Rick DiMichele, a physically fit 55-year-old, came down with a mysterious disease last summer. He had a fever of 103 degrees, he looked pale and puffy, and he had a terrible pain in his side.
It turned out to be a rare infection called babesiosis, which is similar to malaria. While malaria is common in tropical climates, DiMichele believes he caught this disease in his own Ipswich backyard.
Babesiosis is spread by deer ticks, the same insects that spread Lyme disease. DiMichele, who works at New Balance in Lawrence, lives on a wooded road about two miles from the center of Ipswich, where deer eat people’s shrubs and Lyme disease is a major concern.
Babesiosis is so new North of Boston that many doctors — including DiMichele’s — fail to recognize it. The disease wasn’t even known in Massachusetts until the 1980s, said Dr. Bela Matyas, medical director of the epidemiology program at the Massachusetts Department of Public Health. It didn’t reach Essex County until 1998. The New Hampshire Department of Health and Human Services doesn’t monitor the disease, so it’s unclear how many cases there are in that state.
Where the disease is being monitored, it appears to be spreading, Matyas said. Much like Lyme disease, babesiosis seems to have arrived in coastal communities like Ipswich first and then spread inland. There have now been recorded cases of babesiosis in Lowell and Lawrence, he said.
“More of Essex County is impacted now,” Matyas said. “There’s been more of a movement west.”
Dr. Hilary Aroke, chief of infectious disease at North Shore Medical Center in Salem, said the hospital laboratory is on alert for the disease because there has been an increase in cases in the past two years.
“We are seeing more cases than usual,” Aroke said. “I think we have seen definitely an increase in the number of cases per year.”
Around the same time DiMichele was diagnosed, his neighbor’s dog died of a disease believed to be babesiosis. Last month another Warner Road neighbor, 78-year-old Tom Gregory, spent a week at Salem Hospital with the disease.
The good news is that babesiosis is treatable. Once a doctor suspects babesiosis, the test to confirm the diagnosis gives a clear-cut answer and the treatment is usually a combination of antimicrobial drugs. Less than 1 percent of patients die of the disease, and sometimes it goes away on its own.
The trouble is getting doctors to recognize the symptoms in the more severe cases and to order the test.
Many doctors still think of babesiosis as a problem limited to Nantucket, Martha’s Vineyard and Cape Cod, where it has been circulating for nearly a generation, Matyas said.
“Physicians have historically seen the tick-borne diseases being limited to certain parts of the state,” he said. “A lot of people think that’s the only place to get it. ... Unfortunately the risk has spread.”
Doctors here are simply not on alert for babesiosis the same way they are for other diseases, Aroke said.
“In the right time of the year, almost every physician in Massachusetts is aware of Lyme disease,” Aroke said. “I don’t think all physicians are aware that the deer tick can transmit other infections.”
Also, the symptoms are nonspecific and can be mistaken for other things, Aroke said. A patient might be sick with nondescript flu-like symptoms for weeks or months before seeing a doctor, he said, and in most cases the patient doesn’t remember being bitten by a tick.
Still, as more local patients are diagnosed with babesiosis, doctors are getting better at picking it up, he said.
“Physicians are becoming more and more aware of this disease,” Aroke said. “The laboratories are more attuned to looking for it.”
In DiMichele’s case in July, a local emergency department missed his diagnosis entirely. He followed up with his regular doctor at Massachusetts General Hospital, who told him he might have cancer. It wasn’t until DiMichele saw a hematologist at Massachusetts General that he first heard the word babesiosis, and the doctor thought it was a long shot because the disease is so rare.
Before the test results came back, DiMichele was convinced he had cancer. It seemed impossible that he could have a tick-borne infection, he said, because he’s so vigilant about ticks because of Lyme disease.
DiMichele runs in the woods for an hour three or four times a week, and he always takes care to stay in the middle of the path and to scan his body for ticks.
“I check myself all the time,” he said, “and I just did not believe that I could be infected with something like that.”
The test results were clear, though. He had babesiosis.
By the time DiMichele got the diagnosis, he was jaundiced, weak and having trouble breathing because of the pain in his side, which turned out to be caused by his swollen spleen. He got himself to work every day at New Balance, where he is an information technology manager, but in retrospect, he’s not sure how.
His fever went away quickly after he started the antimicrobial drugs. His spleen also returned to a normal size, causing him to drop 15 pounds in the course of about a week.
Some of his other symptoms, such as night sweats and low red blood cell count, reacted more slowly to the medicine, he said, but about six weeks after he started taking the drugs, he felt healthy again.
Gregory, DiMichele’s 78-year-old neighbor, had the misfortune to catch babesiosis and Lyme disease at the same time, possibly from the same tick bite. He had a fever of 102.5 degrees. The doctors diagnosed Lyme disease right away, he said, but it wasn’t until he went home a week later that the hospital called and told him that lab tests confirmed he also had babesiosis. They put him on a different set of medications.
He and his wife have both had Lyme disease before and they take precautions against ticks, so he was surprised by the babesiosis diagnosis.
“The Lyme disease didn’t make me sick at all,” Gregory said. “Babesiosis really knocked me out.”
Gregory has mostly recovered now and is taking the same precautions against ticks as before: using bug spray and checking carefully for the little bugs when he comes indoors.
“The ticks can be anywhere,” he said.
DiMichele said he went through a hypervigilant phase after his illness when he tucked his pant legs into his socks and used harsh bug sprays that he previously avoided. He has relaxed a bit since then, but he’s still on the lookout for ticks. He’s actually more worried about catching Lyme disease than babesiosis, he said, because Lyme disease is harder to diagnose and can have longer-lasting effects.
If he catches babesiosis again, DiMichele said, he will recognize it this time and that will make all the difference.
“The toughest part was not knowing what it was,” he said. “After I found out, it was treatable.”
Rick DiMichele contracted a rare parasite infection called babesiosis, which is spread by deer ticks, last summer.Linsey Wuepper/Staff Photo(Click for larger image)
