Babesiosis Making Its Way North
May 22, 2007
Rick DiMichele, a physically fit 55-year-old, came down with a mysterious disease last summer. He had a fever of 103 degrees, looked pale and puffy, and had a terrible pain in his side.
It turned out to be a rare infection called babesiosis, which is similar to malaria. But DiMichele had not visited a place with a tropical climate where malaria is common. Rather, he believes he caught this disease in his own Ipswich, Mass., backyard.
Babesiosis is spread by deer ticks, the same insects that spread Lyme disease. But it's a disease that is so new North of Boston that many doctors - including DiMichele's - fail to recognize it.
Babesiosis, in fact, wasn't even known in Massachusetts until the 1980s, according to the state Department of Public Health. And experts believe it did not reach New Hampshire until 2004.
New Hampshire Public Health Veterinarian Jason Stull said the state doesn't test ticks for the disease, but that the first human case here was reported in 2004. Since, four cases have been reported in New Hampshire.
"But that doesn't mean they acquired the disease in New Hampshire," he said. "There's still no clear evidence it's here."
Still, Stull will not rule out the possibility that babesiosis has traveled this far north.
In Massachusetts, the disease is being monitored and appears to be spreading, according to Bela Matyas, epidemiologist at the Massachusetts Department of Public Health. Much like Lyme disease, he said, babesiosis begins in coastal communities and spreads inland. It has affected communities such as Lowell and Lawrence.
Stull would not say which communities the infected New Hampshire residents were from, but he said that like Lyme disease, babesiosis is a bigger threat for residents of Southern New Hampshire.
Stull said it is impossible to know if 2007 will bring more cases of babesiosis to New Hampshire.
"It's very complex, but basically since a tick acquires (babesiosis) from a rodent, then any increase in the rodent or deer population can increase the tick population and therefore the disease," he said.
Diagnosis and treatment
The good news is that babesiosis is treatable.
Once a doctor suspects babesiosis, the test to confirm the diagnosis gives a clear-cut answer and treatment is usually a combination of antimicrobial drugs. Less than 1 percent of patients die of the disease, and sometimes it goes away on its own.
The trouble is getting doctors to recognize the symptoms and to order the test. Many doctors still think of babesiosis as a problem limited to Nantucket, Martha's Vineyard and Cape Cod, where it has been circulating for nearly a generation, Matyas said.
"Physicians have historically seen the tick-borne diseases being limited to certain parts of the state," he said. "A lot of people think that's the only place to get it. ... Unfortunately the risk has spread."
Also, the symptoms are nonspecific and can be mistaken for other things. A patient might be sick with nondescript flu-like symptoms for weeks or months before seeing a doctor, and in most cases the patient doesn't remember being bitten by a tick.
In DiMichele's case, in July, a local emergency department missed his diagnosis entirely. He followed up with his regular doctor at Massachusetts General Hospital, who told him he might have cancer. It wasn't until DiMichele saw a hematologist at Massachusetts General that he first heard the word babesiosis. And the doctor thought it was a long shot because the disease is so rare.
Before the test results came back, DiMichele was convinced he had cancer. It seemed impossible that he could have a tick-borne infection, he said, because he's so vigilant about ticks because of Lyme disease.
He runs in the woods for an hour three or four times a week, and he always takes care to stay in the middle of the path and to scan his body for ticks.
"I check myself all the time," he said. "And I just did not believe that I could be infected with something like that."
Prevention first
Stull said taking preventative measures is the best thing people can do to avoid tick-borne diseases.
"I try to tell them to practice it like they practice mosquito prevention," he said. "Since you can come into contact with ticks in your own backyard, the key is really to wear protected clothing and a tick repellent, typically with DEET."
He recommends walking and running on roads instead of in the woods. And if the woods or marshes are unavoidable, he said to remove the tick and examine the bite as soon as possible.
"If you can remove the tick in 24 hours, your risk of Lyme disease is very low," he said. "The sooner you remove it, the better off you are for both diseases."
But DiMichele did not know he had been bitten. By the time he was diagnosed, he was jaundiced, weak and having trouble breathing because of the pain in his side, which turned out to be caused by his swollen spleen.
His fever went away quickly after he started the antimicrobial drugs, however. And his spleen also returned to a normal size, causing him to drop 15 pounds in the course of about a week.
Some of his other symptoms, such as night sweats and low red blood cell count, reacted more slowly, he said. But about six weeks after he started taking the drugs, he felt healthy again, he said.
Last month, a neighbor of DiMichele, 78-year-old Tom Gregory, spent a week at Salem (Mass.) Hospital with the disease.
Gregory had the misfortune to catch babesiosis and Lyme disease at the same time, possibly from the same tick bite. He had a fever of 102.5 degrees. The doctors diagnosed Lyme disease right away, he said, but it wasn't until he went home a week later that the hospital called and told him that lab tests confirmed he also had babesiosis. They put him on a different set of medications.
He and his wife have both had Lyme disease and they take precautions against ticks, so he, too, was surprised by the babesiosis diagnosis.
"The Lyme disease didn't make me sick at all," Gregory said. "Babesiosis really knocked me out."
Gregory has mostly recovered now, and is taking the same precautions against ticks as before: using bug spray and checking carefully for the little bugs when he comes indoors.
"The ticks can be anywhere," he said.
DiMichele said he went through a hypervigilant phase after his illness when he tucked his pant legs into his socks and used harsh bug sprays that he previously avoided. He has relaxed a bit since then, but he's still on the lookout for ticks.
If he catches babesiosis again, DiMichele said, he will recognize it this time and that will make all the difference.
"The toughest part was not knowing what it was," he said. "After I found out, it was treatable."
Source: Eagle-Tribune by Julie Kirkwood, Rebecca Correa
Printed with Permission
