Tick-borne malaria-like illness caused by species of the intraerythrocytic protozoan Babesia


  • Fever, fatigue and hemolytic anemia
  • Drenching sweats
  • Muscle aches, chest pain, hip pain
  • Shortness of breath
  • Low blood pressure
  • Liver problems
  • Kidney failure
  • Weight loss
  • Emotional liability
  • Abdominal pain
  • Nonproductive cough
  • Pharyngeal erythema
  • Retinal infarcts
  • Pink eye
  • Retinopathy with splinter hemorrhages
  • Photophobia
  • Enlarged liver
  • Jaundice (yellowing of the skin and of the sclera)


  • Caused by infection with intraerythrocytic parasites of the genus Babesia,
  • Microscopic parasites that infect red blood cells
  • Tick-borne transmission

Risk factors:

  • Endemic in coastal region of the United States
  • Age: persons of any age can be affected
  • More common after 50 years age
  • Pregnancy: Transmitted from infected mother to her baby
  • Serologic testing for antibodies against Babesia (both IgG and IgM)

Diagnostic tests:

  • Blood tests
  • PCR (polymerase chain reaction) test
  • FISH (Fluorescent In-Situ Hybridization) assay
  • microscopic examination of Giemsa-stained blood or organ smears

Differential diagnostics:

  • CMV
  • Infectious mononucleosis (EBV)
  • Acute Anemia
  • Colorado Tick Fever
  • Ehrlichiosis
  • Insect Bites
  • Lyme Disease
  • Malaria
  • Q Fever
  • Relapsing Fever in Emergency Medicine
  • Rocky Mountain Spotted Fever
  • Tick-Borne Diseases
  • Typhoid Fever


  • Combination of anti-malarial drugs and antibiotics
  • Blood transfusions
  • Vaccination using live, attenuated strains of the parasites
  • Supportive treatment


  • Atovaquone and azithromycin
  • clindamycin and quinine
  • diminazene aceturate
  • imidocarb dipropionate

Lifestyle Management:

  • Use of tick repellents before entering a tick-infested area
  • Avoidance of or minimization of exposure to tick-infested areas
  • Applying repellents to skin and clothing
  • Thorough examination of skin after exposure
  • Walking on cleared trails and staying in the center of the trail,
  • Minimizing the amount of exposed skin,
  • wearing socks, long pants, and a long-sleeved shirt
  • Permethrin products can be applied to clothing/boots (kill ticks)