by Dr. Bill Rawls
Updated 11/26/19

Babesia is spread primarily by ticks, and so perhaps unsurprisingly, it’s a relatively common coinfection in people with chronic Lyme disease. In fact, it may be present in up to 40% of Lyme patients, according to a report in Trends in Parasitology.

But it’s not just a single Babesia strain you have to worry about: A tick can carry multiple species and strains of Babesia, and there are more than 100 different species of Babesia in all, though only about a dozen are known to cause human illness. The most common Babesia species known to cause human illness are Babesia microti, Babesia divergens, and Babesia duncani (WA-1).

Babesia species, however, are more like groups of very similar organisms than distinct species. Babesia has a near infinite ability to continually change its genotype (genetic presentation). It can easily alter its physical form and function to adapt to disruptions in its environment such as antibiotics.

Babesia is a distant but less virulent cousin of malaria. It is a protozoan, meaning it is a one-celled organism with a nucleus surrounding its DNA (protozoans have a nucleus like other higher-level organisms, as opposed to bacteria which have no true nucleus). Otherwise, it is more bacteria-like, and even responds to some antibacterial agents. But because it’s a parasite, it must have a host to survive.

Blood cells in the vein. 3D illustration

Like malaria, Babesia primarily infects red blood cells. It can infect anything with red blood cells (mammals, birds, reptiles, amphibians). From the days of the dinosaurs to modern day, Babesia has been infecting animals for hundreds of millions of years. The modern reservoir for Babesia is the white-footed mouse. It does not cause disease in the mouse or the tick that transmits it.

Infections with Babesia occur most commonly in New England, New York, New Jersey, Wisconsin, and Minnesota, but it is also becoming common in the Southeast. Georgia is the epicenter of southern U.S. infections. It is most commonly spread by black-legged deer ticks (Ixodes scapularis), primarily during the nymph stage. Nymph ticks are only about the size of a sesame seed and very hard to see. And because tick saliva reduces sensation and allergic reaction at the tick bite site, it can be days (or never) before the tick is noticed.

Once inside a human host, Babesia itself often goes unnoticed, too. It is a stealth microbe with similar low virulence characteristics to other stealth microbes.

Stealth Characteristics of Babesia

  • Initial infection is mild or does not cause symptoms in most people.
  • A carrier state is common.
  • Chronic infection is associated with Chronic Immune Dysfunction.
  • Low-grade chronic illness is associated with vague and nonspecific symptoms.
  • The microbe is typically present in low concentrations in the body.
  • It has a slow growth rate.
  • It lives (and reproduces) inside red blood cells (intracellular).
  • It is extremely difficult to diagnose.
  • It responds poorly to antibiotics and vaccines.
  • It can alter its genotype at will for any change in its environment.

In certain situations, Babesia can become highly virulent and cause severe acute illness and even death. Severe acute Babesia infections should be managed appropriately and aggressively, usually with one or more medications.

Because of its potential to cause severe disease, Babesia is higher on the virulence scale (about 5 to 6) than other Lyme coinfections. Initially, Babesia was thought to be less prevalent than other coinfections like Bartonella and Mycoplasma.

But the results of a 2014 patient survey of more than 3,000 participants indicated that 32% of the respondents had been diagnosed with Babesia, which places it second only to Borrelia. One thing is for sure: Babesia, like all tick-borne infections, is on the rise, and knowing its signs and symptoms is crucial for getting an accurate diagnosis and prompt treatment.

Symptoms of Mild and Severe Babesia Infection

People bitten by a tick carrying Babesia may hardly get sick at all, or they may get very sick rather suddenly.

For individuals with a healthy immune system, Babesia infections are typically associated with a few symptoms that feel like a mild bout of the flu lasting one to two weeks. After a mild initial infection, the person can become an asymptomatic carrier. Asymptomatic carriers can become severely ill if immune status falters at a later time (such as another bite from a tick carrying Borrelia or other stealth microbes).

Cold And Flu. Sick Afro Man Blowing Nose In Paper Tissue Calling Doctor Sitting On Couch At Home. Copy Space

In certain situations, however, Babesia can cause very severe illness very acutely. Certain people are more susceptible to become severely ill from a Babesia infection, including:

  • People who do not have a spleen (up to 20% mortality)
  • People with a weak immune system (AIDS, corticosteroid therapy, malignancy with therapy, multiple stealth microbe infections at one time)
  • Older adults (>50 years old, especially those with health problems)

The spleen is an essential organ for overcoming Babesia. It acts like a sieve to clear organisms from the blood. The spleen is also the source of chemical messengers that ultimately allow the body to eradicate Babesia.

