Pediatric Babesiosis Workup

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

Laboratory Studies

The following may be observed in patients with babesiosis:

  • Hemolytic anemia, decreased serum haptoglobin levels, and elevated reticulocyte counts are noted, and the anemia may occasionally be severe.
  • The percentage of erythrocytes parasitized in clinical cases is usually 1-10% but has ranged from less than 1% to 85%.
  • The total leukocyte count may be within the reference range or mildly decreased.
  • Thrombocytopenia is common.
  • The erythrocyte sedimentation rate may be elevated.
  • Coombs test may react positively.
  • Urinalysis reveals proteinuria and hemoglobinuria.
  • BUN and serum creatinine levels may be elevated.
  • The following usually have mildly elevated levels:
    • Serum bilirubin
    • Alkaline phosphatase
    • Serum aspartate aminotransferase (AST)
    • Serum glutamic-oxaloacetic transaminase (SGOT)
    • Serum alanine aminotransferase (ALT)
    • Serum glutamic-pyruvic transaminase (SGPT)
    • Lactic dehydrogenase (LDH)
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Other Tests

Babesiosis is usually diagnosed by microscopic examination of Giemsa-stained or Wright-stained thin or thick blood smears (see the image below).

Blood smear showing Babesia species in erythrocyteBlood smear showing Babesia species in erythrocytes. Courtesy of the Centers for Disease Control and Prevention.

Babesia may be mistaken for malarial parasite, particularly the ring forms of P falciparum. Helpful features that distinguish Babesia from Plasmodium include the absence of brownish pigment deposits (hemozoin), the lack of synchronous stages (schizonts and gametocytes observed with Plasmodium species), and the occasional presence of tetrads (as seen in the image below) of merozoites or Maltese-cross forms.

Babesia species, tetrad formation. Courtesy of theBabesia species, tetrad formation. Courtesy of the Centers for Disease Control and Prevention.

Babesia varies more in shape and in size and may be observed outside erythrocytes with heavier infestation.

An indirect immunofluorescent antibody (IFA) assay can be used to make a serologic diagnosis of babesiosis.

A titer of 1:256 or greater is considered diagnostic for recent Babesia microti infection. Most patients with an active infection develop serum titers 1:024 or greater within a few weeks. Antibody titers decline slowly over months to 1:256 or less. Titers of 1:32 or less indicate prior infection. Cross-reactions may occur in serum specimens from patients with malaria infections.

Because of the antigenic differences, infections with WA-1 species and MO-1 strain Babesia are not detected by IFA for B microti. Test individuals whose exposure could have occurred on the West Coast of the United States for antibodies to the WA-1 species Babesia.

A polymerase chain reaction (PCR)–based diagnostic assay has been reported and holds great promise for increasing the detection rate of very low-level parasitemia. Persistence of antibody titers for B microti has been shown to correlate with the detection of babesial DNA by PCR.[5] In 1998, Krause and colleagues reported the detection of babesial DNA by PCR for as long as 27 months after untreated infection.[6]

Currently, the suspected B microti infection can be confirmed through intraperitoneal inoculation of 1 mL of ethylenediaminetetraacetic acid (EDTA) whole blood into the peritoneum of golden hamsters. B divergens replicates readily in gerbils. Within 2-4 weeks, smears are positive in the infected animals.

Consider the possibility of co-infection with Lyme disease because the 2 organisms share the same tick vector. Co-infection often results in increased duration and severity of illness.

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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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