Heavy parasitemia in babesiosis treated without adjunctive red cell exchange

Cervera-Hernandez, Miguel E.; Zaidi, Najam; Sweeney, Joseph D.

doi:10.1016/j.transci.2019.04.026

Cited by 11 publications

(6 citation statements)

References 8 publications

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“…The authors emphasized that use of RCE based on a >10% parasitemia (or the other criteria presented in the guidelines) has not been validated in a randomized controlled trial and that the association between disease severity and parasitemia does not necessarily mean that this parameter is a useful indicator for exchange or that RCE is effective. Cervera‐Hernandez et al (2019) described three patients with >10% parasitemia who were successfully treated without RCE 24 . We noted one such case in this retrospective series.…”

Section: Discussionsupporting

confidence: 50%

“…Cervera-Hernandez et al (2019) described three patients with >10% parasitemia who were successfully treated without RCE. 24 We noted one such case in this retrospective series. The patient was treated with antimicrobial therapy alone after the parasitemia level rapidly decreased (from 12.7% at peak to 8.2%) within 12 hours of admission.…”

mentioning

confidence: 67%

“…Several recent studies have questioned the use of parasitemia >10% as a sole indication for RCE 12,13,24 . The study authors have advocated for a more holistic approach that takes into greater consideration the overall clinical status of the patient, especially with regard to renal compromise or failure.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have questioned the use of parasitemia >10% as a sole indication for RCE. 12,13,24 The study authors have advocated for a more holistic approach that takes into greater consideration the overall clinical status of the patient, especially with regard to renal compromise or failure. The authors emphasized that use of RCE based on a >10% parasitemia (or the other criteria presented in the guidelines) has not been validated in a randomized controlled trial and that the association between disease severity and parasitemia does not necessarily mean that this parameter is a useful indicator for exchange or that RCE is effective.…”

mentioning

confidence: 99%

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Parasite burden and red blood cell exchange transfusion for babesiosis

O’Bryan

Gokhale

Hendrickson

et al. 2020

J of Clinical Apheresis

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Background: The association between parasite burden and end-organ dysfunction in subjects with Babesia microti infection has not been extensively studied, nor has the optimal role of red blood cell exchange (RCE) transfusion in babesiosis treatment. This retrospective chart review evaluates the associations between parasitemia, end-organ dysfunction, and outcomes in babesiosis patients treated with antimicrobial agents and RCE compared to those treated with antimicrobial agents alone. Materials and Methods: We evaluated adults (≥18 years of age) with laboratory-confirmed babesiosis who were admitted between 2011 and 2017 to Yale New Haven Hospital, located in a Babesia-endemic region of the Northeastern United States. Patient demographics, parasitemia levels, clinical and laboratory indicators of end-organ dysfunction, and outcomes were examined. Results: Ninety-one subjects (mean age 65.1 years, 69.2% male) were studied. Subjects were stratified according to peak parasitemia: <1% (n = 34), 1-5% (n = 24), 5-10% (n = 15), and >10% (n = 18). Laboratory measures indicating degrees of hemolysis, coagulopathy, and pulmonary, renal and hepatic dysfunction differed significantly across peak parasitemia levels. Median length of hospital stay increased with each successive peak parasitemia level (P < .001). These results indicate a strong association between peak parasitemia level and disease severity. Nineteen subjects underwent RCE, all with peak parasitemia ≥9% and some degree of end-organ dysfunction. Conclusions: Babesia microti parasitemia is closely associated with disease severity, though not all subjects with end-organ dysfunction had high-grade parasitemia. Our data suggest that the use of parasitemia >10%, coupled with clinical status, is a reasonable indicator for RCE in babesiosis patients.

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Section: Discussionsupporting

confidence: 50%

mentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Parasite burden and red blood cell exchange transfusion for babesiosis

O’Bryan

Gokhale

Hendrickson

et al. 2020

J of Clinical Apheresis

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“…Consequently, the status of asplenic B. divergens -infected patients is regarded as a medical emergency, requiring immediate treatment to arrest hemolysis and prevent complications [ 111 , 137 ]. The combination of clindamycin and quinine for 7 to 10 days ( Table 5 ) dramatically improves disease outcome [ 137 , 146 , 147 , 148 , 149 ], but in recent years, a more favorable disease course has been increasingly reported for B. divergens -infected patients, including those not treated with a full course of clindamycin and quinine because of quinine side effects [ 70 , 111 , 150 ]. These findings underscore the impact of improved adjunctive measures provided by modern intensive care medicine, including exchange transfusion [ 111 , 137 ].…”

Section: Clinical Managementmentioning

confidence: 99%

Human Babesiosis in Europe

et al. 2021

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Babesiosis is attracting increasing attention as a worldwide emerging zoonosis. The first case of human babesiosis in Europe was described in the late 1950s and since then more than 60 cases have been reported in Europe. While the disease is relatively rare in Europe, it is significant because the majority of cases present as life-threatening fulminant infections, mainly in immunocompromised patients. Although appearing clinically similar to human babesiosis elsewhere, particularly in the USA, most European forms of the disease are distinct entities, especially concerning epidemiology, human susceptibility to infection and clinical management. This paper describes the history of the disease and reviews all published cases that have occurred in Europe with regard to the identity and genetic characteristics of the etiological agents, pathogenesis, aspects of epidemiology including the eco-epidemiology of the vectors, the clinical courses of infection, diagnostic tools and clinical management and treatment.

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

159

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. In the Ninth Edition, the JCA Special Issue Writing Committee has incorporated systematic review and evidence-based approaches in the grading of evidence and categorization of apheresis indications to make recommendations on the use of apheresis in a wide variety of diseases and conditions. This edition has largely maintained the general layout and concept of a fact sheet introduced in the Fourth Edition (2007). Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease or medical condition. The Ninth Edition of the JCA Special Issue comprises 91 fact sheets and

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Heavy parasitemia in babesiosis treated without adjunctive red cell exchange

Cited by 11 publications

References 8 publications

Parasite burden and red blood cell exchange transfusion for babesiosis

Parasite burden and red blood cell exchange transfusion for babesiosis

Human Babesiosis in Europe

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

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