Common Symptoms Associated with Severe Babesia Infection

  • Recurrent severe drenching sweats
  • High fever (105° F)
  • Severe fatigue and malaise
  • Shaking chills and sweats
  • Severe headache
  • Muscle aches (myalgia)
  • Joint pain (arthralgia)
  • Gastrointestinal symptoms (nausea, abdominal pain, diarrhea)
  • Decreased blood pressure
  • Jaundice (yellow skin and eyes)
  • Bruising
  • Petechiae (small red spots on the skin)
  • Decreased cognition (from intravascular coagulation)
  • Dark urine
  • Pulmonary edema (lungs fill with water)

Severe infection can last weeks to months. A relapsing form of the illness with a recurring cycle happening every several months is common.

Diagnosing Babesia

Like many stealth microbes, Babesia is notoriously difficult to diagnose. Because concentrations of the organism in the body are so low, it is often hard to find. Here are some different tests and methods for sussing it out.

Signs and Abnormal Labs

  • Enlarged spleen and liver
  • Anemia (low hemoglobin)
  • Decreased platelets
  • Evidence of hemolysis (destruction of red blood cells)
  • Elevated liver function
  • Mild neutropenia / leukopenia (decreased white blood cells)
  • Low or unstable blood pressure
  • Organ malfunction (heart attack, stroke, respiratory distress, kidney failure)

Direct Visualization

Red blood cells stained with a special stain called Giemsa are viewed under a microscope. Babesia organisms have the appearance of a Maltese cross or “double pear sign” inside affected red blood cells.

Like other stealth microbes, however, Babesia often remains elusive. Because concentrations of the organism are low in the body (only 1% of red blood cells are typically affected) and hard to see inside stained cells, even the best lab technicians have a hard time picking them up. About the only time direct visualization is valuable is during acute infection with high fever.

In a 2015 article in the Townsend Letter, James Schaller MD, MAR (specialist in the treatment of Lyme disease and Babesia) stated that all direct testing for Babesia is 95% inaccurate.

Polymerase Chain Reaction (PCR)

PCR detects microbial DNA in a blood sample. It is sensitive enough to pick up only a few copies of Babesia DNA in a blood sample and is species specific. It has a better pickup rate than direct visualization, but reviews are mixed on the actual accuracy of the test.

Fluorescent In Situ Hybridization (FISH)

FISH tests for rRNA of a specific Babesia species in blood. It is also designed to be more sensitive and specific than other forms of testing.

Indirect Fluorescence Assay (IFA)

IFA tests for IgG and IgM antibodies produced by the body against Babesia. It does not pick up early infection and is dependent on antibody production by the body. This test is not as valuable as PCR or FISH for diagnosing the presence of Babesia.

Complete Blood Count

An additional test that can be valuable for diagnosing Babesia includes a complete blood count (CBC) showing decreased hemoglobin and low platelets, elevated reticulocyte count, and possibly decreased CD57 and CD8 white blood cells, but this only occurs in very ill individuals. (To an oncologist, this laboratory picture would suggest cancer, and cancer must be completely ruled out if these findings are present.)


This test uses an amplified version of PCR and FISH together for improved accuracy of testing for B. microti and B. ducani. (According to Dr. Schaller, however, in his practice the pick-up rate is only about 25%.) The primary drawback to testing with IGeneX is high expense and lack of coverage by insurance.

Ultimately, the biggest clue to Babesia is generally a high index of suspicion. When a relapsing high fever occurs with anemia, jaundice, and history of tick bite, Babesia should be considered.

The Babesia Life Cycle

Babesia organisms are transmitted mostly by hard ticks. After entering the bloodstream from a tick bite, Babesia immediately invades red blood cells. Inside red blood cells, the organisms rapidly divide (asexual reproduction) and fill the cell with organisms.

Babesia organisms stick large numbers of red blood cells together in a clustering as a food source, and also to gain protection from the immune system. This can result in spontaneous rupture of small blood vessels, causing bruising and formation of petechiae (small red spots on the skin). Because red blood cells are destroyed, severe Babesia infection can mimic cancer.

