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Update: This article was completely rewritten on 7/27/23.
In this article I describe how to diagnose chronic Babesia in chronic Lyme disease. Because testing is not perfect, I often rely on symptoms to guide me.
There are many strains of Babesia. By some estimates there are 15 or more strains. The most well known strains are B. microti and B. duncani. More recent research suggests the most prominent strain in people living with chronic Lyme disease and related tick-borne infections is B. odecoilei.
Babesia strains infect red blood cells. Acutely this can lead to red blood cell rupture and anemia.
Chronically, the infected red blood cells wrap themselves in a blood clotting protein called fibrin. These infected cells wrapped in fibrin form nests. These nests attach to blood vessel walls, limiting blood flow in the smallest blood vessels. This leads to limited blood flow to every organ system in the body causing system wide symptoms and problems.
Both acute and chronic Babesia trigger excess white blood cell cytokines leading to a host of problems like immune suppression, insomnia, fatigue, thinking problems, hormonal dysfunction, body pains, and even neurologic dysfunction. Read more about cytokines in Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System.
Acute babesia symptoms include fever, body pains, shortness of breath (air hunger) headaches, and fatigue. These symptoms are caused by acute white blood cell cytokine increases or due to anemia that develops from red blood cell and spleen involvement.
Chronic babesia symptoms may involve most organs in the body. These can include marked fatigue, exercise or activity intolerance, memory and thinking issues, muscle aches, air hunger, racing or skipping of the heart, low blood pressure on standing, panic attacks, night sweats, migraines, frontal headaches, temperature intolerance (hot one minute, cold the next), a feeling of imbalance while walking, and increased deja vu episodes.
One physical sign of Babesia is the sudden development of numerous small cherry red spots on the skin.
B. microti, B. duncani, and B. odecoilei can all trigger acute Babesia symptoms. Chronic Babesia is more likely due to B. odecoilei as it leads to fibrin nests and decreased blood flow to the tissues. B. duncani and B. microti may also lead to chronic Babesia symptoms due to increased cytokines.
The best test for Babesia is the IGenex Immunoblot. I explain why below.
There are a lot of false negative tests in Babesia. This means the test is negative, even when a person truly has the infection. One reason for this is a common immune system test to detect antibodies called an IFA test, does not exist for most strains of Babesia. IFA testing is easily available for B. microti and B. duncani. However, there is not a test for B. odecoilei or the other strains. This is the test method most doctors use. In my opinion, it is not worth doing.
IGenex has the newest and best testing method for Babesia called an Immunoblot. The Immunoblot can see if the immune system is making antibodies against Babesia. More specifically, IGenex tests to see if there are antibodies against two specific strains (B. microti and B. duncani). But, IGenex goes one step further and also tests if there are antibodies against the whole family of Babesia. This means it can tell if a person is infected with one of the 15 different strains of Babesia that infect a person including B. odecoilei. This makes the IGenex Immunoblot the most sensitive test to determine if a person is infected with any strain of Babesia. The IGenex Immunoblot is also very specific. So if the test comes back positive, it really is positive.
IGenex has a microscope test to see if Babesia is in red blood cells. To help the Babesia germs standout, a fluorescent marker is attached to the Babesia genetic material. This marker attaches to any germ that is part of the Babesia family. The problem is the test clinically is not that sensitive at finding Babesia. I have found that a person has to have a lot of Babesia germ load for this test to detect an infection. So if a test is negative—it does not exclude having an infection. This test is very specific for Babesia—so if it is positive, a person really has a strain of Babesia living in them.
A question I am often asked in Conversations with Marty Ross MD is:
My Babesia Fish test was positive, does a negative test mean I am done treating Babesia?
Not necessarily, if a person still has a lot of Babesia symptoms, I still recommend treating. As I point out above, a Babesia FISH test may be negative if there is a lower germ load—but not an absent germ load. On the other hand, if the test comes back positive, it definitely means Babesia is still present.
There is one additional way to test for Babesia called an Elispot. This test looks to see if the white blood cells called T cells have seen Babesia before. This test has a major drawback. The two companies that offer the Elispot for Babesia only test for reaction to B. microti. In other words, they do not look for reactions to all the 15 strains that can infect a person including B. odecoilei.
For more information and a more detailed review of the testing options see The Best Lab & Test for Borrelia, Bartonella, & Babesia.
Figuring out if a person has Babesia as part of Lyme disease involves putting together the pieces of the puzzle. If there are a large number (but not all) of signs or symptoms of this coinfection, then in my opinion it is appropriate to treat without testing. I say this because a negative Babesia test does not exclude or rule out the diagnosis.
When it is not clear enough based on a lack of a tick bite history and the symptoms that Babesia is present, then I suggest doing the IGenex IGM and IGG Immunoblot for Babesia (tests 900 and 905). If it comes back positive, then definitely treat for Babesia.
See Kills Babesia: A Brief Guide for herbal and prescription antibiotic options to get rid of Babesia in a chronic Lyme disease infection.
The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.
Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.
Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).
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