Diagnosis of a tick-borne coinfection in a patient with persistent symptoms following treatment for Lyme disease

Published Date
Journal
BMJ Case Reports
Citation
2018:bcr2018225342
DOI
10.1136/bcr-2018-225342.
Authors
Hoversten K
Bartlett MA
Abstract

A 67-year-old woman presented with 5 days of myalgias and fevers on completion of a 21-day course of amoxicillin for Lyme disease (Borrelia burgdorferi infection). She was found to have profound thrombocytopenia, as well as new anaemia and leucopenia. Workup revealed Babesia microti as the causative agent of her symptoms. The patient quickly improved after appropriate antimicrobial therapy directed against babesiosis was started. This case illustrates the importance of basic microbiology, including epidemiology and common vectors, when creating a differential diagnosis. Because the Ixodes scapularis tick can harbour and transmit multiple parasites simultaneously, the possibility of coinfection should be considered in any patient not responding to appropriate initial medical therapy.

Keywords: infectious diseases; travel medicine.