Infectious Disease Book

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BabesiosisAka: Babesia

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  1. See also
    1. Vector Borne Disease
    2. Prevention of Tick-borne Infection
    3. Tick Removal
  2. Epidemiology
    1. Region affected
      1. Sporadic cases worldwide
      2. Endemic areas predominately in United States
        1. Massachusetts Islands: Nantucket, Martha's Vineyard
        2. New York Islands (Long Island, Shelter Island)
        3. Connecticut
        4. Cases also noted in California and southern states
    2. Peak transmission: May to September
    3. Transmission
      1. Tick-borne infection (Ixodid ticks)
        1. Ixodes dammini or Ixodes Scapularis
        2. Ixodes ricinus
        3. Tick must attach for 24 hours before transmission
      2. Less common transmission
        1. Red Blood Cell transfusion
          1. Risk 0.17% in endemic regions
        2. Transplacental and perinatal transmission
    4. Incubation
      1. After tick bite: 5 to 33 days
      2. After blood transfusion: over 60 days
    5. Ages affected: 40 to 50 years old
  3. Pathophysiology
    1. Protozoans
      1. United States (mostly in Northeastern U.S.)
        1. Babesia microti (small mammal and primate hosts)
      2. Europe
        1. Babesia divergens (rat, gerbil, cow hosts)
        2. Babesia bovis
    2. Infection
      1. Invades and replicates within Red Blood Cells
  4. Risk factors for severe infection
    1. Older age
    2. Asplenic patient
    3. Immunodeficiency (e.g. AIDS)
  5. Complications
    1. Acute Respiratory Distress Syndrome
    2. Severe Anemia
    3. Congestive Heart Failure
    4. Disseminated Intravascular Coagulation
    5. Hypotension or shock
    6. Myocardial Infarction
    7. Acute Renal Failure
  6. Symptoms and signs (Onset 7 days after inoculation)
    1. Generalized symptoms (Influenz-like symptoms)
      1. Fever, chills and diaphoresis
      2. Weakness
      3. Weight loss
      4. Arthralgia
      5. Myalgia
    2. Gastrointestinal symptoms
      1. Anorexia
      2. Nausea
      3. Abdominal Pain
      4. Vomiting
      5. Diarrhea
    3. Respiratory symptoms
      1. Cough
      2. Shortness of Breath
    4. Genitourinary symptoms
      1. Dark urine
    5. Neurologic symptoms
      1. Headache
      2. Photophobia
      3. Neck and back stiffness
      4. Altered Level of Consciousness
  7. Differential Diagnosis
    1. Falciparum Malaria
      1. Both cause Hemolytic Anemia and Renal Failure
      2. Both cause high fever, Jaundice and Hemoglobinuria
  8. Labs
    1. Complete Blood Count
      1. Anemia
      2. Decreased Leukocyte count
    2. Peripheral Smear (Wright stain or Giemsa stain)
      1. Intraerythrocytic parasites
      2. Similar to plasmodium (Malaria) except
        1. Babesia form tetrads (Maltese cross)
        2. No hemozoin pigments in RBCs
        3. Extracellular merozoites
    3. Serologic Detection
      1. Immunofluorescent Antibody titer >1:64
      2. Polymerase chain reaction
  9. Management: Antibiotics
    1. Combination Quinine and Clindamycin for 7-10 days
      1. Quinine (dosing is for salt component)
        1. Adult: 650 mg PO tid
        2. Child: 20 to 40 mg/kg/day PO divided tid
      2. Clindamycin
        1. Adult: 600 mg PO tid or 1.2 g PO bid
        2. Child: 25 mg/kg/day divided tid
    2. Combination Atovaquone and Azithromycin for 7-10 days
      1. Atovaquone (Mepron) 750 mg PO bid
      2. Azithromycin (Zithromax)
        1. First day: 600 mg orally daily
  10. Management: Exchange Transfusion
    1. Indications: Critical illness
      1. Blood parasitemia exceeding 10%
      2. Massive Hemolysis
      3. Asplenic patient
  11. Course
    1. Variable
    2. Carried asymptomatically for years in some patients
    3. Mortality in some studies: 6-7%
  12. Prevention
    1. See Prevention of Vector-borne Infection
  13. Co-Transmission of other tick-borne infection
    1. Borrelia Burgdorferi (Lyme Disease)
    2. Ehrlichia (Ehrlichiosis)
  14. References
    1. Boustani (1996) Clin Infect Dis 22:611
    2. Krause (2000) N Engl J Med 343:1454
    3. Mylonakis (2001) Am Fam Physician 63(10):1969
    4. Pruthi (1995) Mayo Clin Proc 70:853

Babesia (C0004572)

Definition (MSH)A genus of tick-borne protozoan parasites that infests the red blood cells of mammals, including humans. There are many recognized species, and the distribution is world-wide.
Definition (CSP)genus of tick borne protozoan parasites that infests the red blood cells of mammals, including humans; there are many recognized species, and the distribution is world wide.
ConceptsInvertebrate (T009)
EnglishBabesia, Genus: Babesia, Nuttallia, Piroplasma
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Babesiosis (C0004576)

Definition (MSH)A group of tick-borne diseases of mammals including ZOONOSES in humans. They are caused by PROTOZOANS of the genus BABESIA, which parasitize erythrocytes, producing hemolysis. In the U.S., the organism's natural host is mice and transmission is by the deer tick IXODES SCAPULARIS.
Definition (CSP)tickborne disease caused by infection with protozoa; occurs in wild and domestic animals; in humans causes malaria-like symptoms, myalgia, nausea and splenomegaly; classic zoonotic disease.
ConceptsDisease or Syndrome (T047)
ICD9088.82
EnglishBabesiases, Babesiasis, Babesioses, Babesiosis, Infection by babesia, Piroplasmoses, Piroplasmosis
Spanishbabesiasis, babesiosis, infección por Babesia, infeccion por Babesia, piroplasmosis
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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