Babesia microti Infection in Pregnancy Mimicking HELLP Syndrome

Abstract

Babesiosis during pregnancy is an uncommon cause of hemolysis during pregnancy and may have a similar presentation to hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. We report a case of a 34-year-old healthy gravida 3 para 1-0-1-1 at 38 weeks of gestation who was transferred to our tertiary care center for induction of labor for suspected HELLP syndrome. Peripheral blood smear from the referring hospital showed intraerythrocytic ring forms consistent with Babesia microti infection. She was treated with clindamycin and quinine and had a vaginal delivery of a healthy infant. This case demonstrates that although uncommon, babesiosis should be on the differential for imitators of HELLP syndrome to optimize treatment and outcomes.

Babesiosis in Pregnancy: An Imitator of HELLP Syndrome

“…The differential diagnosis of babesiosis should be considered on the differential of HELLP syndrome imitators to avoid iatrogenic preterm delivery, delay in treatment, and complications of undiagnosed and untreated babesiosis. 17 Table 1 demonstrates the similar clinical manifestations and laboratory evaluation in HELLP syndrome and babesiosis.…”

“…Two of these patients never had a fever. 5 17 HELLP syndrome was considered in 50% of the cases. All patients had laboratory features found in HELLP syndrome, including transaminitis (not reported by Raucher et al); and thrombocytopenia ranging from 8,000–120,000/μL.…”

“…Two patients had coinfection with other tick-borne diseases, namely Lyme disease (case 2) and anaplasmosis. 17…”

“…Clindamycin and quinine provide better placental penetration to prevent vertical transmission; however, atovaquone and azithromycin have also been used to treat malaria in pregnancy without increased risk of congenital birth defects, stillbirth, or anemia. 4 17 An alternative drug therapy option is critical to note because quinine therapy is often interrupted because of drug toxicity; thus, azithromycin plus atovaquone may be considered appropriate for some hospitalized patients with severe babesiosis. 14 Antibiotic dosing and side effects are noted in Table 3 .…”