Case Presentation: A 77-year-old male with chronic kidney disease and mitral valve prolapse with a history of Lyme disease and West Nile Virus presented with fevers, night sweats, chills, and fatigue for 3 weeks. The patient had been visiting family in Texas for one month but gradually started to notice his symptoms. A few weeks prior to the onset of symptoms in March, he had discovered a tick on his knee and was prescribed a dose of doxycycline, however did not note any abnormal rashes.Upon presenting to the hospital, he had a temperature of 36.9C, white blood cell count of 5.1 K/uL, hemoglobin of 10.9 g/dL thrombocytopenia at 67 K/uL, transaminitis with ALT of 63 unit/L and AST of 55 unit/L, and an elevated total bilirubin of 1.4 mg/dL. Due to suspicion of tickborne illness due to history and symptoms, IV doxycycline was started. The patient continued to have pancytopenia in addition to being febrile but did subjectively feel better while on IV doxycycline. Peripheral blood smear demonstrated babesia with 2% parasitemia load. Azithromycin and atovaquone were added to treatment regimen in addition to doxycycline as Lyme antibodies IgG and IgM were positive so it was not known whether this was an old infection with IgM persisting or a new infection. Once the appropriate treatment was begun, his pancytopenia began to resolve with complete resolution by the end of the treatment course.
Discussion: Both Babesiosis and Lyme disease are commonly transmitted by Ixodes scapularis ticks and are able to be transmitted together2,3. Tick bites characteristically occur during warm months in Pennsylvania, peaking in May and June however can be seen earlier4. Babesia infections may be seen in any individual but are notably found in patients who are greater than 60 years old or are asplenic5. Common symptoms are similar to other tickborne illnesses, including fever, chills, and headaches so blood smear is necessary for diagnosis2. Unfortunately, tickborne illnesses are on the rise in Pennsylvania. At Hershey Medical Center during 2005-2010, there were no cases of babesiosis, however since that time there has been a steady rise in cases with 1 case in 2011, increasing to 4 in 20181.This trend is not unique to Pennsylvania. The CDC has recognized growing expansion of ticks which has led to an increase in tickborne infections in addition to new species of ticks which have introduced new diseases6. Factors including climate change and changes in the landscape have caused this trend but it is now the duty of providers to be aware that tickborne illnesses are an emerging concern6.
Conclusions: The CDC has recognized growing expansion of ticks which has led to an increase in tickborne infections in addition to new species of ticks which have introduced new diseases6. Factors including climate change and changes in the landscape have caused this trend but it is now the duty of providers to be aware that tickborne illnesses are an emergent concern6. Public Health Actions: educate patients on how to avoid and check for ticks, how to remove ticks, and when to seek medical care.