Doc: Avid hiker meets bad bug, ends up with babesiosis
Dear Dr. Roach: I am an avid hiker, and I live in an area with lots of Lyme disease. I recently developed some fever, headache, shaking chills and dark urine, and just felt awful. My doctor did some blood tests and said I had Babesia and/or Anaplasma. Are these related to Lyme disease?
Dear I.J.M.: Like Lyme disease, babesiosis (caused usually by Babesia microti) and anaplasmosis (caused by Anaplasma phagocytophilium) can be spread by the bite of the deer tick, Ixodes scapularis, but neither bacteria species are related to Borrelia burgdorferi, the cause of Lyme disease. These diseases are not well-known by most people, nor even by many general doctors outside the areas where they are common, such as Wisconsin and Connecticut.
Babesiosis causes fever as high as 105.6 F, fatigue and feeling unwell. Dark urine is occasionally present. There are nonspecific lab findings, such as anemia and low platelet counts, but the diagnosis is confirmed by seeing the bacteria inside the red blood cells or by sophisticated blood testing (PCR). Treatment is with azithromycin and atovaquone.
Anaplasmosis has a generally lower fever, muscle aches, headache, chills and the same feeling of being unwell (called “malaise” in medical literature). Blood counts frequently show low white blood cell counts. The diagnosis is made by antibody or PCR testing, but treatment is usually started in the appropriate setting even before positive results. Treatment is with doxycycline.
Tickborne diseases may exist at the same time, so consideration must be given to people having both anaplasmosis and babesiosis, with or without Lyme disease. Doxycycline treatment for anaplasmosis also treats early Lyme disease, but does not treat babesiosis.
Both anaplasmosis and babesiosis can be very severe in people with immune system disease, such as HIV or an organ transplant. Older people are also at higher risk for severe disease.
Dear Dr. Roach: I read that high blood pressure is 140/90, but I thought 120/70 was optimal. Has the standard number increased?
Dear D.M.I: The “pressure” in “blood pressure” is given in millimeters of mercury. It is a measurement of the pressure inside large blood vessels, first at its peak during the left ventricle squeezing (the systolic, or top number) and then at its lowest, right before the ventricle starts squeezing again (diastolic, or bottom number). Both of these numbers are important, and they provide important information about the physiology of the heart and blood vessels, as well as provide prognostic information about the risk of heart attack and stroke. In general, for healthy people, the higher the numbers, the greater the risk. The optimum blood pressure for health is about 110/70, but there are some people with lower values who are also very healthy and who have very low risk for vascular disease.
Risk for heart disease starts to go up more significantly at about 140/90, but above a systolic number of 160, the risk goes up even more dramatically. The trend in blood pressure control over recent years has been toward making the blood pressure closer to the optimum, as long as treatment is well-tolerated. Having a slightly lower risk of heart attack may not be worth it to a person who has significant symptoms from blood pressure medicines.
Fortunately, blood pressure is much easier to control than it used to be with better medications and with non-drug treatments, such as stress reduction, healthy diet, regular moderate exercise and, for some people, salt restriction.
Readers may email questions to ToYourGoodHealth@med.cornell.edu