Babesiosis and Infection with Human Immunodeficiency Virus (HIV)

Benezra, Diane; Brown, Arthur E.; Polsky, Bruce; Gold, Jonathan W. M.; Armstrong, Donald

doi:10.7326/0003-4819-107-6-944_1

Cited by 48 publications

(27 citation statements)

References 3 publications

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“…For instance, patients coinfected with B. burgdorferi (the causative agent in Lyme disease) and B. microti experienced increased disease severity (108). Finally, human immunodeficiency virus (HIV) infection may also exacerbate the symptoms of babesial infection; several relatively treatment-resistant cases have been described (13,58,152).…”

Section: Host Susceptibilitymentioning

confidence: 99%

“…Patients with connective tissue disorders such as systemic lupus erythematosus and rheumatoid arthritis (160) may also generate false-positive results by other mechanisms. Conversely, immunosuppressed patients and patients from whom samples are collected early in the course of the infection could generate false-negative results (13,152); HIV-infected and splenectomized patients generally have very low titers (S. R. Telford III, unpublished data).…”

Section: Serology and Immunologymentioning

confidence: 99%

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Babesiosis

Homer¹,

Aguilar-Delfín²,

Telford³

et al. 2000

Clinical Microbiology Reviews

520

402

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Section: Host Susceptibilitymentioning

confidence: 99%

Section: Serology and Immunologymentioning

confidence: 99%

Babesiosis

Homer¹,

Aguilar-Delfín²,

Telford³

et al. 2000

Clinical Microbiology Reviews

520

402

View full text Add to dashboard Cite

“…Primary therapy is with antibiotics including clindamycin and quinine, with RBC exchange transfusion reported to be effective in severe cases [2,5-71. Although the role of HIV coinfection in babesiosis is uncertain, two previously reported cases raise the concern that it may predispose to a more severe clinical course [8,9]. We describe another case of severe babesial infection in an HIV-seropositive, asplenic patient, whose disease relapsed twice on various appropriate antibiotic regimens, but resoIved entirely following RBC exchange transfusions combined with antibiotic therapy.…”

Section: Introductionmentioning

confidence: 90%

Treatment of babesiosis by red blood cell exchange in an HIV‐positive, splenectomized patient

Machtinger

Telford²,

Inducil

et al. 1993

J of Clinical Apheresis

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Babesiosis is a malaria-like parasitic disease causing subclinical or mild illness in most cases. Splenectomized patients, however, may experience a more severe course. Although generally responsive to antibiotic therapy, several cases of severe babesiosis refractory to appropriate antibiotic therapy have been reported to respond promptly and dramatically to red blood cell (RBC) exchange transfusion. Although the role of HIV coinfection in babesiosis is uncertain, two previously reported cases raise a concern that it may predispose to a more severe clinical course. We report a third case of severe babesiosis in an HIV-positive splenectomized man, following travel to an endemic area. Antibiotic therapy, though initially effective, ultimately failed to prevent severe disease. RBC exchange transfusion resulted in prompt clinical improvement, which has been sustained during 26 months of follow-up. Although the patient has since developed various sequelae of HIV infection, including disseminated Kaposi's sarcoma, CMV retinitis, and enteritis, there has been no recurrence of observable parasitemia. In severe babesiosis, RBC exchange transfusion, combined with appropriate antibiotic therapy, appears to be a rapidly effective therapeutic modality which can induce sustained remissions.

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“…27 Indeed, human babesial infection was reported more severe in splenectomized and HIV-infected patients, [14][15][16] and eradication of Babesia infection in HIVinfected patients with severe immunosuppression is unlikely. 16 However, clearance of Babesia infection after appropriate antibiotic treatment was observed in our asymptomatic immunocompetent human case.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Based on numerous clinical observations and an experimental hamster model, [11][12][13] the drug combination of clindamycin plus quinine has been recommended as the standard regimen for human babesial infection. However, failure of elimination of babesial infection by the standard regimen has been reported in some immunocompromised and human immunodeficiency virus (HIV)-infected persons, [14][15][16] and relapses of Babesia infection following therapy with chloroquine and other combination regimens are well documented. 12,17 Azithromycin, a new azalide analog of erythromycin, has been proven effective against various protozoal infections, [18][19][20][21] especially its therapeutic and prophylactic effects on chloroquine-resistant malaria infections of humans.…”

mentioning

confidence: 99%

Ability of azithromycin in combination with quinine for the elimination of babesial infection in humans.

Shih

Wang²

1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. We report the ability of azithromycin in combination with quinine to eliminate the Babesia infection in a native Taiwanese woman. Failure of elimination of the babesial infection was observed two weeks after treating with standard regimen of oral quinine plus intravenous clindamycin for a 10-day course of therapy. Azithromycin in place of clindamycin was administered for another 10-day course of therapy two months following initial treatment. Clearance of Babesia parasites was observed and verified by hamster inoculation. These results suggest that azithromycin plus quinine should be considered as an alternative therapy for human babesiosis, especially in the failure of treatment with standard regimens.Babesiosisis a tick-transmitted protozoan infection caused by an intraerythrocytic malaria-like organism that infects a wide variety of wild and domestic animals. 1 Human infection with Babesia parasite is usually acquired via the bite of an infective Ixodes tick 2,3 or accidentally acquired via blood transfusion. [4][5][6] Although numerous cases of human babesial infections have been reported in Europe and the United States, 7,8 reported cases of human babesiosis are rare in eastern Asia and the possible vector responsible for transmission remains undefined. 9,10 Based on numerous clinical observations and an experimental hamster model, 11-13 the drug combination of clindamycin plus quinine has been recommended as the standard regimen for human babesial infection. However, failure of elimination of babesial infection by the standard regimen has been reported in some immunocompromised and human immunodeficiency virus (HIV)-infected persons, [14][15][16] and relapses of Babesia infection following therapy with chloroquine and other combination regimens are well documented. 12,17 Azithromycin, a new azalide analog of erythromycin, has been proven effective against various protozoal infections, 18-21 especially its therapeutic and prophylactic effects on chloroquine-resistant malaria infections of humans. [22][23][24] Although the suppression of Babesia parasitemia by azithromycin plus quinine has been reported in the hamster model, 21 the ability of this combination regimen to eliminate Babesia infection in human remains unclear. In this paper, we report the efficacy of a drug combination of azithromycin plus quinine for the clearance of Babesia infection in humans. MATERIALS AND METHODSCase history. A suspected case of Babesia infection was diagnosed in a 51-year-old Taiwanese woman who presented to the local hospital of Chia-i Country in March 1994 with the chief complaints of headache, malaise, fatigue, and frequently mild fever (38.3ЊC) during the past few months. She was transferred to the Medical Center in Taipei and was hospitalized from April 15 to May 18, 1994. Routine hematologic examinations revealed that the patient had a normal leukocyte count (5.1 ϫ 10 3 /l) and platelet count (200 ϫ 10 3 /l), but an abnormal erythrocyte count (3.95 ϫ 10 6 / l) and hematocrit (27.8%). She also had a decrease...

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Babesiosis and Infection with Human Immunodeficiency Virus (HIV)

Cited by 48 publications

References 3 publications

Babesiosis

Babesiosis

Treatment of babesiosis by red blood cell exchange in an HIV‐positive, splenectomized patient

Ability of azithromycin in combination with quinine for the elimination of babesial infection in humans.

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