Babesiosis: Difference between revisions
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=Background= | ==Background== | ||
*Babesiosis is an infection of the ''Babesia'' species of intraerythrocytic protozoa, causing lysis of host red blood cells. | |||
*Spread by the deer tick (Ixodes scapularis) | *Spread by the deer tick (Ixodes scapularis) | ||
**People often unaware they are bitten | **People often unaware they are bitten | ||
| Line 5: | Line 6: | ||
*Endemic in US, Europe, parts of Russia and China | *Endemic in US, Europe, parts of Russia and China | ||
**Babesia Microti is pathogen in US | **Babesia Microti is pathogen in US | ||
*Possible to have co-infection with Lyme (same tick family) | |||
= | ==Clinical Features== | ||
* | *[[Fever]], hemolytic anemia, chills, [[thrombocytopenia]], [[DIC]] | ||
*More severe disease in immunocompromized patients ([[HIV]], Elderly, [[Asplenic]]) | |||
=Diagnosis= | ==Differential Diagnosis== | ||
{{Tick borne illnesses DDX}} | |||
** | |||
***Maltese Cross sign | ==Evaluation== | ||
[[File:Maltese_Cross.png|thumb|Peripheral blood smear showing "Maltese Cross" classic for babesiosis.]] | |||
*CBC | |||
**Often with depressed white count | |||
*Peripheral Blood Smears | |||
**Shows intracellular parasites: Maltese Cross sign | |||
**May need large smear as parasitemia can be as low as 1% | **May need large smear as parasitemia can be as low as 1% | ||
**Can often be confused for malaria parasites | **Can often be confused for malaria parasites | ||
*Electrolytes and renal function | |||
*LFTs | |||
**Total bilirubin and haptoglobin values reflect the intensity of the infection (hemolysis) | |||
*Lyme | |||
*Urine - hemolysis | |||
*[[CXR]] - rare but possible ARDS | |||
= | ==Management== | ||
* | {{Babesiosis Antibiotics}} | ||
** | |||
** | ==Disposition== | ||
===Admission=== | |||
*Severe anemia (hemoglobin <10g/dL) | |||
*Parasitemia >4% | |||
*Mortality risk higher in asplenic patients | |||
===Discharge=== | |||
*Parasitemia <4% | |||
*Asymptomatic or mild disease with intact spleen | |||
*Discharged patients should follow-up with primary care or infectious disease specialist | |||
==See Also== | ==See Also== | ||
*[[Tick Borne Illnesses]] | *[[Tick Borne Illnesses]] | ||
= | ==External Links== | ||
* | *CDC http://www.cdc.gov/parasites/babesiosis/ | ||
* | *[https://www.merckmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/babesiosis Merck Manual - Babesiosis] | ||
==References== | |||
*Tobler WD, Cotton D, Lepore T, Agarwal S, Mahoney EJ. Case Report: Successful non-operative management of spontaneous splenic rupture in a patient with babesiosis. World Journal of Emergency Surgery : WJES. 2011;6:4. doi:10.1186/1749-7922-6-4. | |||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 03:55, 27 September 2021
Background
- Babesiosis is an infection of the Babesia species of intraerythrocytic protozoa, causing lysis of host red blood cells.
- Spread by the deer tick (Ixodes scapularis)
- People often unaware they are bitten
- Natural reservior is the white footed mouse
- Endemic in US, Europe, parts of Russia and China
- Babesia Microti is pathogen in US
- Possible to have co-infection with Lyme (same tick family)
Clinical Features
- Fever, hemolytic anemia, chills, thrombocytopenia, DIC
- More severe disease in immunocompromized patients (HIV, Elderly, Asplenic)
Differential Diagnosis
Tick Borne Illnesses
- Babesiosis
- Colorado tick fever
- Ehrlichiosis
- Heartland virus
- Lyme
- Murine typhus
- Rocky mountain spotted fever
- Southern tick-associated rash illness (STARI)
- Tick paralysis
- Tularemia
Evaluation
- CBC
- Often with depressed white count
- Peripheral Blood Smears
- Shows intracellular parasites: Maltese Cross sign
- May need large smear as parasitemia can be as low as 1%
- Can often be confused for malaria parasites
- Electrolytes and renal function
- LFTs
- Total bilirubin and haptoglobin values reflect the intensity of the infection (hemolysis)
- Lyme
- Urine - hemolysis
- CXR - rare but possible ARDS
Management
Each regimin is for 10 days duration and option 1 is often used for mild parasitemia <4% with option two for sever cases with >4% parasite load
Option 1
Atovaquone (750mg BID) and Azithromycin (500-1000mg on first day, 250-1000mg on subsequent days)[1]
Option 2
- 600 mg PO q8h x 7-10 days
- Alt: 300-600mg IV q6h x 7-10 days
- First Dose: 300-600mg IV x 1
- Give with Quinine (650mg TID); use IV for severe infections
Pediatrics
- Clindamycin 20mg/kg/day for children and 25mg/kg/day for children for 7-10 days
Disposition
Admission
- Severe anemia (hemoglobin <10g/dL)
- Parasitemia >4%
- Mortality risk higher in asplenic patients
Discharge
- Parasitemia <4%
- Asymptomatic or mild disease with intact spleen
- Discharged patients should follow-up with primary care or infectious disease specialist
See Also
External Links
References
- Tobler WD, Cotton D, Lepore T, Agarwal S, Mahoney EJ. Case Report: Successful non-operative management of spontaneous splenic rupture in a patient with babesiosis. World Journal of Emergency Surgery : WJES. 2011;6:4. doi:10.1186/1749-7922-6-4.
- ↑ Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. Nov 16 2000;343(20):1454-8.