1/10. 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 = parasitemia (Clic here for more details about this article) |
2/10. 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 = 2keywords = parasitemia (Clic here for more details about this article) |
3/10. Morphologic and clinical observations in human infection with babesia microti.On admission to the hospital, a splenectomized man was found to have 85% of his erythrocytes parasitized by babesia microti. His extensive parasitemia allowed for direct study of the morphology and ultrastructure of this organism as it appears in human infection; the need for animal inoculation and rescue techniques was thus eliminated. Positive characteristics (other than the tetrad form) that are diagnostic for babesiosis were identified. By transmission and scanning electron microscopy, parasite-induced changes in the erythrocyte membrane were observed; these alterations may explain the hemolysis seen in babesiosis. Factors that may have allowed the patient to sustain such high-level parasitemia are considered. The experience with this patient confirms that exchange transfusion is a reliable, rapid method for reduction of the parasite load in serious infection with B microti.- - - - - - - - - - ranking = 2keywords = parasitemia (Clic here for more details about this article) |
4/10. babesiosis in post-splenectomy hosts.Two persons who had been splenectomized later contracted babesiosis, one on Cape Cod and one near Islip, Long Island, areas where human cases of babesiosis had not been previously identified. One of the patients received pentamidine, but parasitemia persisted after therapy. No deaths have been recorded for persons who had had splenectomies and were later infected with babesia microti. Until more effective therapy is available, such patients should be treated conservatively.- - - - - - - - - - ranking = 1keywords = parasitemia (Clic here for more details about this article) |
5/10. 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 = 3keywords = parasitemia (Clic here for more details about this article) |
6/10. Response of babesiosis to pentamidine therapy.Three nonsplenectomized patients were infected with babesia microti. One had fever, abdominal pain suggesting gallbladder disease, and evidence of disseminated intravascular coagulation; another was considered to have lymphoma, partly because two smears for Babesia before admission were negative. All three patients were treated with pentamidine isethionate and improved clinically. parasites were no longer seen on smears after 5 days of therapy, but Babesia could still be recovered by hamster inoculation 5 weeks after therapy in one of the patients tested, underscoring the need for this test to properly evaluate eradication of the organism. In one patient, pentamidine was stopped after 7 days because of increased creatinine concentration, and this amount of drug appeared adequate to control the parasitemia. Pain at drug injection sites was a major side effect in all three patients. pentamidine appears to be useful in controlling clinical manifestations of babesiosis and decreasing parasitemia, but it does not eradicate the organism.- - - - - - - - - - ranking = 2keywords = parasitemia (Clic here for more details about this article) |
7/10. Human babesiosis.OBJECTIVE: To describe a case of human babesiosis and review the literature on the disease. MATERIAL AND methods: We describe a 62-year-old man with babesiosis, outline his clinical course and response to therapy, and discuss the use of the polymerase chain reaction for the diagnosis and monitoring of the infection. RESULTS: The onset of the disease was insidious, with fatigue, fever, weight loss, intermittently discolored urine, and anemia. Computed tomography of the abdomen revealed a small, shrunken spleen with an irregular border. With treatment, the symptoms gradually resolved. Although peripheral blood smears were negative soon after therapy, babesia microti dna was detected by polymerase chain reaction 53 days after initial examination. CONCLUSION: The development of improved methods for diagnosis, including indirect immunofluorescent antibody assays and the polymerase chain reaction, provides more sensitive detection of the parasitemia associated with babesiosis. Use of these methods may help to delineate the complete clinical spectrum of this infection and its geographic distribution in the united states.- - - - - - - - - - ranking = 1keywords = parasitemia (Clic here for more details about this article) |
8/10. 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 = 1keywords = parasitemia (Clic here for more details about this article) |
9/10. Human babesiosis in taiwan: asymptomatic infection with a babesia microti-like organism in a Taiwanese woman.An asymptomatic Babesia infection was confirmed by laboratory diagnoses. The intraerythrocytic protozoan (designed TW1) isolated from a 51-year-old Taiwanese woman appeared to be morphologically consistent with small-form piroplasm, and measurements indicated that it had a body size of 1.5 to 2.5 microm in diameter. The typical features of ring, binary, and tetrad forms were observed in Giemsa-stained thin blood smears. A persistent and low-grade parasitemia was established after hamster inoculation. Indirect immunofluorescent-antibody reactivities indicate that this strain (TW1) of Babesia was serologically related to, but not identical to, the Babesia species (B. microti) that infects rodents. Antibody titers in the patient's sera combined with the clinical symptoms suggested that the present case was a chronic and subclinical babesial infection. A neighborhood human serologic survey indicated that the infection may have been acquired accidentally from an infected rodent and localized within the same family. Indeed, rodents from areas around the neighborhood were trapped, and a high prevalence (83%) of babesial infection was observed. The possible vector responsible for the transmission remains to be identified.- - - - - - - - - - ranking = 1keywords = parasitemia (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 = 3keywords = parasitemia (Clic here for more details about this article) |
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