Red Cell Exchange as Adjunctive Therapy for Babesiosis: Is it Really Effective?

Area of Science:

• Infectious Diseases
• Hematology
• Parasitology

Background:

• Human babesiosis is a tick-borne parasitic disease prevalent in the US, typically treated with antibiotics.
• Red cell exchange (RCE) is used as an adjunctive therapy for severe babesiosis cases.
• Existing data on RCE efficacy in babesiosis are limited to case reports and series.

Purpose of the Study:

• To evaluate the efficacy of red cell exchange (RCE) as an adjunctive treatment for severe human babesiosis.
• To analyze clinical outcomes and parasitemia levels in babesiosis patients treated with RCE.
• To compare outcomes of RCE treatment with antibiotic-only therapy in severe babesiosis.

Main Methods:

• Conducted a literature search for babesiosis cases treated with RCE since 1980.
• Extracted clinical and laboratory data from 50 retrieved reports (41 case reports, 9 case series) involving 108 patients.
• Analyzed data from 23 patients who underwent RCE at local hospitals between 2000-2020 and compared them to 9 patients treated with antibiotics only.

Main Results:

• The 108 patients who underwent RCE had an overall mortality rate of 20%, with parasitemia levels decreasing from >10% to 1-10%.
• In the local cohort (2000-2020), 23 patients received RCE, with mortality at 22%, similar to national data.
• Patients treated with RCE showed similar parasitemia reduction and time to <1% parasitemia compared to the antibiotic-only group, which had 0% mortality.

Conclusions:

• After over 40 years of use, there is no conclusive evidence that red cell exchange (RCE) improves clinical outcomes in severe babesiosis.
• The study suggests equipoise between RCE and antibiotic-only treatment for severe babesiosis.
• A registry for severe babesiosis patients treated with or without RCE is needed to definitively assess treatment benefits.