Enlarged red blood cells, swollen with organisms, can impede passage through capillaries. Babesia also increases clotting (people infected with Babesia clot very fast). In the worst case scenario, this can cause mini strokes. Blockage of small blood vessels from swollen blood vessels and increased clotting are one of the main ways Babesia causes harm.

Babesia parasites inside red blood cell, the causative agent of babesiosis. 3D illustration showing classic tetrad-forms of Babesia merozoites so-called Maltese cross formation

Via red blood cells, Babesia organisms are circulated throughout the body. Babesia organisms then invade cells lining the liver and spleen (endothelial cells). Vacuoles (small cysts) are formed to gain protection from the immune system and antibiotics. Inside the liver and spleen, Babesia organisms reproduce sexually. Sexual reproduction allows maximal genetic diversity.

During a complete lifecycle, Babesia goes through four separate stages (sporocytes, gametocytes, ookinetes, merozoites). All four stages can be present in the body at one time. This guarantees maximal survivability.

The cycle repeats every several months with the release of a flood of microbes into circulation and a relapse of symptoms.

Babesia can be present without causing symptoms for a long time and then a trigger — such as an infection with Borrelia, travel, stress, trauma, or surgery — precipitates an acute attack.

Immune Reaction to Babesia

Like other stealth microbes, Babesia very specifically affects chemical messengers of the immune system to allow itself to flourish. These chemical messengers, called cytokines, orchestrate the entire immune response. Disabling or interfering with the cytokine system is a key strategy of microbes during infection.

The immune system uses specific pathways for dealing with different types of microbes. Different pathways use different cytokines.

  • The Th1 pathway is specific for microbes that thrive inside cells (intracellular). This is the pathway the immune system uses to deal with stealth microbes.
  • The Th2 pathway is designed to deal with intestinal parasites such as nematodes. Babesia (and other stealth microbes) try to shift the immune response away from Th1 toward Th2.
  • Cytokine pathways for:
    Th1 cytokines: intracellular microbes (cytokines: IFN-gamma, IL-12, TNF-alpha)
    Th2 cytokines: intestinal parasites (IL-4, IL-5, IL-10, IL-13)

Th1 cytokines enhance formation of the amino acid, l-arginine, which is necessary for the production of nitric oxide (NO). Nitric oxide is very toxic to microbes and is necessary for killing Babesia organisms.

At initial infection, Babesia immediately stimulates IL-10. This has the effect of down regulating all of the Th1 cytokines, reducing l-arginine (Babesia creates a state of l-arginine depletion), and therefore inhibiting NO production. IFN-gamma also stimulates NO production. Decreasing NO is one of the major actions of the organism in the body.

Encephalitis tick  Ticks on human skin. Ixodes ricinus can transmit both bacterial and viral pathogens such as the causative agents of Lyme disease and tick-borne encephalitis.

Interestingly, tick saliva also inhibits the Th1 cytokines. The longer the tick feeds, the more opportunity the microbe has to infect.

The spleen is a vital organ for overcoming Babesia. Recovery is primarily dependent on the spleen’s production of IFN-gamma and production of NO.

Gradually, the immune system wins out and IL-10 increases. The spleen and immune response clear the infection, but if all microbes are not eradicated from the spleen and liver, the entire cycle can repeat itself.

Conventional Medical Solutions

The conventional medical solution is focused exclusively on killing microbes. While this can be effective in some cases, it does not support restoration of normal immune function or the healing systems of the body. This, along with the fact that antimicrobial resistance by Babesia is becoming commonplace, dramatically limits the value of conventional medical therapy alone.

Blue medication, pills and blister pack from above on grey wooden background. Copy space. Top view, frame. Painkillers, tablets, generic pills, drugs.

It should be noted that doxycycline, commonly used for tick-borne infections, is not effective against Babesia.

Most physicians follow standards recommended by the Centers for Disease Control and Prevention (CDC).

CDC Guidelines for Babesia

Standard treatment of 7-10 days

Atovaquone 750 mg twice daily and Azithromycin 500-1,000 mg, initially followed by 250-1,000 mg daily OR Clindamycin 600 mg 3 times daily or 600 mg IV 4 times daily and Quinine 650 mg 3 times daily

Atovaquone is associated with high incidence of side effects; some people are very sensitive to it. Because of extensive use for prevention of Babesia in livestock, resistance to Atovaquone is becoming common.

