Pediatric Babesiosis Follow-up

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

Further Inpatient Care

If the patient with babesiosis is critically ill, transfer the patient to the ICU.

Exchange transfusions are used in patients who are profoundly ill with high levels of parasitemia and hemolysis.

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Deterrence/Prevention

The prevention of babesiosis requires avoidance of areas endemic for Ixodes scapularis during May through September. This is especially important for individuals who are splenectomized and others who are immunocompromised.

In endemic areas, wear clothing to cover the lower portion of the body (eg, long pants and socks). Because ticks may crawl up pants and legs, tucking pants into boots or socks or cinching the legs at the ankles is helpful. Wearing light-colored clothes enables the ticks to be spotted more easily.

Diethyltoluamide (DEET) insect repellent applied to the skin or clothes is only partially repellant for hours.

A spray containing permethrin (Duranon, Permanone) is far more effective; however, only apply the spray to clothes (eg, pants bottoms, socks, shirtsleeves).

Inspect pets carefully for ticks before allowing them inside the home.

Avoid tall grass and brush in endemic areas and restrict walks and hikes to well-worn roads or paths.

Examine skin thoroughly for the presence of ticks. If a tick is found, speedy removal is indicated. Grasp the tick below the mouth with a small forceps or tweezers where it attaches to the skin and steadily pull the tick off.

Discouraging blood donors from endemic areas during May through September, avoiding accepting donations from donors with fevers during the 2 months before intended donation, and not accepting donations from those with a history of tick bites can reduce transfusion-associated babesiosis.

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Complications

The following may be observed:

  • Shock
  • Acute respiratory distress syndrome
  • Death
  • Relapse
  • Spontaneous splenic rupture[11]
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Prognosis

In healthy individuals with intact spleen, babesiosis is rarely fatal; however, in patients who are asplenic, babesiosis is generally quite severe and frequently fatal.

In a 1998 review by White and colleagues, 9 of 139 (6.5%) patients who were hospitalized with babesiosis in New York State from 1982-1983 died.[4]

In Europe, most symptomatic patients are asplenic, and the mortality rate is over 50%.

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Patient Education

Advise patients to take precautions against tick exposure.

Advise patients to refrain from donating blood until completely cured of babesiosis.

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

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.

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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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