1/10. Presumptive Babesia ovis infection in a spanish ibex (Capra pyrenaica).On December 29 1995, a 13-year old, male Spanish ibex was easily captured by hand, with depression, weakness and severe tick infestation, mainly in the periocular and auricular regions. Blood and serum samples were collected and haematological analysis and serum iron levels were determined. Red blood cell count, haematocrit, haemoglobin concentration and mean corpuscular haemoglobin concentration (MCHC) were decreased and mean corpuscular volume (MCV) increased (macrocytic-hypochromic anemia). serum iron and transferrin saturation were decreased and total and unbound iron-binding capacity were increased. Piroplasms were observed within parasitized erythrocytes and presumptively identified as Babesia spp. ticks were identified exclusively as Ripicephalus bursa. The animal was treated with imidocarb but died after 15 days of capture. Histopathological examination revealed congestion of pulmonary capillaries and spleen, glomerulonephritis, hemoglobinuric nephrosis and generalized hemosiderosis. An indirect fluorescent antibody test was performed using a Babesia ovis isolate of ovine origin as antigen and the animal was positive with a titre of 1:640.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
2/10. Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion.BACKGROUND: babesiosis is an increasingly recognized parasitic infection with manifestations that range from a subclinical or mild flu-like illness to life-threatening disease. risk factors that may be associated with a more severe clinical course include immunosuppression, splenectomy, and advanced age. The most effective chemotherapeutic regimen, clindamycin plus quinine, is sometimes ineffective in cases of severe disease. CASE REPORT: A previously healthy, 58-year-old man was infected by babesia microti, presumably through a tick bite. He developed fulminant disease characterized by severe hemolytic anemia, disseminated intravascular coagulation, acute renal failure, and respiratory failure. There was no history of splenectomy or immunodeficiency. He was given oral clindamycin (300 mg/4x/day) 2 days before admission. Oral quinine (650 mg/3x/day) was added upon hospitalization. There was no clinical improvement despite antibiotic therapy with clindamycin and quinine. On the second hospital day, a whole-blood exchange transfusion was performed to simultaneously lower the parasite load and replace the patient's plasma. With an automated blood cell separator, 87 percent of the patient's total blood volume was exchanged. As replacement fluid, 6.7 L of packed RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's Hct increased from 26.9 percent before the exchange to 28.3 percent after the exchange. The percentage of parasitized RBCs decreased from 13.8 percent just before exchange to 4.2 percent immediately after exchange. There was rapid clinical improvement after the whole-blood exchange transfusion. The patient's subsequent clinical course was marked by a disappearance of the parasitemia and continued slow, general improvement. Therapy with clindamycin was continued for 14 days after the exchange transfusion and quinine for 17 days. CONCLUSION: In cases of severe babesiosis, prompt institution of whole-blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life-saving.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
3/10. babesiosis in a renal transplant recipient acquired through blood transfusion.BACKGROUND: The success of organ-replacement therapies has resulted in a population of chronically immunosuppressed but active people who experience increased vulnerability to tick-borne zoonoses. Several of these infections may be life threatening. Human babesiosis is an emerging zoonosis that is transmitted by the same tick that transmits lyme disease and human granulocytic ehrlichiosis. methods: We briefly review these zoonoses and present a case of a renal transplant recipient who survived infection by babesia microti contracted through blood transfusion. RESULTS: A recipient of a living-related renal transplant developed acute postoperative hemolytic anemia. The etiology of this anemia was diagnosed by peripheral red blood cell smear as babesia microti. The patient was managed by a reduction in transplant immunosuppressive therapy and administration of clindamycin and quinine antimicrobials. CONCLUSIONS: Transplant patients may contract babesiosis after tick exposure and/or via blood transfusion. The diagnosis of babesiosis may be confused with malaria and should be included in the differential diagnosis of posttransplant hemolytic-uremic syndrome in organ transplant patients.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
4/10. babesiosis. Diagnostic pitfalls.A case of babesiosis complicated by quinine-induced hemolysis is described. A splenectomized woman contracted babesiosis after visiting an endemic area. The patient presented with high fevers and minimal hemolysis. While she was on treatment, the hemolysis increased. The increased hemolysis was initially attributed to babesiosis, but after additional evaluation quinine therapy was found to be the cause. In the setting of this brisk hemolysis, there was an increase in red blood cell inclusions. At first, the inclusions were thought to be Babesia, but iron stain demonstrated that many of the inclusions were hemolysis-induced Pappenheimer bodies. The role of the clinical laboratory in sorting out this confusing picture is presented.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
5/10. life-threatening babesiosis in a women from wisconsin.A 63-year-old women from wisconsin presented with severe hemolytic anemia and was found to have babesiosis by red blood cell morphologic appearance and serologic testing. Despite having an intact spleen, she developed adult respiratory distress syndrome, which required prolonged mechanical ventilation. An unusually high level of parasitemia was noted and resolved completely following treatment with quinine, clindamycin, and exchange transfusion. This case illustrates that the geographic distribution and clinical severity of babesiosis may be greater than previously recognized and that reduction in parasitemia may be achieved with exchange transfusion, quinine, and clindamycin.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