Limiting the duration of therapy to 7-10 days is associated with a high relapse rate of 40% to 50%. Longer therapy of 6-8 weeks, especially in immunocompromised individuals, is recommended by most experts who regularly treat Babesia.

The clindamycin-quinine combination is an older regimen associated with a high incidence of side effects. Clindamycin should never be used orally because it can stimulate overgrowth of Clostridium difficile (C.diff.) in the gut. C. diff. is a notorious pathogen associated with severe bloody diarrhea.

It should be noted that Babesia is actually harder to kill than malaria because it is slow growing and occurs in low concentrations in the body. According to Dr. James Schaller, a combination of at least three anti-Babesia medications should be used at one time (when medical therapy is the primary choice of treatment).

Additional Heroic Therapies

The following medications and heroic therapies may be useful for addressing Babesia infection:

Nitazoxanide: This is an anti-parasite drug designed for giardia. It is a broad-spectrum antiparasitic agent that may have activity against Babesia. It is generally well tolerated.

Artemether / Lumefantrine: This is a semisynthetic derivative of the herb artemisia. It can be effective against Babesia and has fewer side effects than Atovaquone.

Atovaquone / Proguanil (Malarone): It kills Babesia, but the combination medication is associated with nausea and other severe side effects.

Mefloquine (Lariam): This drug kills Babesia, but it’s associated with terrible side effects including insomnia, mood changes, irritability, restlessness, and poor concentration.

Heparin: A commonly used anticoagulant administered by subcutaneous or IV injection, Heparin has value for severe Babesia and has the following properties:

  • Inhibits blood coagulation
  • Reduces cerebral impacts
  • Suppresses replication of organisms

Hyperbaric Oxygen Therapy: This therapy involves breathing purified oxygen in a pressurized tube or room. It’s expensive and does not kill Babesia or any other Lyme pathogen.

Ozone Therapy: Ozone administered via IV is unsafe. No studies have adequately defined its efficacy. The value of rectally-administered ozone has not been defined and significant safety issues are present.

Natural Solutions for Babesia Infection

Individuals with healthy immune function generally do not have difficulty clearing Babesia. Any natural approach to overcoming Babesia should be focused on supporting restoration of normal immune function and enhancing the healing systems of the body, as well as killing or suppressing microbes.

The list of herbal and natural therapies with value in Babesia infection is extensive. The following herbs have antiparasitic and antiprotozoal properties to get you moving in the right direction.


Native to India, andrographis contains antiviral, antibacterial, and antiparasitic properties. It is widely used in the treatment of Lyme disease and coinfections like Babesia. The herb also enhances immune function and has cardioprotective properties.

Suggested dosage: 200-800 mg, extract standardized to 10% to 30% andrographolides 2-3 times daily.

Side effects: About 1% of people who take andrographis develop an allergic reaction with whole-body hives and itching skin (a higher percentage than most herbs). The reaction will resolve gradually over several weeks after stopping use of the herb.


Alchornea is a tropical plant that can be found on both hemispheres. There are at least 60 plant species; six of them are found in Africa alone. The most well-known species and the one most likely to be used for medicinal purposes is A. cordifolia. Alchornea has a variety of therapeutic properties, including antimalarial, antiprotozoal, and anti-inflammatory, among others.

Suggested dosage: Varies according to the preparation of the herb; follow the instructions on the product label.

Side effects: There are no known side effects or reports of toxicity associated with this herb.


The primary chemical compound found in artemisia is artemisinin, a potent anti-parasitic that is commonly used for treatment of malaria and Babesia.

Suggested dosage: Varies depending on the preparation, however, artemisia should not be taken for longer than seven days. Its potency quickly declines with extended use, but the dose can be repeated after three weeks.

Side effects: There’s a significant risk of neurotoxicity (damage to nervous tissue) with extended use. Never use the herb for more than a month or two.


Bidens pilosa is the species that has the most powerful action against malaria and malaria-like microorganisms like Babesia. In addition to its antimalarial properties, it’s antibacterial, anti-inflammatory, and neuroprotective.

Suggested dosage: Bidens pilosa is most potent when prepared as an alcohol tincture. The dose may vary depending on the company, but tinctures are an excellent way to begin at a low dose of the herb and increase drops as tolerated.

