Babesiosis: A Retrospective Review of 38 Cases in the Upper Midwest

Fida, Madiha; Challener, Douglas W.; Hamdi, Ahmed; O’Horo, John C.; Saleh, Omar Abu

doi:10.1093/ofid/ofz311

Cited by 12 publications

(9 citation statements)

References 19 publications

(20 reference statements)

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“…Of note, most other severe complications of babesiosis occurred primarily in the elderly [1,2]. Curiously, while one recent study from a babesiosis-endemic area in the US reported a female predominance [14], we find that splenic complications occur almost exclusively in men. In our systematic review, 30 of 34 cases (88%) were males.…”

Section: Resultscontrasting

confidence: 58%

“…Asplenic individuals, the elderly, and immunocompromised patients have higher mortality rates due to the development of severe complications [11,12]. Severe complications of B. microti infection include acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and liver or renal failure [12][13][14]. Splenic rupture is a severe but rarely reported complication of B. microti infection.…”

Section: Introductionmentioning

confidence: 99%

“…Canadian Journal of Infectious Diseases and Medical Microbiology Yes 2No AZ + ATQ (14) No, SA embolization 11 [27] 2011 (El Khouri)…”

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confidence: 99%

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Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Dumić

Madrid

Prada

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

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Section: Resultscontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Dumić

Madrid

Prada

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…The average number of days of symptoms before diagnosis was ≈10 days, which is a slightly shorter period compared with reports from other studies (5,24) and might have been because all patients had blood smears obtained early on during admission. The reason for obtaining blood smears was predominately for work-up of new anemia or thrombocytopenia.…”

Section: Discussionmentioning

confidence: 61%

Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018

Ingram¹,

Crook²

2020

Emerg. Infect. Dis.

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B abesiosis, a tickborne infection caused by protozoan parasites that infect erythrocytes, has been identified as an emerging infection of concern in the state of Pennsylvania, USA (1-4). Infection with Babesia parasites can cause a range of symptoms, including fever, myalgias, and fatigue. Although many patients are asymptomatic, the infection can be severe in some persons, especially those who are >50 years of age, immunosuppressed, or asplenic (1,5,6). The most common species known to cause human infection in the United States is Babesia microti, which is transmitted by the Ixodes scapularis tick (blacklegged tick). Transmission can also occur through blood transfusion; B. microti is currently the most common pathogen transmitted through the blood supply in the United States (7,8). The highest incidence of human infection has been reported in the Northeast and upper Midwest states (9). Until fairly recently, few cases of B. microti infection have occurred in Pennsylvania. However, new data suggest not only increased prevalence of ticks harboring B. microti within the state (10) but also a rise in the number of cases seen in clinical practice (2-4). Babesiosis is not a mandatory reportable infection in Pennsylvania; however, the Pennsylvania Department of Health does receive reports of cases of babesiosis from healthcare providers that elect to do so. Among these recounted cases, the department has seen a 20-fold increase in the past 12 years (E. Negrón, Pennsylvania Department of Health, pers. comm., 2018 Aug 1). A similar trend was documented in a recent study from February 2019 involving a 4-hospital system in southeastern Pennsylvania, where clinicians saw an increase in cases from <7 cases annually during 2008-2014 to 26 cases in 2015 (4). We have suspected a similar increase in the number of cases at our institution, Penn State Milton S. Hershey Medical Center (Hershey, PA, USA), which is a tertiary academic center located in central Pennsylvania. We performed a retrospective review of all of the confirmed cases of babesiosis at our institution for the period 2005-2018 to determine whether we were truly seeing an increased number of cases and to highlight the demographic and clinical characteristics of these patients. Methods We obtained a list of all patients who had International Classification of Diseases, 9th Revision (ICD-9) (088.82), and International Classification of Diseases, 10th Revision (ICD-10) (B60.0), diagnostic codes for babesiosis as well as patients that had Babesia serologic tests ordered at Hershey Medical Center during 2005-2018. The list consisted of 352 patient encounters, some of which were duplicates. We retrospectively chart reviewed each patient encounter to identify confirmed cases of babesiosis. Only patients who met Centers for Disease Control and Prevention criteria for confirmed cases of babesiosis were included in our study (Table 1): patients who had confirmatory laboratory results (i.e., parasite seen on peripheral smear, positive PCR from blood, or both) and met >1 of t...

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“…Perhaps this disparity in RBC-related research is because the number of babesisosis cases is small compared to the estimated 228 million [23] cases of malaria in year 2018. A retrospective study of babesiosis in the Midwestern US examined just 38 babesiosis cases at 3 different locations over 13 years (2005-2017) [24]. Historically, studies have analyzed small sample sizes that can make it difficult to identify new associations between, for example, RBC variables and babesiosisdisease progression.…”

mentioning

confidence: 99%

The Centers for Disease Control and Prevention and State Health Departments should include Blood-Type Variables in their Babesiosis Case Reports

Jajosky

2020

Transfusion and Apheresis Science

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is CMO and part-owner of Biconcavity Inc. Biconcavity Inc. is a biotechnology research and development company exploring drug-linked-erythrocytes. Biconcavity does not have any interest in babesiosis or disease surveillance. Visit www.biconcavity.com for more information. Dr. Audrey Jajosky has nothing to disclose. Babesiosis is a growing threat in the United States (US)-likely due to climate change [1]. Babesiosis is an infectious disease caused by Babesia parasites, which invade red blood cells (RBCs). [2] Parasitized RBCs can (1) hemolyze or (2) block microvascular blood flow by adhering to vascular endothelium [3]. Because babesiosis is a serious "emerging disease" in the US, the Centers for Disease Control and Prevention (CDC) designated babesiosis "a nationally notifiable disease" in 2011 [2]. This means US state and territorial health departments are encouraged to report babesiosis cases to the CDC. For the 5year period from 2011 to 2015, CDC received 6277 "confirmed" and 1335 "probable" babesiosis case reports [2]. Of concern, the most recent year analyzed (2015) had the highest total number of cases (confirmed + probable) [2]. State health departments individually decide how to investigate and report cases of babesiosis. Because Babesia microti is endemic [4] in Rhode Island, clinicians are required (by state regulations) to report suspected, confirmed, or probable babesiosis cases to the Rhode Island Department of Health within 4 days [5]. Rhode Island requires local healthcare workers to complete as much of the state's babesiosis Case Report Form (CRF) as possible before sending it to the Rhode Island Department of Health. Rhode Island's babesiosis CRF includes data elements that describe the patient's risk factors, treatment, clinical complications, final outcome (hospital discharge date or death), and other information. [6] To complete the CRF, state health department officials may request medical records from the healthcare facility

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Babesiosis: A Retrospective Review of 38 Cases in the Upper Midwest

Cited by 12 publications

References 19 publications

Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018

The Centers for Disease Control and Prevention and State Health Departments should include Blood-Type Variables in their Babesiosis Case Reports

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