6/10. Red cell exchange: treatment of babesiosis in a splenectomized patient.A splenectomized woman with a history of hepatic disorders was diagnosed as having babesiosis. The patient was unsuccessfully treated with chloroquine and with pentamidine isothionate. A parasitemia of 15 per cent was reduced permanently to less than 1 per cent after a red blood cell exchange, but a low grade parasitemia still existed 10 months after onset. On two separate occasions, the patient was found to have selective iga deficiency, a reduction of T lymphocytes, and a reduction in function of both T and B lymphocytes. This case represents the highest and the longest duration of parasitemia ever recorded. It reports the first use of pentamidine and red blood cell exchange transfusion in human babesiosis, one of the earliest diagnosed cases of babesiosis, and the most severe clinical case to survive.- - - - - - - - - - ranking = 2keywords = blood cell (Clic here for more details about this article) |
7/10. Acute respiratory failure in patients treated for babesiosis.babesiosis is a tick-borne protozoal disease with infrequent clinical complications. We report three cases of noncardiogenic pulmonary edema in patients from Nantucket Island, MA, with a history of lyme disease and review the clinical presentation of babesiosis and its treatment. Respiratory complications in our patients, as well as in the four previously reported cases in the literature, occurred a few days after initiation of medical therapy. We hypothesize that the pathophysiology of the pulmonary edema is multifactorial, due to decreased deformability of the infected erythrocytes, increased cytoadherence of red blood cells in capillaries and venules, and a possible role of excessive production of certain cytokines, such as tumor necrosis factor and interleukin-1.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
8/10. The risk of acquiring lyme disease or babesiosis from a blood transfusion.To determine the risk of acquiring lyme disease or babesiosis from blood transfusion, serum was collected before and 6 weeks after patients received multiple transfusions during cardiothoracic surgery and antibodies to borrelia burgdorferi and babesia microti were measured. Of 155 subjects, 149 received 601 total units of packed red blood cells (PRBC) and 48 received 371 total units of platelets. No patient developed clinical or serologic evidence of lyme disease; 1 (who received 5 units of PRBC) developed clinical and serologic evidence of babesiosis. The risk of acquiring lyme disease from a transfused unit of PRBC was 0 (95% confidence interval [CI], 0-0.5%) and from a transfused unit of platelets was 0 (95% CI, 0-0.8%); the same risks for babesiosis were 0.17% (95% CI, 0.004%-0.9%) and 0 (95% CI, 0-0.8%), respectively. The risk of acquiring either lyme disease or babesiosis from a blood transfusion in connecticut is very low.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
9/10. Treatment of babesiosis by red blood cell exchange in an hiv-positive, splenectomized patient.babesiosis is a malaria-like parasitic disease causing subclinical or mild illness in most cases. Splenectomized patients, however, may experience a more severe course. Although generally responsive to antibiotic therapy, several cases of severe babesiosis refractory to appropriate antibiotic therapy have been reported to respond promptly and dramatically to red blood cell (RBC) exchange transfusion. Although the role of hiv coinfection in babesiosis is uncertain, two previously reported cases raise a concern that it may predispose to a more severe clinical course. We report a third case of severe babesiosis in an hiv-positive splenectomized man, following travel to an endemic area. Antibiotic therapy, though initially effective, ultimately failed to prevent severe disease. RBC exchange transfusion resulted in prompt clinical improvement, which has been sustained during 26 months of follow-up. Although the patient has since developed various sequelae of hiv infection, including disseminated Kaposi's sarcoma, CMV retinitis, and enteritis, there has been no recurrence of observable parasitemia. In severe babesiosis, RBC exchange transfusion, combined with appropriate antibiotic therapy, appears to be a rapidly effective therapeutic modality which can induce sustained remissions.- - - - - - - - - - ranking = 5keywords = blood cell (Clic here for more details about this article) |
10/10. Therapeutic apheresis for babesiosis.Infection with the tick-borne protozoa Babesia is becoming more common. babesiosis is usually successfully treated with antibiotics but, in some cases, apheresis may also be indicated. We report two patients with babesiosis and hemolysis treated by apheresis and antibiotics. One case had traditional indications for red blood cell (RBC) exchange, and a second patient was treated with RBC exchange, and plasmapheresis for hemolysis, probably secondary to Babesia parasitemia. Case 1 involved a 44-year-old man with chronic relapsing pancreatitis who had become infected with Babesia from a unit of RBCs transfused during surgery. At 5 weeks after surgery, fever and severe hemolysis developed, along with a hemoglobin of 69 g/L; 30% of his RBCs were found to be infected with Babesia. This patient had several postoperative complications; the babesiosis was treated with clindamycin, quinine, and three RBC exchanges. parasitemia fell to less then 1% of RBCs, but the patient died of pancreatitis. Case 2 was a 47-year-old man with a renal transplant who had been receiving immunosuppressive therapy for 8 years. He had a history of tick bites, fever, and hemolytic anemia. Analysis of a peripheral blood smear detected Babesia. He was initially treated with antibiotic therapy and two RBC exchanges. hemolysis improved transiently but worsening parasitemia developed later, as well as an IgG RBC autoantibody. He was then treated by plasmapheresis and RBC exchange. Although his condition improved, he had a third hemolytic episode, which was treated with plasmapheresis and RBC exchange before the parasitemia and autoimmune hemolytic anemia disappeared. In conclusion, immunosuppressed or severely ill people who become infected with Babesia may benefit from RBC exchange or plasmapheresis, or both.- - - - - - - - - - ranking = 1keywords = blood cell (Clic here for more details about this article) |
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