Babesiosis in Emergency Medicine Follow-up

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

Further Inpatient Care

Monitor level of oxygenation and watch for development of respiratory complications after initiation of treatment in patients who present with respiratory complaints. Respiratory distress may be due to endotoxin sensitivity; endotoxin release often results from medication-induced intraerythrocytic death of the parasites.

In severe cases of babesiosis, exchange transfusion may be the only means of reducing the level of parasitemia.

Mechanical ventilation may be necessary in patients with severe disease.

Monitor CBC count for development of hemophagocytic syndrome.

If the patient does not respond to or cannot tolerate treatment with clindamycin and quinine, commence alternative treatment with atovaquone and azithromycin.

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Deterrence/Prevention

Persons at risk of severe infection should avoid endemic areas between the months of May and September.

Skin should be covered with appropriate clothing, including tucking long pants inside socks.

Early removal of ticks from humans and pets should prevent transmission of disease; a tick must remain attached for at least 24 hours for transmission of the parasite.

Tick repellent, such as products with 10-35% diethyltoluamide (DEET), should be applied on skin and clothes.

People from endemic areas who report a fever within the last 2 months or a history of tick bite are not allowed to donate blood.

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Complications

Respiratory

Patients who have undergone splenectomy are unable to clear infected RBCs, thereby leading to higher levels of parasitemia, eventually leading to hypoxemia and subsequent risk of cardiopulmonary arrest.

In severe cases, damage to RBC membranes, decreased deformability, and cytoadherence to capillaries and venules lead to pulmonary edema and respiratory failure.

These respiratory problems begin after treatment has been initiated when intraerythrocytic death of parasites has been postulated to cause sensitivity to endotoxin.

ARDS may be due to mechanisms such as endotoxemia, complement activation, immune complex deposition, cytoadherence, microemboli, and disseminated intravascular coagulation.

Cardiac complications include the following:

  • Myocardial infarction
  • Congestive heart failure

Renal complications include the following:

  • Renal insufficiency
  • Renal failure

Postsplenectomy patients may develop hemophagocytic syndrome, acute renal failure, and generalized seizure.

Coma can occur, possibly due to severe sepsis, ARDS, or multisystem organ failure.

Co-infection with Lyme disease is a possible complication.

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Prognosis

In the United States, the prognosis for babesiosis is excellent; most patients recover spontaneously. Patients who have had their spleen removed are at the greatest risk for severe complications and death.

In Europe, most symptomatic patients are asplenic, which contributes to a poor prognosis. More than 50% of patients become comatose and die.

Babesiosis may continue for more than 2 months after treatment; asymptomatic infections can persist silently for months to years. Patients with positive smears or PCR more than 3 months after initial treatment should be re-treated, regardless of the presence or absence of seizures.

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Patient Education

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

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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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