Pediatric Babesiosis Clinical Presentation

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C); Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 29, 2010
 

History

The spectrum of disease manifestation in babesiosis is broad, ranging from a silent infection to a fulminant malarialike disease, which results in severe hemolysis and, occasionally, death. In the United States, infection with Babesia microti in otherwise healthy individuals generally remains subclinical; however, symptomatic infection is common in patients who are asplenic, older patients, and those with underlying medical conditions, including human immunodeficiency virus (HIV) infection. Because bovine babesiosis due to Babesia divergens and Babesia bovis in Europe mostly occurs in patients who are asplenic, such infections are generally clinically overt and frequently fatal.

The incubation period after the tick bite is usually 1-3 weeks but may occasionally be as long as 9 weeks. Because the nymph, the primary vector, is only 2 mm in diameter when engorged, most patients do not recall a tick bite.

Patients with clinical illness and intact spleens are usually aged 50 years or older, suggesting that age plays a factor in the severity of the clinical response. Previously healthy individuals with babesiosis are generally older (mean >60 y) than are patients with babesiosis with antecedent medical problems (mean 48 y).

Initial symptoms begin gradually and are nonspecific. Common symptoms include the following:

  • Malaise
  • Fatigue
  • Anorexia
  • Shaking chills
  • Fever (Fever may be sustained or intermittent, and temperatures may reach levels of 40ºC.)
  • Headache
  • Myalgias
  • Arthralgias
  • Nausea
  • Vomiting
  • Abdominal pain
  • Depression and emotional lability
  • Dark urine
  • Photophobia, conjunctival injection, sore throat, cough (less common symptoms)

In a series of 139 patients who were hospitalized with babesiosis in New York, the following were the most common symptoms:[4]

  • Fatigue, malaise, and weakness (91%)
  • Fever (91%)
  • Shaking chills (77%)
  • Diaphoresis (69%)

In some untreated patients, symptoms of babesiosis may last for months. Subclinical infections may spontaneously recrudesce after splenectomy and after immunosuppressive therapy.

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Physical

Findings may vary depending on the severity of disease. Fever is generally present. Splenomegaly may be present in some patients.

Hepatomegaly may be noted. Petechiae may be present in a few patients. Ecchymoses have been noted occasionally. Rash similar to erythema chronicum migrans (ECM) has been described, but this probably represents intercurrent Lyme disease.

Slight pharyngeal erythema may occur. Jaundice may be observed. Babesiosis has been associated with shock and acute respiratory distress syndrome.

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Causes

Babesiosis is acquired through a tick bite and is caused by the rodent strain B microti (in the United States) and the cattle strains B divergens and B bovis (in Europe). The tick vectors are the hard-bodied I scapularis in the United States and I ricinus in Europe.

Babesiaduncani (WA-1, CA5) has caused disease in Washington State and northern California.

A fatal case of babesiosis from a strain (MO-1) that was closely related to B divergens was described in Missouri.

Transfusion-associated babesiosis has been described. In transfusion-associated cases, sources of babesiosis have included platelets and frozen erythrocytes.

Transplacental or perinatal transmission of babesiosis has been described.

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Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C)  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center, Downey, California.

Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Coauthor(s)

Allan D Friedman, MD, MPH  Chairman, Division of General Pediatrics, Dept of Pediatrics, Professor of Pediatrics, Virginia Commonwealth University, VCUH Health System

Allan D Friedman, MD, MPH is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Vannier E, Gewurz BE, Krause PJ. Human babesiosis. Infect Dis Clin North Am. Sep 2008;22(3):469-88. [Medline].

  2. Vannier E, Krause PJ. Update on babesiosis. Interdiscip Perspect Infect Dis. 2009;2009:984568. [Medline].

  3. Ngo V, Civen R. Babesiosis acquired through blood transfusion, California, USA. Emerg Infect Dis. May 2009;15(5):785-7. [Medline].

  4. White DJ, Talarico J, Chang HG, et al. Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors. Arch Intern Med. Oct 26 1998;158(19):2149-54. [Medline].

  5. Persing DH, Mathiesen D, Marshall WF, Telford SR, Spielman A, Thomford JW, et al. Detection of Babesia microti by polymerase chain reaction. J Clin Microbiol. Aug 1992;30(8):2097-103. [Medline]. [Full Text].

  6. Krause PJ, Spielman A, Telford SR 3rd, et al. Persistent parasitemia after acute babesiosis. N Engl J Med. Jul 16 1998;339(3):160-5. [Medline]. [Full Text].

  7. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. Feb 1 2008;46(3):370-6. [Medline].

  8. Krause PJ, Lepore T, Sikand VK, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. Nov 16 2000;343(20):1454-8. [Medline]. [Full Text].

  9. Vyas JM, Telford SR, Robbins GK. Treatment of refractory Babesia microti infection with atovaquone-proguanil in an HIV-infected patient: case report. Clin Infect Dis. Dec 15 2007;45(12):1588-90. [Medline].

  10. Wormser GP, Prasad A, Neuhaus E, Joshi S, Nowakowski J, Nelson J, et al. Emergence of resistance to azithromycin-atovaquone in immunocompromised patients with Babesia microti infection. Clin Infect Dis. Feb 1 2010;50(3):381-6. [Medline].

  11. Kuwayama DP, Briones RJ. Spontaneous splenic rupture caused by Babesia microti infection. Clin Infect Dis. May 1 2008;46(9):e92-5. [Medline].

  12. Benezra D, Brown AE, Polsky B, et al. Babesiosis and infection with human immunodeficiency virus (HIV). Ann Intern Med. Dec 1987;107(6):944. [Medline].

