Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness.

 JAMA. 1996 Jun 5; 275,21, :1657-60. Concurrent Lyme disease and babesiosis. Evidence for 
increased severity and duration of illness. K rause PJ, Telford SR 3rd, Spielman A, Sikand V, 
Ryan R, Christianson D, Burke G, Brassard P, Pollack R, Peck J, Persing DH.
Department of Pediatrics, University of Connecticut School of Medicine, Farmington 06030, 
OBJECTIVE--To determine whether patients coinfected with Lyme disease and babesiosis in sites 
where both diseases are zoonotic experience a greater number of symptoms for a longer period of 
time than those with either infection alone. DESIGN--Community-based, yearly serosurvey and 
clinic-based cohort study. SETTING--Island community in Rhode Island and 2 Connecticut 
medical clinics from 1990 to 1994. STUDY PARTICIPANTS--Long-term residents of the island 
community and patients seeking treatment at the clinics. MAIN OUTCOME 
MEASURES--Seroreactivity to the agents of Lyme disease and babesiosis and number and 
duration of symptoms. RESULTS--Of 1156 serosurvey subjects, 97, 8.4%, were seroreactive
against Lyme disease spirochete antigen, of whom 14, 14%, also were seroreactive against babesial
antigen. Of 240 patients diagnosed with Lyme disease, 26, 11%, were coinfected with babesiosis. 
Coinfected patients experienced fatigue, P = .002, headache, P < .001, sweats, P < .001, chills, P = 
.03, anorexia, P = .04, emotional lability, P = .02, nausea, P = .004, conjunctivitis, P = .04, and 
splenomegaly, P = .01, more frequently than those with Lyme disease alone. Thirteen, 50%, of 26 
coinfected patients were symptomatic for 3 months or longer compared with 7,4%, of the 184 
patients with Lyme disease alon e from whom follow-up data were available, P < .001.Patients 
coinfected with Lyme disease experienced more symptoms and a more persistent episode of 
illness than did those, n = 10, experiencing babesial infection alone. Circulating spirochetal 
DNA was detected more than 3 times as often in coinfected patients as in those with Lyme 
disease alone, P = .06.
CONCLUSIONS-- Approximately 10% of patients with Lyme disease in southern New 
England are coinfected with babesiosis in sites where both diseases are zoonotic. The number of 
symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are 
greater than in patients with either infection alone. In areas where both Lyme disease and 
babesiosis have been reported, the possibility of concomitant babesial infection should be 
considered when moderate to severe Lyme disease has been diagnosed

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