Babesiosis acquired from a pet dog: a second reported case in Hong Kong

Abstract

A 61-year-old Chinese man was admitted to our hospital in June 2012 with a 2-week history of fever and chills. After admission, he developed hypotension and respiratory distress and was transferred to the intensive care unit (ICU) for further management.He frequently commuted between New York, Hong Kong, and Shanghai for business. He lived in his own house in New York and had a dog. Three weeks before onset of his symptoms, he swept his basement where his dog spent most of its time. He was not aware of any tick bite.He was a chronic smoker but enjoyed good past health. His symptoms began with fever and chills while in China. He also experienced malaise and a mild dry cough. He had no skin rash, or abdominal or urinary symptoms. A diagnosis of upper respiratory tract infection was made and he was given a course of piperacillin-tazobactam during hospitalisation in China. Symptoms persisted, however, and he presented to a public hospital in Hong Kong. Initial blood tests revealed a normochromic normocytic anaemia (haemoglobin, 81 g/L) with reticulocytosis, marked thrombocytopenia, and moderate renal impairment. Blood smear revealed the presence of intra-erythrocytic ring-form parasites, suggestive of Plasmodium falciparum infection (Fig 1). Chest X-ray showed bilateral extensive abnormal lung infiltrates. He was transferred to our hospital for further management.He soon developed shock and was transferred to the ICU. Further blood tests revealed hyperbilirubinaemia and evidence of haemolysis. Peripheral blood smear for malaria was repeated and revealed 3.8% parasitised red cells. Pleomorphic ring forms were noted, with occasional arrangement in a cross-like pattern (Fig 2). Rapid antigen test for P falciparum was negative and this raised the suspicion of babesiosis. A subsequent blood Babesia microti polymerase chain reaction (PCR) test was positive and a diagnosis of babesiosis was confirmed.Quinine and clindamycin were initiated. The patient experienced severe tinnitus after 5 days of treatment and quinine was stopped. Doxycycline was added for treatment due to persistent fever

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