eMedicine Specialties > Infectious Diseases > Parasitic Infections

Babesiosis: Follow-up

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Jul 28, 2008

Follow-up

Further Inpatient Care

  • Patients being treated for babesiosis should be monitored clinically, and serial blood smears should be obtained to document the degree of parasitemia and the effectiveness of therapy.
  • Serial CBC counts may be obtained to access the reticulocyte response and decrease in the hemolytic process.
  • Exchange transfusion may be life saving in severe cases.

Further Outpatient Care

  • Patients with mild-to-moderate babesiosis who are discharged from the hospital should undergo the same laboratory tests as hospitalized patients.

Inpatient & Outpatient Medications

  • The medications are administered orally in all but the most extreme cases and are the same in inpatient and outpatient settings.
  • Persons with severe cases of babesiosis are obviously treated in inpatient settings, with the same anti-Babesia medications administered intravenously.

Deterrence/Prevention

  • If possible, people should avoid entering highly tick-infested areas where babesiosis is endemic. If avoidance of these areas is not possible, care should be taken cover exposed body areas. Although the Ixodes ticks are small, patients should check themselves for ticks after coming out of a highly infested tick area. Ticks should be removed carefully and as soon after exposure as possible.
  • Diethyltoluamide (DEET) may be used on clothing or exposed areas of the body to prevent tick bites.

Complications

  • The complications of babesiosis are related to the degree of intravascular hemolysis. The main complications include jaundice, hemoglobinuria, and potential renal failure.

Prognosis

  • Most cases of babesiosis are subclinical or are mildly symptomatic. The prognosis is excellent in patients with intact splenic function. Most fatalities occur in patients with asplenia.

Patient Education

  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Lyme disease is occasionally a co-infection in patients with babesiosis because both are transmitted by I scapularis and I dammini ticks.
  • Co-infection with RMSF or ehrlichiosis is rare because these zoonoses are transmitted by the large Dermacentor ticks rather than by the small Ixodes ticks.
  • While babesiosis should be considered in patients with a malarialike illness in endemic areas, babesiosis is a difficult infectious disease to diagnose. Although the index of suspicion should be high in areas endemic for Babesia infection, patients with babesiosis have few, if any, localizing signs to suggest the disease. Confirmation of the diagnosis depends on the degree of parasitemia and the expertise and experience of the laboratory personnel. All of the findings in babesiosis are nonspecific, and only the demonstration of Babesia in the peripheral smear can rapidly confirm the diagnosis.

Special Concerns

  • Patients with asplenia should take particular care to avoid tick-infested areas.
  • Patients with congenital or acquired asplenia should be expected to have severe or fulminant babesiosis.
 


More on Babesiosis

Overview: Babesiosis
Differential Diagnoses & Workup: Babesiosis
Treatment & Medication: Babesiosis
Follow-up: Babesiosis
Multimedia: Babesiosis
References
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Further Reading

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Keywords

babesiosis, Babesia, Babesia infection, Babesia microti, B microti, Babesia divergens, B divergens, Ixodes, Ixodes scapularis, I scapularis, Ixodes dammini, I dammini, Babesia bigemina, B bigemina, Babesia bovis, B bovis, Babesia major, B major, Babesia equi, B equi, Babesia canis, B canis, Babesia felis, B felis, Babesia microti, B microti, tick-borne infection, tick disease, tickborne illness, tick-borne illness, tick infection, malaria, Lyme disease, protozoan infection, Ixodidae, Texas cattle fever

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Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H, Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine
Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine
Disclosure: Keck School of Medicine, USC None None

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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