Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone

Abstract

BackgroundBabesiosis is a potentially life-threatening, tick-borne infection endemic in New York. The purpose of this study was to review recent trends in babesiosis management and outcomes focusing on patients, who were treated with combination of azithromycin and atovaquone.MethodsA retrospective chart review of patients seen at Stony Brook University Hospital between 2008 and 2014 with peripheral blood smears positive for Babesia was performed. Clinical and epidemiological information was recorded and analyzed.Results62 patients had confirmed babesiosis (presence of parasitemia). Forty six patients (74%) were treated exclusively with combination of azithromycin and atovaquone; 40 (87%) of these patients were hospitalized, 11 (28%) were admitted to Intensive Care Unit (ICU), 1 (2%) died. Majority of patients presented febrile with median temperature 38.5 °C. Median peak parasitemia among all patients was 1.3%, and median parasitemia among patients admitted to ICU was 5.0%. Six patients (15%) required exchange transfusion. Majority of patients (98%) improved and were discharged from hospital or clinic.ConclusionSymptomatic babesiosis is still rare even in endemic regions. Recommended treatment regimen is well tolerated and effective. Compared to historical controls we observed a lower overall mortality.

The use of cytapheresis in the treatment of infectious diseases

“…An additional 26 cases have been reported in 20 publications in the intervening time (1981–2016) with 22 survivors and 4 deaths (reviewed in). Recently, Kletsova and colleagues reported on the treatment of 62 babesiosis patients in which 6 patients received ET (no treatment specifics provided) and 5 of the 6 survived . In total, there have been reported 32 babesiosis patients treated with ET, with an 84% survival rate.…”

“…Recently, Kletsova and colleagues reported on the treatment of 62 babesiosis patients in which 6 patients received ET (no treatment specifics provided) and 5 of the 6 survived. 61 In total, there have been reported 32 babesiosis patients treated with ET, with an 84% survival rate. Two other case series have also reported the combined use of ET in 13 additional patients, but provide no outcome data.…”

Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient

“…As per Infectious Diseases Society of America guidelines of 2006, mild-moderate babesiosis should be treated with azithromycin and atovaquone, and severe disease with quinine and clindamycin. However, based on a more recent retrospective study, atovaquone and azithromycin may have equal efficacy in severe disease 4 15 17. There are no prospective studies for comparison.…”

Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

“…Initial therapy includes atovaquone (20 mg/kg every 12 hours) plus azithromycin (10 mg/kg/day on day 1 followed by 5 mg/kg/day from day 2) or intravenous clindamycin (7-10 mg/kg every 6 to 8 hours) plus quinine (8 mg/kg in every 8 hours) for 7 to 10 days. 14,16,45 Hematocrit and percentage of parasitized erythrocytes should be monitored daily until the level of parasitemia has decreased to <5% of erythrocytes. 16 According to the Infectious Disease Society of America Guidelines, exchange transfusion and quinine plus clindamycin should be used for all patients with severe babesiosis, defined as high grade parasitemia (10%), significant hemolysis, or renal, hepatic, or pulmonary compromise.…”

“…16 According to the Infectious Disease Society of America Guidelines, exchange transfusion and quinine plus clindamycin should be used for all patients with severe babesiosis, defined as high grade parasitemia (10%), significant hemolysis, or renal, hepatic, or pulmonary compromise. 14,45 The clinician must be prepared to provide supportive care for severe illness, such as antipyretics, vasopressors, blood transfusions, exchange transfusions, mechanical ventilation, or dialysis. 38…”