Ectopic pregnancy is a life-threatening condition affecting up to 2% of gestations. Implantation in the fallopian tube is most common, with symptoms typically presenting earlier for gestations in the ampulla and isthmus compared with the cornua and non-tubal sites. In this paper, the cases are described of two patients with advanced ectopic pregnancies that ruptured. One woman aged 36 years presented at 17 1/7 weeks' gestation with a ruptured cornual ectopic pregnancy. The other woman, aged 35 years, presented at 11 1/7′ weeks gestation with a ruptured ectopic pregnancy in the left tubal ampulla. To our knowledge, there are no other reported cases of a tubal ampulla pregnancy presenting at such an advanced gestation with no prior symptoms.

Procalcitonin is gaining momentum in the study of protozoal sepsis, but its utility as a biomarker has yet to be fully discovered in human babesiosis. A total of 33 cases of acute babesiosis dating between 2012 and 2019 were retrospectively collected from Stony Brook University Hospital (SBUH) and Stony Brook South Hampton Hospital (SHH), both of which are located on Long Island, NY. Cases were cross-referenced for the need for ICU admission, and the procalcitonin levels were measured by the use of BRAHMS Elecsys assay at SBUH and BRAHMS Architect assay at SHH. Our study demonstrated that the log-transformed procalcitonin levels had a linear correlation with log-transformed maximum parasitemia, which suggests that procalcitonin directly correlates with parasitemia values. Furthermore, when comparing values that predict ICU admission, our ROC analysis of procalcitonin demonstrated similar AUC values to the percentage of parasitemia, suggesting that procalcitonin may assist in determining the severity of disease. We demonstrate that procalcitonin may directly correlate with the parasitemia percentage and have prognostic capabilities, which suggests that procalcitonin may have biomarker potential in human babesiosis.

Background Procalcitonin (Pct) has been gaining momentum as a potential biomarker during parasitic infections as studies have demonstrated that Pct levels are significantly elevated during certain forms of protozoal sepsis. Given this, the goal of this pilot study is to determine the relationship between Pct levels and parasitemia (Par) during infection with Babesia microti and to elucidate the potential for Pct to be used as a biomarker in the study of babesiosis. Methods Babesia cases were collected from Stony Brook University Hospital (SBUH) and South Hampton Hospital (SHH) from 2012 to 2019. Median values of maximum Par and Pct throughout hospitalization were recorded and cases were referenced for admission to the intensive care unit (ICU). Correlation between maximum Par and Pct values were examined with the nonparametric Spearman rank correlation and fractional polynomials were used to assess the functional form of the correlation. Receiver-operator characteristic (ROC) curve analyses were used to identify cutoff points for Pct and maximum Par as markers for prediction of ICU admission. Results A total of 33 patients met the inclusion criteria for acute babesiosis. In fractional polynomial analysis, log-transformed Pct levels had a linear correlation with log-transformed maximum Par, r=0.556 (P=0.001, Fig 1A). In ROC curve analysis, a cut off level of ≥ 1.2 ng/mL for Pct had optimal prediction characteristics for ICU admission (sensitivity 62.5%, specificity 88%; correct classification 82%) with a relevant AUC of 0.77 (95% CI: 0.58–0.89; P=0.005, Fig 1B). A cut off level of ≥ 3.6% for maximum Par had optimal prediction characteristics for ICU admission (sensitivity 75%, specificity 92%, correct classification 88%) with a relevant AUC of 0.75 (95% CI 0.58—0.89; P= 0.005, Fig 1B). Comparison of AUC for Pct and Par yielded no significant difference (P=0.8). Figure 1A. Linear correlation between log10-parasitemia and log10- procalcitonin levels. The linear correlation of the log-transformed variables was r=0.556 (P=0.001), similar to the nonparametric (Spearman) correlation coefficient (ρ=0.567). The red dots represent patients who were admitted to the intensive care unit. Figure 1B. Receiver-operator characteristic curve of parasitemia for prediction of intensive care unit admission (0.75; 95%CI: 0.58—0.89; P=0.005); optimal cut-off is 3.6%. Receiver-operator characteristic curve of procalcitonin for prediction of intensive care unit admission (C=0.77; 95%CI: 0.58–0.89; P=0.005); optimal cut-off is 1.2 ng/mL. Conclusion Our analysis demonstrated a positive linear correlation between Pct and maximum Par, which is the current standard marker for severe disease. Also, our ROC analyses estimate that Pct values ≥ 1.2 ng/mL and Par ≥ 3.6% suggests severe disease and need for ICU admission (Fig 1A, 1B). Given this, our findings suggest that Pct may have potential for predicting severe disease during babesiosis. Disclosures All Authors: No reported disclosures.

HighlightsTraumatic splenic hematoma may present as large bowel obstruction.Large bowel obstruction secondary to splenic hematoma may become a more-frequently recognized phenomenon.Large bowel obstruction secondary to splenic hematoma may be managed non-operatively and resolve in approximately one week.