  13. Buckingham SC. Tick-borne infections in children: epidemiology, clinical manifestations, and optimal management strategies. Paediatr Drugs. 2005;7(3):163-76. [Medline].

  14. Cunha BA, Nausheen S, Szalda D. Pulmonary complications of babesiosis: case report and literature review. Eur J Clin Microbiol Infect Dis. Jul 2007;26(7):505-8. [Medline].

  15. Dobroszycki J, Herwaldt BL, Boctor F, et al. A cluster of transfusion-associated babesiosis cases traced to a single asymptomatic donor. JAMA. Mar 10 1999;281(10):927-30. [Medline].

  16. Dorman SE, Cannon ME, Telford SR 3rd, et al. Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion. Transfusion. Mar 2000;40(3):375-80. [Medline].

  17. Falagas ME, Klempner MS. Babesiosis in patients with AIDS: a chronic infection presenting as fever of unknown origin. Clin Infect Dis. May 1996;22(5):809-12. [Medline].

  18. Florescu D, Sordillo PP, Glyptis A, et al. Splenic infarction in human babesiosis: two cases and discussion. Clin Infect Dis. Jan 1 2008;46(1):e8-11. [Medline].

  19. Fox LM, Wingerter S, Ahmed A, et al. Neonatal babesiosis: case report and review of the literature. Pediatr Infect Dis J. Feb 2006;25(2):169-73. [Medline].

  20. Gelfand JA, Callahan MV. Babesiosis. Curr Clin Top Infect Dis. 1998;18:201-16. [Medline].

  21. Genchi C. Human babesiosis, an emerging zoonosis. Parassitologia. May 2007;49 Suppl 1:29-31. [Medline].

  22. Gorenflot A, Moubri K, Precigout E, et al. Human babesiosis. Ann Trop Med Parasitol. Jun 1998;92(4):489-501. [Medline].

  23. Herwaldt BL, Kjemtrup AM, Conrad PA, et al. Transfusion-transmitted babesiosis in Washington State: first reported case caused by a WA1-type parasite. J Infect Dis. May 1997;175(5):1259-62. [Medline].

  24. Homer MJ, Aguilar-Delfin I, Telford SR 3rd, Krause PJ, Persing DH. Babesiosis. Clin Microbiol Rev. Jul 2000;13(3):451-69. [Medline]. [Full Text].

  25. Hunfeld KP, Hildebrandt A, Gray JS. Babesiosis: recent insights into an ancient disease. Int J Parasitol. Sep 2008;38(11):1219-37. [Medline].

  26. Jacoby GA, Hunt JV, Kosinski KS, et al. Treatment of transfusion-transmitted babesiosis by exchange transfusion. N Engl J Med. Nov 6 1980;303(19):1098-100. [Medline].

  27. Kjemtrup AM, Conrad PA. Human babesiosis: an emerging tick-borne disease. Int J Parasitol. Nov 1 2000;30(12-13):1323-1337. [Medline].

  28. Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. Jun 5 1996;275(21):1657-60. [Medline].

  29. Linden JV, Wong SJ, Chu FK, et al. Transfusion-associated transmission of babesiosis in New York State. Transfusion. Mar 2000;40(3):285-9. [Medline].

  30. Persing DH, Herwaldt BL, Glaser C, Lane RS, Thomford JW, Mathiesen D, et al. Infection with a babesia-like organism in northern California. N Engl J Med. Feb 2 1995;332(5):298-303. [Medline]. [Full Text].

  31. Pfeiffer CD, Kazmierczak JJ, Davis JP. Epidemiologic features of human babesiosis in Wisconsin, 1996-2005. WMJ. Jul 2007;106(4):191-5. [Medline].

  32. Quick RE, Herwaldt BL, Thomford JW, et al. Babesiosis in Washington State: a new species of Babesia?. Ann Intern Med. Aug 15 1993;119(4):284-90. [Medline]. [Full Text].

  33. Raju M, Salazar JC, Leopold H, Krause PJ. Atovaquone and azithromycin treatment for babesiosis in an infant. Pediatr Infect Dis J. Feb 2007;26(2):181-3. [Medline].

  34. Rios L, Alvarez G, Blair S. Serological and parasitological study and report of the first case of human babesiosis in Columbia. Rev Soc Bras Med Trop. 2003;36:493-8. [Medline].

  35. Rodgers SE, Mather TN. Human Babesia microti incidence and Ixodes scapularis distribution, Rhode Island, 1998-2004. Emerg Infect Dis. Apr 2007;13(4):633-5. [Medline].

  36. Saito-Ito A, Tsuji M, Wei Q, et al. Transfusion-acquired, autochthonous human babesiosis in Japan: isolation of Babesia microti-like parasites with hu-RBC-SCID mice. J Clin Microbiol. Dec 2000;38(12):4511-6. [Medline]. [Full Text].

  37. Vannier E, Borggraefe I, Telford SR, et al. Age-associated decline in resistance to Babesia microti is genetically determined. J Infect Dis. May 1 2004;189(9):1721-8. [Medline].

  38. Wittner M, Lederman J, Tanowitz HB, et al. Atovaquone in the treatment of Babesia microti infections in hamsters. Am J Trop Med Hyg. Aug 1996;55(2):219-22. [Medline].

  39. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Nov 1 2006;43(9):1089-134. [Medline].

 
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Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
Blood smear showing Babesia species in erythrocytes. Courtesy of the Centers for Disease Control and Prevention.
Babesia species, tetrad formation. Courtesy of the Centers for Disease Control and Prevention.
 
 
 
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