Table 1. Clinical features, diagnosis, and treatment of babesiosis, anaplasmosis and Lyme disease.

PCR: polymerase chain reaction, Ig: immunoglobulin, IFA: indirect fluorescent antibody

Infection	Clinical Features	Diagnosis	Management
Babesiosis	fatigue and malaise fever up to 40.9°C (105.6°F) chills, sweats, anorexia, headache, myalgia, nausea, cough, and arthralgia Physical examination: Hepatosplenomegaly, pharyngeal erythema, jaundice, and retinopathy with splinter hemorrhages and retinal infarcts	Positive Giemsa or Wright staining of thin blood smear or Positive PCR antibody assay A history of tick exposure is useful but may be absent because the bite often is unnoticed	Mild to moderate: atovaquone plus azithromycin for 7 to 10 days. Severe disease: Clindamycin plus quinine for at least 6 weeks including 2 weeks after babesia parasites are no longer detected on blood smears
Lyme Disease	Localized stage: erythema migrans, flu-like symptoms, lymphadenopathy Disseminated stage:  multiple secondary annular rashes, Flu-like symptoms, lymphadenopathy Rheumatologic manifestations: transient, migratory arthritis. single or multiple joint effusion, bone, muscle, bursae pain Cardiac manifestations: conduction abnormalities, myocarditis, pericarditis Neurologic manifestations; Bell’s palsy, meningitis, encephalitis.	If positive enzyme immunoassay or immunofluorescent essay and signs and < 30 days of symptoms: positive IgM and IgG Western Blot	Adults: doxycycline (10-21 days), amoxicillin or cefuroxime (14-21 days) Children: amoxicillin (14-21 days) Neurological or cardiac forms: intravenous ceftriaxone or penicillin.
Anaplasmosis	Early illness: Fever, chills, Severe headaches, Myalgias, nausea, vomit, diarrhea, loss of appetite Severe illness: Respiratory failure, Bleeding problems, Organ failure, Death Laboratory findings: leukopenia, thombocytopenia	Based on clinical signs and symptoms, and can be confirmed by: IFA or PCR testing, or characteristic intraleukocytic morulae on peripheral blood.	Doxycycline in all ages