Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Abstract

Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

Diseases Transmitted by the Black-Legged Ticks in the United States: A Comprehensive Review of the Literature

“…Most of the individuals affected by Babesiosis appear to be asymptomatic. However, a group of elderly and immunocompromised patients, including asplenic patients, are at increased risk of developing adverse clinical complications such as hemolysis, thrombocytopenia, acute respiratory distress, renal failure, hepatic compromise, disseminated intravascular coagulation (DIC), altered mental status, and multiorgan failure ultimately causing death [ 21 , 25 ]. Some patients might require supportive care, such as antipyretics, vasopressors, blood transfusions, exchange transfusions, mechanical ventilation, or dialysis [ 26 ].…”

Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction

“…Several infection diseases could lead to a splenic infraction, such as babesiosis and malaria [10,11]. Splenic infarction is a rare complication of infectious mononucleosis.…”

“…Insufficient blood supply due to hypercellular splenomegaly, especially in chronic hemolytic disorders, the transient hypercoagulable state, and increased levels of circulating immune complexes (CICs) which facilitate leukocyte aggregation and adhesiveness are noted as probable mechanisms for splenic infarction [12,14]. In contrast to babesiosis, erythrocyte lysis by direct organism invasion is not a prominent mechanism of splenic infarction in IM; however, increased CIC levels may have a role in both diseases [10]. Similar to IM, the hypercoagulable state may contribute to splenic infarction in malaria.…”

“…), abdominal CT scan results revealed that the US is diagnostic only in 18% of patients [18,19]. e treatment strategy for splenic infarction is primarily based on the underlying disease and ranges from supportive care to splenectomy [10,20]. Life-threatening complications of splenic infarction are pseudocyst formation, abscess, hemorrhage, splenic rupture, and aneurysmal formation [20].…”

“…Life-threatening complications of splenic infarction are pseudocyst formation, abscess, hemorrhage, splenic rupture, and aneurysmal formation [20]. As our patient was asymptomatic and did not have any risk factors for splenectomy in babesiosis (hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture), mentioned by Dumic et al, conservative management strategy was selected [10]. And he was advised to avoid strenuous physical activity for 3-6 months, considering the chance of splenic rupture.…”