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Babesiosis — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsBabesiosisSCE Infectious Diseases

A 52-year-old man presents with a 5-day history of fever, severe headache, myalgia, and jaundice after hiking in the Scottish Highlands. He reports multiple tick bites. Blood film shows intra-erythrocytic ring forms resembling Plasmodium. He has no travel history outside the UK. What is the most likely diagnosis?

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Correct answer: B — Babesiosis (Babesia divergens)

Intra-erythrocytic ring forms resembling Plasmodium in a patient with tick exposure in the UK (no malaria-endemic travel) is highly suggestive of Babesiosis. Babesia divergens (transmitted by Ixodes ricinus ticks in Europe) causes a malaria-like illness with fever, haemolytic anaemia, and jaundice. It is particularly severe in asplenic patients. Distinguishing features from Plasmodium include: maltese cross/tetrad forms, multiple ring forms per RBC, and lack of schizonts/gametocytes. Treatment is Atovaquone plus Azithromycin (or Clindamycin plus Quinine for severe disease).

Reference: UKHSA 2023 – Babesiosis; PHE 2019 – Tick-borne infections in the UK