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Babesia is a single celled protozoan parasite which may be transmitted through the bite of an infected tick, blood transfusion and/ or maternal-fetal transmission. We describe the case of a woman previously treated for Lyme disease and babesiosis who relapsed with severe malaria-like symptoms during the 3rd trimester of two consecutive pregnancies. Testing for active babesiosis was positive in both pregnancies despite prior conventional therapies, and she was subsequently treated with high dose atovaquone (1500 mg PO BID) and Zithromax during each of her 3rd trimesters, along with clindamycin during her 3rd pregnancy. At term, neonates were healthy with no clinical evidence of active babesiosis (no fever, acute respiratory distress syndrome [ARDS], hepatosplenomegaly or jaundice) and no laboratory evidence of babesiosis (no positive blood smears, hemolytic anemia, neutropenia or thrombocytopenia). Intramuscular benzathine penicillin was simultaneously used throughout her four pregnancies to prevent transmission of Borrelia burgdorferi, the agent of Lyme disease, with no evidence of transmission of the spirochete to the fetuses. Although this novel Lyme and Babesia therapy was effective in preventing congenital transmission of Borrelia burgdorferi and Babesia microti in consecutive pregnancies, future studies are needed to define the optimal management strategy for pregnant patients with Lyme disease and babesiosis due to the possible relapsing, remitting nature of the disease and the potential for associated morbidity and mortality. Horowitz R, Freeman PR. Healthy Fetal Outcomes using a Novel Treatment for Maternal Lyme Disease and Babesiosis During Consecutive Pregnancies: A Case Study and Literature Review. Arch Med Case Rep. 2020; 2(1): 1-19. Arch Med Case Rep. 2020 Volume 2, Issue 1 2 [21], and atovaquone and azithromycin [22], both established regimens for the treatment of babesiosis [23]. She was subsequently rotated to a combination regimen of higher dose atovaquone (1500 mg PO BID) and azithromycin, along with a 10-day course of clindamycin during her third pregnancy. At birth, all neonates were asymptomatic with healthy Apgar scores and no clinical or laboratory signs of active babesiosis. Published medical literature on treatment for babesiosis during pregnancy recommends either clindamycin and quinine [24], or atovaquone and azithromycin [25], with variable outcomes in neonates, oftentimes resulting in thrombocytopenia and hemolytic anemia requiring a blood transfusion [17]. It is therefore imperative to find novel therapies that are safe and effective. Our case report is to our knowledge the first to describe the use of a novel combination of Lyme disease and babesiosis therapies during pregnancy which were well tolerated and beneficial in the mother, without clinical or laboratory signs of active infections of B. burgdorferi or B. microti in the newborns.

Healthy Fetal Outcomes Using A Novel Treatment For Maternal Lyme Disease And Babesiosis During Consecutive Pregnancies: A Case Study and Literature Review