Babesiosis in Emergency Medicine Clinical Presentation

  • Author: Tarlan Hedayati, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 4, 2010
 

History

Patients report a history of travel to an endemic area between the months of May and September. This is the period during which the Ixodes tick is in its infectious nymph stage; however, most do not recall the tick bite. The incubation period is between 1 and 4 weeks. The signs and symptoms mimic malaria and range in severity from asymptomatic to septic shock.

Symptoms include the following:

  • Generalized weakness
  • Fatigue
  • Depression
  • Fever
  • Anorexia and weight loss
  • CNS - Headache, photophobia, neck stiffness, altered sensorium
  • Pulmonary - Cough, shortness of breath
  • GI - Nausea, vomiting, abdominal pain
  • Musculoskeletal - Arthralgia and myalgia
  • Renal - Dark urine
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Physical

Physical examination findings of babesiosis can include the following:

  • Fever
  • Rigors
  • Diaphoresis
  • Altered mental status
  • Renal insufficiency/failure
  • Pulmonary edema
  • Hepatosplenomegaly
  • Spontaneous splenic rupture[3]
  • Jaundice
  • Shock
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Causes

More than 100 species of Babesia exist, but only a small number of species are known to be responsible for the majority of symptomatic disease. The causative agent of babesiosis varies according to geographic region.

In the United States, human infection with Babesia species is primarily due to Babesia microti, found mostly in northeastern and midwestern states. A few cases have been reported in Missouri, California, and Washington and are found to be caused by Babesia -like agents named after their geographic location, MO1 (Missouri), CA-1 (California), and WA-1 (Washington).

In Europe, the causative agent of babesiosis is typically Babesia divergens, though B microti and B microti -like agents have been identified.

Several reported cases of infection via blood transfusions from donors who lived in or traveled to an endemic area have been documented. All of these cases have occurred in the United States with the exception of one patient in Canada (acquired from a donor who became infected while in the United States) and one in Japan. The rate of acquiring B microti from a unit of packed red cells has been estimated to be 1 in 600-1800 in endemic areas.

Case reports of transplacental/perinatal transmission have been documented.

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Contributor Information and Disclosures
Author

Tarlan Hedayati, MD  Assistant Professor of Emergency Medicine, Rush Medical College, John H Stroger Hospital of Cook County

Tarlan Hedayati, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Cameron Nima Nourani, MD  Resident Physician, Department of Emergency Medicine, John H Stroger Hospital of Cook County

Cameron Nima Nourani, MD is a member of the following medical societies: Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
Peripheral smear showing babesiosis.
 
 
 
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