Side effects: There are no known side effects associated with Bidens pilosa, however, some plants can become contaminated with heavy metals. Make sure you purchase the product from a reputable company who takes steps to minimize exposure to heavy metals. Additionally, you should not take this plant if you are diabetic, as it can cause fluctuations in blood glucose or insulin levels.

Cat’s Claw

Native to the Amazon, cat’s claw has a long history of traditional use for treatment of a wide range of inflammatory conditions. The herb is considered an immunomodulator, meaning it calms an overactive immune system (reducing inflammation). Cat’s claw is antiprotozoal and may provide coverage against Babesia, too.

Suggested dosage: 400-800 mg (inner bark standardized to 3% alkaloids or 10:1 concentrate inner bark is preferred) 2-3 times daily. It is especially important to take this herb with food, as it is activated by stomach acid. If you take acid-blocking drugs, cat’s claw will have limited value.

Side effects: It may cause stomach upset, but it’s generally very well tolerated.


Traditionally used to treat malaria in Africa, cryptolepis demonstrates systemic antibacterial properties and antiprotozoal properties. The herb is anti-inflammatory and provides antimicrobial activity against Babesia.

Suggested dosage: Cryptolepis is available as powder, tea, capsule, or tincture, so the dose varies depending on the preparation.

Side effects: It tends to be well-tolerated in most people.


Neem is native to India and offers potent antibacterial, antiviral, antifungal, anti-inflammatory, and antioxidant properties. Also, it has a protective effect on the liver and kidneys.

Suggested dosage: Dosing varies by preparation, so follow the recommendations provided by whatever product use.

Side effects: Most people tolerate the leaf and bark extracts well.

Red Root

Native to North America, red root clears the lymphatic system and improves lymphatic drainage. This herb may help reduce Herxheimer reactions by clearing debris from dead microbes.

Suggested dosage: It’s available as tinctures, tea, and capsules. Follow the recommendations provided by the product label.

Side effects: Red root enhances coagulation of blood, so individuals who are at risk of blood clots shouldn’t use red root. Also, the herb should only be used short term. Don’t take it if you are pregnant, and avoid using it with coagulant or anticoagulant drugs.

Stabilized Garlic Extract

Garlic has been used medicinally since the beginning of recorded time, but the active chemicals in garlic, called allicin, are very volatile. Through a proprietary process, it is possible to stabilize allicin to increase yield to nearly 100%. Stabilized allicin is now available from several companies. It’s been shown to have potent broad-spectrum activity against gram-positive and gram-negative bacteria and has antiviral, antifungal, and antiparasitic properties.

Suggested dosage: 180-1,200 mg of a stabilized allicin product up to 3 times daily. Like all herbs, dosage is dependent on the garlic preparation used.

Side effects: Raw garlic can cause stomach upset, but stabilized allicin products are associated with few side effects, so stabilized garlic is generally well tolerated.

Sida Acuta

Species of Sida plants are found throughout the world, and the one that is most well-known for its medicinal properties is Sida acuta. The herb has many properties, including antimicrobial, antimalarial, antiprotozoal, and adaptogenic benefits.

Suggested dosage: The herb is available in a variety of forms such as tinctures, tea, capsules, and powder. The dosage varies by preparation, so follow the recommendations provided on the product label.

Side effects: Sida acuta is thought to prevent pregnancy, so the herb should be avoided in women who are pregnant or trying to become pregnant.

The Bottom Line

If you experience symptoms of severe Babesia infection, like high fevers, drenching sweats, bruising, jaundice, and more, it is very important to have a knowledgeable healthcare provider involved in your care to determine the appropriate course of treatment. Recommended therapy may include a combination of conventional drug therapy (for at least 6 weeks) and herbal therapy.

Alternative medicine tablets on a wooden spoon, green leaf.

Babesia infections with mild symptoms or hidden Babesia infections with no symptoms will generally respond to natural protocols focused on immune enhancement and general suppression of microbes. Immune enhancement is the key during your recovery.

In addition to antimicrobials, be sure to support your immune health by focusing on getting great sleep, reducing refined carbohydrates and processed foods in your diet, detoxing to remove toxins, and increasing exercise as tolerated to enhance circulation. Stay the course of treatment, and you’ll notice that your health will gradually improve.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.
You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.


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