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Persistent parasitemia after acute babesiosis
P J Krause1, A Spielman, S R Telford
1Department of Pediatrics, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford 06106, USA.
The New England Journal of Medicine
|July 17, 1998
Summary
Untreated babesiosis can persist for months, even years. While clindamycin and quinine treatment shortens parasitemia, infection may recur and cause side effects, indicating a need for better therapies.
Area of Science:
- Medical Entomology
- Infectious Diseases
- Parasitology
Background:
- Babesiosis, a zoonotic disease caused by Babesia microti, often presents with mild symptoms and is typically not treated due to the perceived transient nature of parasitemia.
- Current diagnostic methods for Babesiosis are insensitive, limiting longitudinal follow-up of infected individuals.
- This study addresses the lack of data on the duration of parasitemia in both treated and untreated Babesiosis cases.
Purpose of the Study:
- To compare the duration of Babesia microti parasitemia in individuals receiving specific antibabesial therapy versus those with silent infections who did not receive treatment.
- To evaluate the effectiveness of current treatment regimens and identify potential limitations.
Main Methods:
- A prospective, community-based study monitored 46 infected subjects over 27 months using thin blood smears, PCR, serologic tests, and questionnaires.
- Subjects were categorized into those with acute babesial illness receiving clindamycin and quinine, and those with silent infections receiving no specific therapy.
- Parasitemia duration was assessed using Babesia microti polymerase-chain-reaction (PCR) assays.
Main Results:
- Babesial DNA persisted for a mean of 82 days in untreated subjects, compared to 16 days in those treated with clindamycin and quinine (P=0.03).
- Among untreated subjects, symptoms lasted longer in those with prolonged parasitemia (mean 114 days) than in those with shorter detectable DNA (mean 15 days).
- One untreated subject experienced disease recrudescence after two years, and 9 treated subjects reported side effects.
Conclusions:
- Silent Babesia microti infections can remain persistent for extended periods, potentially months to years.
- Clindamycin and quinine therapy effectively reduces parasitemia duration but does not eliminate the risk of persistent infection, recrudescence, or side effects.
- There is a clear need for the development of improved treatment strategies for Babesiosis.