01
Suspect babesiosis with fever, hemolytic anemia, fatigue, and dark urine after Ixodes exposure, especially in the Northeast or upper Midwest.
02
Diagnosis: peripheral blood smear (looking for intraerythrocytic parasites) and Babesia PCR.
03
Mild to moderate disease: atovaquone 750 mg + azithromycin 500 mg day 1 then 250 mg daily, for 7-10 days.
04
Severe disease (hospitalized, immunocompromised, asplenic): clindamycin + quinine, sometimes with exchange transfusion.
05
Doxycycline does not cover babesiosis; co-infection with Lyme requires both regimens.
06
Asplenic and immunocompromised patients may relapse; longer courses are sometimes needed.