Atypical challenging and first case report of babesiosis in Ecuador

Abstract

Babesia is known to be prevalent in the Eastern United States and other temperate countries but the prevalence of babesia is not well known in the tropical malaria-endemic countries because of the higher prevalence of malaria.A 72-year-old Hispanic male from Ecuador presenting with increasing left lower quadrant abdominal pain and distention for one year. He experienced nausea, vomiting, diarrhea, fever, chill, and myalgias. He reported 9 kg weight loss over the last two months. Patient moved to Chicago recently from Ecuador where he worked at a banana plantation and had frequent exposure to many insects and animals.Vital signs were normal but patient appeared chronically ill. Mild tenderness to palpation over the left side of the abdomen with marked splenomegaly, measuring 16 cm below the costal margin.Laboratory results with no leukocytosis hemoglobin 7.8 × 109/L; and platelet count, 55 × 109/L. Sodium was 128 mmol/L. Labs showed elevated LDH, ESR and ferritin values. The haptoglobin was low with a positive Combs test. CT abdomen showed moderate splenomegaly with large patchy, wedge-shaped hypodense area in posterior mid and upper spleen suggesting splenic infarction. Rapid malaria screening was negative, but a peripheral smear identified plasmodium species in more than 0.5% of red blood cells. Treatment with atovaquone and proguanil started.Two weeks later, molecular testing revealed Babesia DNA.This report details a case of babesiosis in a patient coming from a malaria-endemic region. The initial workup and blood work highly suggested a plasmodium infection. However the polymerase chain reaction confirmed the diagnosis of a Babesia microti.Learning objectives: We report the first case of human Babesiosis in previously healthy individual from Ecuador.

Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature

“…A PubMed database search for articles published in English using the key words “ Babesia and splenic rupture”, “Babesiosis and splenic rupture”, “ Babesia and hemorrhagic shock” and “ Babesia and splenic infarct”, yielded 9 cases of babesiosis associated with splenic rupture and 3 cases associated with splenic infarct. Interestingly, all cases were reported in the U.S and among these, only 1 case [ 27 ] was identified in a patient who recently immigrated to the U.S. from Ecuador. All the cases of splenic infarct or splenic rupture were due to B. microti infection.…”

Splenic infarction in babesiosis: A rare presentation

“…21,[35][36][37][38] Splenic infarction is a rare complication in babesiosis that has been reported in very few (babesiosis) cases. 27,32,39 Although our patient's age (>50 years) is a risk factor for severe disease, this case reveals that significant complications from babesiosis may arise in the setting of immunocompetent individuals with low levels of parasitemia. In all reported cases, CT scans of the abdomen without contrast revealed hypodense lesions within the patient's spleen.…”

Case report of the patient source of the Babesia microti R1 reference strain and implications for travelers

“…[38][39][40] Case of B. microti in South America was reported for a traveler coming back in the USA. 17 A patient traveling from Uruguay to Spain presented mild symptoms of B. microti infection a few days after he return to his home but the origin of the parasite remains uncertain. 18 Babesia venatorum infection is endemic in Heilongjiang province, the most northeastern province of China.…”

“…34 Physicians and other health care workers in areas where both babesiosis and malaria are endemic should order Babesia and malaria PCR, in addition to blood smears. 17,42…”

“…[3][4][5][6] Human babesiosis due to B. microti is endemic in the northeastern and northern midwestern United States and sporadically reported in Asia, Australia, Europe and South America. 2,[7][8][9][10][11][12][13][14][15][16][17][18] In 2011, the Institute of Medicine in the United States designated babesiosis an emerging health threat 19 and the United States Centers for Disease Control and Prevention (CDC) designated babesiosis as a nationally notifiable disease. 20 In 2012, the sequencing and annotation of the full B. microti genome was completed, an important advance in our understanding of B. microti biology and evolution.…”