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Published on: December 3, 2019
Persistent and relapsing babesiosis in immunocompromised patients
Peter J Krause1, Benjamin E Gewurz, David Hill
1Division of Infectious Diseases, Connecticut Children's Medical Center, and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut 06106, USA. PKrause@ccmckids.org
Summary
Immunocompromised individuals with Babesia microti infection face persistent illness. Treatment for these severe babesiosis cases requires at least six weeks of therapy, including two weeks post-parasitemia.
Area of Science:
- Infectious Diseases
- Parasitology
- Immunology
Background:
- Human babesiosis is a tick-borne illness mimicking malaria.
- Standard treatment with atovaquone and azithromycin or clindamycin and quinine is usually effective.
- Unresponsive babesiosis cases present challenges in understanding pathogenesis and optimal treatment.
Purpose of the Study:
- To compare the immunologic status, clinical course, and treatment of severe babesiosis cases with controls.
- To elucidate factors contributing to persistent Babesia microti infection.
- To define optimal treatment regimens for complicated babesiosis.
Main Methods:
- Retrospective case-control study comparing 14 severe babesiosis cases with 46 controls.
- Analysis of immunologic status, clinical presentation, and treatment outcomes.
- Study conducted in southern New England, New York, and Wisconsin.
Main Results:
- All severe babesiosis cases involved immunosuppressed patients, primarily with B cell lymphoma, asplenia, or rituximab treatment.
- Severe cases had higher complication rates, with 3 deaths.
- Resolution of persistent infection required 2-10 courses of therapy, lasting over 6 weeks.
Conclusions:
- Immunocompromised individuals are at high risk for persistent, relapsing Babesia microti infections.
- Cure typically necessitates antibabesial treatment exceeding six weeks.
- Treatment should continue for two weeks after parasite clearance on blood smears.
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