A Case of Babesiosis Complicated by Hepatic and Renal Failure

Abstract

A 67-year-old male with a past medical history of chronic kidney insufficiency, splenectomy, and recurrent babesiosis infection was transferred to with jaundice and abdominal pain.The patient initially presented to an outside hospital (OSH) with generalized weakness, chills, and gastrointestinal symptoms and was found to have Babesia on peripheral blood smears. The patient received seven days of azithromycin and atovaquone, followed by three days of clindamycin and quinine sulfate. The patient was discharged home with improved symptoms and a negative peripheral blood smear. Less than 24 hours later he returned to the OSH with worsening myalgias and abdominal pain. Physical exam was significant for jaundice and hepatomegaly. Laboratory data revealed anemia, elevated creatinine, bilirubin of 30 mg/dL, and 1% parasitemia. At this point the patient was transferred for further management.Patient's past medical history was significant for chronic renal insufficiency, congestive heart failure, type 2 diabetes mellitus, coronary artery disease, and hypertension. Previous surgical procedures included splenectomy after a motor vehicle accident, below the knee amputation (BKA) of the right leg, and cholecystectomy. Patient denied alcohol or substance abuse, and quit smoking tobacco approximately 10 years ago. He is a retired carpenter and denied any recent history of travel. Medications on admission included digoxin, clopidogrel, isosorbide mononitrate, carvedilol, sucralfate, esomeprazole, metoclopramide, amlodipine, octreotide, and insulin lispro.On examination, patient looked fatigued, but in no acute distress. He was afebrile and had stable vital signs. Physical exam was significant for scleral icterus, ventral hernia and diffuse blanching, maculopapular rash on patient's hands and soles.Patient was admitted and started on treatment with clindamycin and quinine. The patient's blood smear showed Babesia species with a 1.7% parasitemia (figure 1). During the hospital stay, patient had an acute mental status change with asterixis. Laboratory data obtained at that time revealed elevated INR, bilirubin, and ammonia levels. Given the clinical findings, patient was started on lactulose for possible hepatic encephalopathy. Hepatitis serology was found to be negative. Dialysis was initiated in the setting of acute renal failure. Patient's clinical status continued to worsen, so red blood cell exchange transfusion was initiated in an attempt to reduce the parasite load and help clear the infection. Despite the exchange transfusion and continued antibiotic treatment, the patient continued to have hemolysis, paracitemia, renal failure, and hepatic failure. At that point hospice discussion was initiated and patient was eventually transferred to hospice home care.

Interactions between Babesia microti merozoites and rat kidney cells in a short-term in vitro culture and animal model

“…These analyses confirmed the powerful influence of the invasion on the structure of the renal tubules. Krawitz et al 28 confirmed the occurrence of complications from the excretory system in the course of human babesiosis.…”

Histopathological Analysis of Selected Organs of Rats with Congenital Babesiosis Caused by Babesia microti

“…A case of a man with Babesia merozoites was described in the literature. The spleen parenchyma was soft, brittle, and not enlarged, and the histopathological analysis of the spleen after splenectomy showed changes in the red pulp, in which there was an increase in the number of plasma cells, histiocytes, immunoblasts, and lymphocytes with features of hyperplasia [26].…”

A comparative analysis of the short-term effects of Babesia microti on rat hepatocytes in both in vitro and in vivo conditions

“…This results in liver, kidney, or spleen failure among the most common complications of acute babesiosis 15,16,17,18,19,20 . Krawitz et al 21 described a case of a 67-year-old man with renal and hepatic failure in the course of babesiosis. The patient's age and lack of a spleen were predisposing factors for complications in the course of infection.…”