Procalcitonin is gaining momentum in the study of protozoal sepsis, but its utility as a biomarker has yet to be fully discovered in human babesiosis. A total of 33 cases of acute babesiosis dating between 2012 and 2019 were retrospectively collected from Stony Brook University Hospital (SBUH) and Stony Brook South Hampton Hospital (SHH), both of which are located on Long Island, NY. Cases were cross-referenced for the need for ICU admission, and the procalcitonin levels were measured by the use of BRAHMS Elecsys assay at SBUH and BRAHMS Architect assay at SHH. Our study demonstrated that the log-transformed procalcitonin levels had a linear correlation with log-transformed maximum parasitemia, which suggests that procalcitonin directly correlates with parasitemia values. Furthermore, when comparing values that predict ICU admission, our ROC analysis of procalcitonin demonstrated similar AUC values to the percentage of parasitemia, suggesting that procalcitonin may assist in determining the severity of disease. We demonstrate that procalcitonin may directly correlate with the parasitemia percentage and have prognostic capabilities, which suggests that procalcitonin may have biomarker potential in human babesiosis.

Purpose of Review This article aims to review the relevant updates in pathogenesis, diagnostics, clinical manifestations, and treatments of tick-borne diseases involving the nervous system, with special emphasis on emerging viral and bacterial infections transmitted by deer ticks (Ixodes scapularis). Recent Findings Neuroborreliosis includes a wide array of peripheral and/or central nervous system syndromes, of which diagnosis depends on a combination of clinical gestalt, serum serologic testing, and CSF cellular and serologic analysis. Powassan virus may cause life-threatening neuroinvasive disease and diagnosis that is based on CSF serology with treatment being largely supportive. Neurologic manifestations of anaplasmosis and babesiosis are rare but have been documented in case reports. Diagnosis is dependent on serum molecular and microscopic and serologic testing, and the pathophysiologic mechanisms of these neurologic syndromes are not fully understood. Borrelia miyamotoi is an emerging pathogen and, in immunocompromised patients, can cause severe meningoencephalitis. Summary Ixodes scapularis-borne infections such as Lyme disease, anaplasmosis, babesiosis, Powassan virus, and Borrelia miyamotoi disease can have significant neurologic manifestations. Due to the potential for poor outcomes, physicians must have a working knowledge of these pathogens, and a high index of suspicion is required to screen for these diseases in patients with the correct risk factors. Future research will help realize the full range of neurologic manifestations of these pathogens and also clarify their underlying pathophysiologic mechanisms, which will aid in developing new methods of diagnosis and treatment.

Background: Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection. Methods: We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as “baseline” if they were drawn within 2 months before or after the infection as part of routine care. Results: A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician’s clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis. Conclusion: LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.