Severe Babesiosis and Disseminated Lyme Presenting as Worsening Cognitive Dysfunction in a Geriatric Patient: Special Considerations for Older Adults.

In this article, we present the case of a 78-year-old man with a history of coronary artery disease status post- coronary artery bypass grafting and mild cognitive impairment (previously treated with donepezil and memantine) who was transferred for consideration of exchange transfusion in the setting of high-grade babesiosis parasitemia complicated by disseminated Lyme disease, acute kidney injury, and acute hemolytic anemia. Using this case, we highlight an atypical presentation of the growing burden of tickborne disease in older adults. We review the epidemiology of Lyme disease and babesiosis in aging populations, outline the diagnostic criteria and management considerations for disseminated Lyme disease and severe babesiosis, and discuss clinical factors unique to older patients, including delayed recognition, baseline cognitive impairment, and increased risk of severe complications. This report adds to the expanding literature emphasizing the distinctive presentation and management challenges of increasingly prevalent tickborne infections in older adults.