Clinical Management of Babesiosis

Many people who acquire the parasitic infection babesiosis will not have any symptoms, and they will do well without any medical treatment. Others with more severe disease require the use of antimicrobial agents some of which are also necessary for the treatment of malaria. In either situation, this medical condition can become life-threatening as several complications may develop.

source

Signs and symptoms of babesiosis, should they occur, include fever, chills, sweats, headache, body or muscular aches, loss of appetite, fatigue, nausea, and vomiting. Through destruction of red blood cells, there may be hemolytic anemia. Moreover, these patients may have enlargement of the liver or spleen, and their skin can become yellow or show jaundice.

In severe cases of babesiosis, there may be low blood pressure, and this may require management with pressor agents in an intensive care unit setting. These patients may have organ failure, alteration of mental status, disseminated intravascular coagulation, acute respiratory distress, and low platelet count. This combination of findings is indicative of impending death of the patient unless the medical team implements aggressive measures to reverse the situation (Centers for Disease Control).

They may need mechanical ventilation, exchange transfusion, dialysis, and medication for fever.

Groups at risk

Certain groups of people are at risk for life-threatening forms of babesiosis. These include elderly individuals and others whose immune systems do not function very well. Patients with human immunodeficiency virus infection, immunosuppressive therapy because of organ transplant, long term steroid therapy, and cancer will also be at risk. Individuals with lymphoma, absent spleen, and chronic liver or kidney disease are prone to severe cases of babesiosis.

As is the case with malaria, which is also a parasitic infection, the best way to confirm the diagnosis of babesiosis is with microscopic peripheral smear of the blood. This may reveal parasites within red blood cells; however, some cases of babesiosis may be difficult to distinguish from malaria. In other words, the Plasmodium parasite which is responsible for malaria will in some cases resemble the Babesia microti parasite upon microscopic view.

Antimicrobial therapy

The Centers for Disease Control provides information to physicians who see these patients, and the question is often about the need for antimicrobial therapy. Many patients with no symptoms from this condition do not require medication. And those who have to take antimicrobials may continue to harbor the parasite in the bloodstream for two months after the completion of treatment.

Severe cases of babesiosis must have therapy with either atovaquone and azithromycin together or the combination of clindamycin with quinine. Some of these agents are well-known for their role in the treatment of malaria. In most instances, medical therapy for babesiosis is successful.

In some states, physicians must report cases of babesiosis to the local or state health department.

Sources

• Centers for Disease Control. Parasites—babesiosis.
• National Institute of Allergy and Infectious Diseases. Babesiosis.