Infectious Disease Book

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Babesiosis

Aka: Babesiosis, 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. Hemolytic Anemia (unique to Babesia compared with Lymes and Anaplasmosis)
      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 Atovaquone and Azithromycin for 10 days (preferred regimen)
      1. Atovaquone (Mepron) 750 mg orally twice daily
      2. Azithromycin (Zithromax)
        1. First day: 500 mg orally
        2. Subsequent days: 250 mg orally daily
    2. Combination Quinine and Clindamycin for 10 days
      1. Quinine (dosing is for salt component)
        1. Adult: 650 mg orally three times daily
        2. Child: 20 to 40 mg/kg/day orally divided three times daily
      2. Clindamycin
        1. Adult: 600 mg orally three times daily or 1.2 g orally twice daily
        2. Child: 25 mg/kg/day divided three times 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 22:611-5
    2. Krause (2000) N Engl J Med 343:1454-8
    3. Mylonakis (2001) Am Fam Physician 63(10):1969-74
    4. Pruthi (1995) Mayo Clin Proc 70:853-62

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.
Concepts Eukaryote (T204)
MSH D001403
SnomedCT 35029001
English Piroplasma, Babesia, NOS, Nuttallia, NOS, Babesia, Babesias, Piroplasmas, babesia, Babesia Starcovici, 1893, Genus: Babesia, Nuttallia, Babesia (organism)
French Piroplasma, Piroplasme, Babésia, Babesia
Swedish Babesia
Japanese ﾊﾞﾍﾞｼｱ, Babesia属, バベシア, バベシア属, ピロプラズマ属, フタゴバベシア, ピロプラスマ属, ピロプラズマ
Czech Babesia, Infekce způsobená rodem Babesia
Finnish Babesia
Italian Piroplasma, Babesia
Russian PIROPLAZMY, BABEZII, BABESIA, БАБЕЗИИ, ПИРОПЛАЗМЫ
Polish Babezja
Hungarian babesia
Spanish Babesia (organismo), Babesia, Piroplasma
German Babesia, Piroplasma
Dutch Babesia, Piroplasma
Portuguese Babesia, Piroplasma
Sources
Derived 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 protozoa 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 (NCI) A parasitic infection caused by Babesia. It is transmitted by ticks and infects the red blood cells. Signs and symptoms include fever, fatigue and hemolytic anemia.
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.
Concepts Disease or Syndrome (T047)
MSH D001404
ICD9 088.82
ICD10 B60.0
SnomedCT 187241002, 276204002, 21061004
English Babesiases, Babesiasis, Babesioses, Babesiosis, Piroplasmoses, Piroplasmosis, BABESIASIS, BABESIOSIS, PIROPLASMOSIS, Infection by Babesia, NOS, babesiasis, babesiosis, babesiosis (diagnosis), Infection by babesia (disorder), Babesia infections, Babesiosis [Disease/Finding], Babesia Parasite Infections, Infections, Babesia Parasite, Babesia Parasite Infection, Infection, Babesia Parasite, babesiose, babesia infection, Infection by Babesia, Infection by babesia, Babesiosis (disorder), piroplasmosis, Piroplasma; infection, Babesia; infection, infection; Babesia, infection; Piroplasma
Italian Infezioni da Babesia, Babesiasi, Piroplasmosi, Babesiosi
Japanese バベシア感染, ﾊﾞﾍﾞｼｱｼｮｳ, ﾊﾞﾍﾞｼｱｶﾝｾﾝ, バベシア症, バベシア病, ピロプラズマ病, ピロプラスマ病, ピロプラスマ症, ピロプラズマ症
Swedish Babesios
Czech babesióza, Infekce způsobené babesiemi, Babesióza
Spanish Babesiosis, Infection by babesia, babesiasis, babesiosis (trastorno), babesiosis, infección por Babesia, piroplasmosis, Infecciones por babesia, Babesiasis, Piroplasmosis
Finnish Babesioosi
Russian BABEZIOZ, PIROPLAZMOZ, БАБЕЗИОЗ, ПИРОПЛАЗМОЗ
Korean 바베스열원충증
Croatian BABEZIOZA
French Infection parasitaire par Babésia, Infections à Babesia, Babésiellose, Babésiose, Piroplasmose
Polish Babezjoza
Hungarian Babesia fertőzések, babesiosis
Dutch Babesia; infectie, Piroplasma; infectie, infectie; Babesia, infectie; Piroplasma, Babesia-infecties, babesiosis, Babesiose, Babesiosis, Piroplasmose
Portuguese Infecções por Babesia, Babesiose, Babesíase, Piroplasmose
German Babesia-Infektionen, Babesiasis, Babesiose, Piroplasmosis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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