Severe Babesiosis in Long Island: Review of 34 Cases and Their Complications

Abstract

Thirty-four consecutive patients were hospitalized with diagnosis of severe Babesia infection over the course of 13 years. The average time from onset of symptoms to diagnosis was 15 days. When compared with uninfected febrile control patients, affected patients complained significantly more often of malaise, arthralgias and myalgias, and shortness of breath (P<.05), and they more often had thrombocytopenia and abnormal liver function (P<.05). Forty-one percent of patients with Babesia developed complications such as acute respiratory failure, disseminated intravascular coagulation, congestive heart failure, and renal failure. Analysis of data revealed that complicated babesiosis was more commonly associated with the presence of severe anemia (hemoglobin level <10 g/dL; P=.01) and higher parasitemia levels (>10%; P=.08). Patients were treated with a combination of drugs that included clindamycin, quinine, atovaquone, or azithromycin. Despite treatment, parasitemia persisted for an average of 8.5 days (range, 3--21 days). Exchange transfusion was performed for 7 patients, and it effectively reduced the high levels of parasitemia. Three patients died. Improved outcomes may result with prompt recognition and treatment of babesiosis.

Can tumor necrosis factor α blockade predispose to severe babesiosis?

“…It does not affect TNF production or serum level; rather, it competitively prevents TNF␣ and Another caveat illustrated by the current case is the presence of anemia and thrombocytopenia in the setting of active babesiosis and anti-TNF␣ use. Mild to severe hemolytic anemia and thrombocytopenia are common findings described in cases of babesiosis (11). Conversely, anti-TNF␣ agents can affect the growth of hematopoietic stem cells and potentially result in peripheral cytopenias.…”

Impact of Co-Infections in Lyme Disease

“…more than 10 days) to be prescribed [32]. In patients severely ill with haemolysis and organ failure with high levels of Babesia in blood, transfusions may be sensible [33,34].…”

Shared features in the pathobiology of babesiosis and malaria

“…P. falciparum generally causes more severe disease than the other species of Plasmodium (P. vivax, P. malariae, P. ovale) or than the Babesia species that infect humans (B. divergens, B. duncani [Washington1 or WA1], B. microti, EU1 [European Union1], MO1 [Missouri1], and TW1 [Taiwan1]). A pattern of disease similar to that of malaria might occur, however, in people experiencing severe babesiosis [22,39,40]. Although individual manifestations are described as discrete entities, patients experiencing fulminant P. falciparum malaria or babesiosis might suffer simultaneous complications of several organ systems with similar pathologic findings [6,41].…”

“…Intravascular sequestration of parasites and leukocytes has been reported on autopsy specimens of lung [63,64]. Pulmonary disease is the most common complication in people experiencing severe babesial infection with up to 20% of patients suffering from non-cardiac pulmonary edema [39,65]. The role of proinflammatory cytokines in the pathogenesis of pulmonary complications of B. duncani infection has been studied in a mouse model [34,35,46].…”

“…Renal failure has been reported in $5% of severe B. microti human infection and even more frequently in patients experiencing severe B. duncani infection [39,40]. On autopsy of patients dying of malaria, several distinct pathologic patterns are noted in the kidneys, with erythrocyte sequestration and exposure to products of lysed red blood cells contributing to the pathology [67].…”