Tick Tock-A Matter of Time: Two Cases of Babesia Acquired in Urban Newark, NJ

Babesiosis is a parasitic tick-borne infectious disease that is well elucidated in medical literature and known to be endemic to the Midwest and northeast United States. However, like other infectious diseases, its epidemiology is subject to change. This case report documents two cases with clinical presentations that deviate from what is expected in typical cases of Babesiosis. Two patients presented to a safety-net hospital in Newark, NJ, during the summer of 2022 with nonspecific symptoms. The first patient had a history of polysubstance use disorder and presented with bilateral leg pain, drowsiness, exertional dyspnea, back pain, and chest pain. The second patient had recently returned from a trip to Guatemala and presented with subjective fevers, generalized myalgias, malaise, headaches, and chills. Both patients underwent similar workups yielding a diagnosis of Babesiosis. Of note, neither patient had recently spent time in wooded areas. Ultimately, both patients were treated for Babesiosis with resolution of their presenting symptoms. These two cases suggest that the epidemiology of Babesiosis is changing and provide a clinical workflow for diagnosing and managing this disease in a modern healthcare setting.