forni.

A few hours prior, Vanessa Hurtado, a medical technologist at Greenwich Hospital saw that a blood sample had been flagged.

“I was working in the Hematology Department, processing the morning blood work drawn on the hospital patients. Lind’s was among the ones that needed further workup. These smears go into an automated instrument for digital images to be taken, but I like to take another look at them under the microscope,” said Hurtado.

Upon looking into the microscope, Ms. Hurtado immediately knew what this patient was facing. Inside the red blood cells were Babesia parasites she had seen a several times in her 20 year career.

Babesiosis was once considered an animal disease, until the late 1950s when a Yugoslavian cattle farmer contracted the parasite. In the United States an outbreak occurred in the 1960’s in Nantucket and since then cases have expanded beyond the northeast to the mid and northwest. The disease appears to be growing in prevalence potentially due to global warming and more people being active outside.

“In the summer if someone has a fever without an obvious source I look for tick-borne infections,” said Dr. Forni who diagnosed another patient with Babesia the week following Lind’s case.

Dr. Forni usually tests for Lyme, Anaplasia and Babesia all at once when a tick-borne infection is suspected—though others often leave Babesia out, as it is rarer. Anemia can be a red flag for Babesia since the parasites infect red blood cells and cause them to break apart.

“This is something you don’t typically see with other tick infections,” said Dr. Forni.

“In most cases of Babesia people might be sick for a day or two and then the spleen filters out the bad blood cells and your immune system clears the parasites,” said Dr. Forni.

“But the condition can be quite serious in some people who are older, immune compromised or have had their spleen removed.”

The biggest issue with Babesia, Dr. Forni warns, is lack of awareness among physicians.

“If we identify and treat early, people like Mr. Lind don’t have to spend weeks feeling sick.”

Mr. Lind was treated with anti-malaria medication and antibiotics until his blood smear test came back parasite-free. He is back to hiking in his woods, this time with long pants tucked into his socks and bug spray that contains 40 percent DEET or lemon eucalyptus oil, as recommended by Dr. Forni.