Babesiosis: Difference between revisions
| (11 intermediate revisions by 6 users not shown) | |||
| Line 1: | Line 1: | ||
==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 9: | Line 10: | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Fever]], hemolytic anemia, chills, [[thrombocytopenia]], [[DIC]] | *[[Fever]], hemolytic anemia, chills, [[thrombocytopenia]], [[DIC]] | ||
*More severe disease in immunocompromized patients ([[HIV]], Elderly, | *More severe disease in immunocompromized patients ([[HIV]], Elderly, [[Asplenic]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Tick borne illnesses DDX}} | {{Tick borne illnesses DDX}} | ||
== | ==Evaluation== | ||
[[File:Maltese_Cross.png|thumb|Peripheral blood smear showing "Maltese Cross" classic for babesiosis.]] | [[File:Maltese_Cross.png|thumb|Peripheral blood smear showing "Maltese Cross" classic for babesiosis.]] | ||
*CBC | *CBC | ||
| Line 30: | Line 31: | ||
==Management== | ==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== | ||
| Line 47: | Line 48: | ||
==External Links== | ==External Links== | ||
*CDC http://www.cdc.gov/parasites/babesiosis/ | *CDC http://www.cdc.gov/parasites/babesiosis/ | ||
*[https://www.merckmanuals.com/professional/infectious-diseases/extraintestinal-protozoa/babesiosis Merck Manual - Babesiosis] | |||
==References== | ==References== | ||
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.