Non-surgical management of spontaneous splenic rupture due to Babesia microti infection

Khoury, Marc El; Gandhi, Roshni; Dandache, Patricia; Lombardo, Gary; Wormser, Gary P.

doi:10.1016/j.ttbdis.2011.08.001

Cited by 16 publications

(8 citation statements)

References 28 publications

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“…In patients who are hemodynamically stable, a conservative approach, including close monitoring in intensive care and as-needed transfusion, is recommended, due to multiple benefits of spleen preservation [ 49 ]. In patients who are hemodynamically stable but with either significant or ongoing bleeding, trans-catheter splenic artery (SA) embolization has been successful in several cases [ 24 , 25 ]. Splenectomy remains the gold standard in patients similar to ours, who present with acute abdomen and hemorrhagic shock [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature

et al. 2018

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Patient: Female, 79Final Diagnosis: Splenic rupture due to babesia microti infectionSymptoms: Abdominal discomfort • chest pain • fever • tachycardiaMedication: —Clinical Procedure: SplenectomySpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Babesiosis is an emerging, tick-borne zoonosis caused by intraerythrocytic protozoa of the genus Babesia. Babesia microti is the main pathogen causing human disease and is endemic in the northeastern and upper midwestern parts of the USA. Severity of infection ranges from mild, self-limited, febrile viral-like illness accompanied by nonspecific symptoms to life-threatening infection complicated by severe hemolytic anemia, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and renal or/and hepatic failure. Splenic rupture (SR) is a very rare but life-threatening complication of severe B. microti infection.Case Report:A 79-year-old female farmer from Wisconsin, USA was admitted during summer with hemorrhagic shock secondary to spontaneous splenic rupture. She was transfused with 3 units of packed red blood cells (PRBC) and underwent emergent splenectomy. Postoperatively, she recovered well and was discharged on postoperative day 4. However, she was re-admitted on postoperative day 10 for febrile hemolytic anemia. Further exposure history was obtained and was significant for multiple tick bites 8 weeks preceding the index hospitalization. She was promptly diagnosed with babesiosis and Lyme disease co-infection. She responded favorably to 10 days of azithromycin and atovaquone and 21 days of oral doxycycline.Conclusions:Despite its rare occurrence, SR due to B. microti infection is a dreaded complication that can rapidly progress to hemorrhagic shock and death. In contrast to other complications of babesiosis, SR is not correlated with parasite burden or immune status of the affected host. Babesiosis should be considered as part of the differential diagnosis in patients from endemic areas presenting with atraumatic splenic rupture.

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Section: Discussionmentioning

confidence: 99%

Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature

et al. 2018

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“…An Excel table was constructed, and for each case, we collected patient demographics, clinical presentation, medical comorbidities, vital signs on admission, time from presentation to diagnosis, type of splenic involvement, severity of parasitemia, patient's immune status, presence of coinfection, treatment, and clinical outcome (Table 1) [13,. Of 34 cases reported, 19 cases were collected from single case reports; there were 4 case series, each including 2 cases [22,23,27,37]. Finally, there was one case series including 7 patients from a single institution in Rhode Island, USA [39].…”

Section: Data Collectionmentioning

confidence: 99%

“…Canadian Journal of Infectious Diseases and Medical Microbiology Yes 2No AZ + ATQ (14) No, SA embolization 11 [27] 2011 (El Khouri)…”

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confidence: 99%

Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Dumić

Madrid

Prada

et al. 2020

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

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“…In reviewing the literature we found 11 cases with this complication. Table 3 summarizes these cases [40][41][42][43][44][45][46][47]. Accordingly, we conclude that babesiosis can cause splenic rupture, just like malaria which is a well-documented cause of this pathology.…”

Section: Discussionmentioning

confidence: 89%

Hematologic Manifestations of Babesiosis

Akel

Mobarakai

2018

Ann Clin Lab Res

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Background: Babesiosis, a zoonotic parasitic infection transmitted by the Ixodes tick, has become an emerging health problem in the human host that is attracting attention worldwide. Most cases of human babesiosis are reported in the United States and Europe. The disease is caused by the protozoa of the genus Babesia, which invade human erythrocytes and lyse them causing a febrile hemolytic anemia. The infection is usually asymptomatic or self-limited in the immunocompetent host, or follows a persistent, relapsing, and/or life threatening course with multi-organ failure, mainly in the splenectomized or immunosuppressed patients. Hematologic manifestations of the disease are common. They can range from mild anemia, to severe pancytopenia, splenic ruture, disseminated intravascular coagulopathy (DIC), or even hemophagocytic lymphohistiocytosis (HLH).

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Non-surgical management of spontaneous splenic rupture due to Babesia microti infection

Cited by 16 publications

References 28 publications

Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature

Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature

Splenic Complications ofBabesia microtiInfection in Humans: A Systematic Review

Hematologic Manifestations of Babesiosis

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