Fulminant babesiosis treated with clindamycin, quinine,and whole‐blood exchange transfusion

Dorman, Susan E.; Cannon, Marie E.; Telford, Sam R.; Frank, Kirby; Churchill, W. Hallowell

doi:10.1046/j.1537-2995.2000.40030375.x

Cited by 57 publications

(35 citation statements)

References 24 publications

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“…Similar to procedures for treating malaria, exchange transfusion is designed to rapidly reduce patient parasitemia and related anemia (17,23,46,60,101). To date, exchange transfusion has been used to treat infections with B. microti and B. divergens; however, this approach should be considered for other species of Babesia as conditions warrant.…”

Section: Treatmentmentioning

confidence: 99%

Transfusion-TransmittedBabesiaspp.: Bull's-Eye onBabesia microti

2011

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SUMMARY Babesia spp. are intraerythrocytic protozoan parasites of animals and humans that cause babesiosis, a zoonotic disease transmitted primarily by tick vectors. Although a variety of species or types of Babesia have been described in the literature as causing infection in humans, the rodent parasite Babesia microti has emerged as the focal point of human disease, especially in the United States. Not only has B. microti become established as a public health concern, this agent is increasingly being transmitted by blood transfusion: estimates suggest that between 70 and 100 cases of transfusion-transmitted Babesia (TTB) have occurred over the last 30 years. A recent upsurge in TTB cases attributable to B. microti , coupled with at least 12 fatalities in transfusion recipients diagnosed with babesiosis, has elevated TTB to a key policy issue in transfusion medicine. Despite clarity on a need to mitigate transmission risk, few options are currently available to prevent the transmission of B. microti by blood transfusion. Future mitigation efforts may stress serological screening of blood donors in regionalized areas of endemicity, with adjunct nucleic acid testing during the summer months, when acute infections are prevalent. However, several hurdles remain, including the absence of a licensed blood screening assay and a thorough cost-benefit analysis of proposed interventions. Despite current obstacles, continued discussion of TTB without proactive intervention is no longer a viable alternative.

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Section: Treatmentmentioning

confidence: 99%

Transfusion-TransmittedBabesiaspp.: Bull's-Eye onBabesia microti

2011

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“…When given concurrently with appropriate chemotherapy, whole-blood exchange transfusion might be life-saving (58). Human infections with the bovine pathogen B. divergens should also be regarded as a medical emergency, and prompt therapy is indicated.…”

Section: Treatment Of Babesiosismentioning

confidence: 99%

Coinfections Acquired from Ixodes Ticks

et al. 2006

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SUMMARY The pathogens that cause Lyme disease (LD), human anaplasmosis, and babesiosis can coexist in Ixodes ticks and cause human coinfections. Although the risk of human coinfection differs by geographic location, the true prevalence of coinfecting pathogens among Ixodes ticks remains largely unknown for the majority of geographic locations. The prevalence of dually infected Ixodes ticks appears highest among ticks from regions of North America and Europe where LD is endemic, with reported prevalences of ≤28%. In North America and Europe, the majority of tick-borne coinfections occur among humans with diagnosed LD. Humans coinfected with LD and babesiosis appear to have more intense, prolonged symptoms than those with LD alone. Coinfected persons can also manifest diverse, influenza-like symptoms, and abnormal laboratory test results are frequently observed. Coinfecting pathogens might alter the efficiency of transmission, cause cooperative or competitive pathogen interactions, and alter disease severity among hosts. No prospective studies to assess the immunologic effects of coinfection among humans have been conducted, but animal models demonstrate that certain coinfections can modulate the immune response. Clinicians should consider the likelihood of coinfection when pursuing laboratory testing or selecting therapy for patients with tick-borne illness.

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“…The removal of parasites decreases parasite burden a potential trigger for additional production of proinflammatory cytokines. Additionally, because Babesia has no extraerythrocytic life cycle, exchange transfusion has the potential to be curative [29,35], although this is unlikely in itself. Clearly, only the more severe cases will have either RCE or WBE and this will bias the outcome data.…”

Section: Discussionmentioning

confidence: 99%

Red cell exchange transfusion for babesiosis in Rhode Island

Spaete

Patrozou

Rich

et al. 2009

J of Clinical Apheresis

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We report four cases of clinically severe tick borne babesiosis treated with chemotherapy and adjunctive red cell exchange (RCE) at two Rhode Island hospitals from 2004 to 2007. All RCE procedures were performed using a Cobe Spectra device and were well tolerated without complications. The volume of allogeneic red cells used in the exchange was determined using the algorithm in the apheresis device with the input variables of preprocedure hematocrit, weight, height, an assumed allogeneic red cell hematocrit of 55 and a desired post procedure hematocrit of 27. The preprocedure level of parasitemia varied between 2.4% and 24% and the postprocedure level of parasitemia between 0.4 and 5.5% with an average overall percent reduction in parasitemia of 74%. Retrospectively, application of a new formula to calculate red cell mass appeared to correlate better with the percent reduction in parasitemia. Previous reports of RCE in babesiosis were reviewed. The reported reduction in parasitemia varied from 50% to >90%. Although a preprocedure level of parasitemia of 10% is sometimes used as a threshold for RCE in clinically severe babesiosis, this threshold does not have a firm empirical basis. No postprocedure desired level of parasitemia is indicated nor the mass of allogeneic red cells needed to achieve such a level. We conclude that current estimates of the dose of allogeneic red cells used in RCE are probably inaccurate, advocate a new formula to estimate this dose and suggest that a 90% reduction in parasitemia should be the minimally desired target of RCE in babesiosis.

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Fulminant babesiosis treated with clindamycin, quinine,and whole‐blood exchange transfusion

Abstract: In cases of severe babesiosis, prompt institution of whole-blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life-saving.

Cited by 57 publications

References 24 publications

Transfusion-TransmittedBabesiaspp.: Bull's-Eye onBabesia microti

Transfusion-TransmittedBabesiaspp.: Bull's-Eye onBabesia microti

Coinfections Acquired from Ixodes Ticks

Red cell exchange transfusion for babesiosis in Rhode Island

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