Unexplained Recurrent Fevers and the Importance of Inquiring About Occupation: A Case Report

INTRODUCTION Many different tick-borne diseases are identified in various geographical areas throughout the United States. Ixodes scapularis tick-borne diseases can present unique diagnostic challenges because of their constellation of vague symptoms. The Ixodes scapularis tick, more commonly known as the blacklegged tick, is responsible for three specific tick-borne infections: Lyme disease (Borellia burgdorferii), Babesiosis (Babesia microti), and Anaplasmosis (Anaplasma phagocytophilum) also known as human granulocytic anaplasmosis. Although these three tick-borne diseases are characteristically found in the New England area, the geographical distribution of the Ixodes tick has expanded to encompass much of the northeastern United States and even states in the upper mid-west.1 Although Lyme disease is the most prevalent of the tick borne illnesses, the incidence of Babesiosis has increased exponentially in the last 50 years and cases have recently been reported in 22 states.2 Here we present a case of Babesiosis which was diagnosed only after an occupational history detailing tick exposure was obtained.