Patients may have multiple secondary cutaneous annular lesions. Fever, adenopathy, and cranial neuritis are common.9 Respiratory symptoms are again unusual, but cough may be present. There are no reports of respiratory symptoms during stage 3 of Lyme disease. Babesia microti is the causative agent in the northeastern United States, Babesia equi in California. Other organisms within the genus Babesia may also cause disease.
Transmission is by the tick Ixodes scapularis in the Northeast.
Other ticks, such as Ixodes pacificus in California, may serve as the vector when disease is contracted outside the normal range of Ixodes scapularis. Most cases occur in the northeastern United States, but cases are reported as far south as Virginia and Georgia. There are sporadic reports of babesiosis in California, Washington, Wisconsin, and Minnesota. Several days later, patients typically have fever, sweats, myalgia, and headache. Six patients have had adult respiratory distress syndrome associated with babesiosis.