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
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*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)


==Symptoms==
==Clinical Features==
*[[Fever]], hemolytic anemia, chills, [[thrombocytopenia]], [[DIC]]
*[[Fever]], hemolytic anemia, chills, [[thrombocytopenia]], [[DIC]]
*More severe disease in immunocompromized patients ([[HIV]], Elderly, '''Asplenic''')
*More severe disease in immunocompromized patients ([[HIV]], Elderly, [[Asplenic]])


==Diagnosis==
==Differential Diagnosis==
*Peripheral blood smear
{{Tick borne illnesses DDX}}
**Shows intracellular parasites
 
***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
==Differential Diagnosis==
*LFTs
{{Tick borne illnesses DDX}}
**Total bilirubin and haptoglobin values reflect the intensity of the infection (hemolysis)
*Lyme
*Urine - hemolysis
*[[CXR]] - rare but possible ARDS


==Management==
==Management==
*2 drug regimen for 7-10 days
{{Babesiosis Antibiotics}}
 
===Option 1===
*Atovaquone (750mg BID) and [[Azithromycin]] (500-1000mg on first day, 250-1000mg on subsequent days)
 
===Option 2===
[[Clindamycin]]
{{Babesiosis Clindamycin Adult}}
 
===Pediatrics===
*Clindamycin 20 mg/kg/day for children and 25 mg/kg/day for children for 7-10 days


===Treatment Failure===
==Disposition==
*Atovaquone 750 mg q12 '''and''' azithromycin 500 mg on day 1 and 250 mg/day x 7 days<ref>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.</ref>
===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]]


=Sources=
==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/>
  <references/>
*CDC http://www.cdc.gov/parasites/babesiosis/


[[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

Differential Diagnosis

Tick Borne Illnesses

Evaluation

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%
    • 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

Clindamycin

  • 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.
  1. ↑ 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.
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