CONCURRENT LYME-DISEASE AND BABESIOSIS - EVIDENCE FOR INCREASED SEVERITY AND DURATION OF ILLNESS

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 Participant s.-Long-term residents of the island community and patients seeking tr eatment at the clinics. Main Outcome Measures.-Seroreactivity to the a gents of Lyme disease and babesiosis and number and duration of sympto ms. Results.-Of 1156 serosurvey subjects, 97 (8.4%) were seroreactive against Lyme disease spirochete antigen, of whom 14 (14%) also were se roreactive against babesial antigen. Of 240 patients diagnosed with Ly me disease, 26 (11%) were coinfected with babesiosis. Coinfected patie nts 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 frequen tly than those with Lyme disease alone. Thirteen (50%) of 26 coinfecte d patients were symptomatic for 3 months or longer compared with 7 (4% ) of the 184 patients with Lyme disease alone from whom follow-up data were available (P<.001), Patients coinfected with Lyme disease experi enced more symptoms and a more persistent episode of illness than did those (n=10) experiencing babesial infection alone. Circulating spiroc hetal DNA was detected more than 3 times as often in coinfected patien ts as in those with Lyme disease alone (P=.06). Conclusions.-Approxima tely 10% of patients with Lyme disease in southern New England are coi nfected with babesiosis in sites where both diseases are zoonotic. The number of symptoms and duration of illness in patients with concurren t 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 shou ld be considered when moderate to severe Lyme disease has been diagnos ed.