The Brief Case: Probable Transfusion-Transmitted Babesiosis in a Transplant Recipient

Abstract

A 3-year-old immunocompromised male who had been hospitalized for 7 months in the cardiac intensive care unit developed fever and tachycardia in December. He was prenatally diagnosed with hypoplastic left heart syndrome and received right ventricle to pulmonary artery conduit surgery days after delivery. Due to worsening right ventricular function, after a hemi-Fontan procedure, he received an orthotopic heart transplant at the beginning of his 3rd year of life. His posttransplant course was complicated by multiple episodes of rejection, cytomegalovirus (CMV) pneumonitis, and several central-line-associated bloodstream infections. As a result of the rejection, necessitating plasmapheresis as well as frequent blood draws for management, which led to anemia, he received 36 packed red blood cell transfusions over the course of 7 months posttransplantation. These transfusions were evenly spaced, and he remained hospitalized during the 7 months. At the time of the febrile episode, he was on caspofungin, trimethoprim-sulfamethoxazole, and ganciclovir. The subsequent diagnostic workup included multiple sets of blood cultures, a urine culture, and a CMV viral load analysis. He was started on vancomycin and cefepime while awaiting microbiologic results. Other pertinent test results included a complete blood count (CBC) with differential showing pancytopenia and an aspartate transaminase (AST) level of 200 U/liter (reference range, 20 to 60 U/liter), an alanine aminotransferase (ALT) level of 84 U/liter (reference range, 5 to 45 U/liter), and a C-reactive protein level of 3.1 mg/dl (reference range, 0 to 0.9 mg/dl), which increased to 7

Babesia microti Infection Changes Host Spleen Architecture and Is Cleared by a Th1 Immune Response

“…Equally dangerous is newly identified route of transmission of B. microti , via blood transfusion. In these cases, immunocompetent donors are undiagnosed and remain Babesia carriers such that blood recipients who are often immunocompromized individuals can exhibit high morbidity and mortality ( Herwaldt et al, 2011 ; Cushing and Shaz, 2012 ; Kitt et al, 2016 ).…”

Do Not Forget About the Ticks: An Unusual Cause of Fever, GI Distress, and Cytopenias in a Child With ALL

“…8 Interestingly, many cases have been reported involving symptomatic neonates in the first month of life with presumed or proven congenital infection (ie, transplacental acquisition), [9][10][11][12][13][14][15][16][17][18] or with infection acquired from tick bites early in life. 19,20 Babesiosis has occurred in neonates [21][22][23][24][25][26][27][28] and immunocompromised children with congenital cardiac disease [29][30][31] because of transfusion of infected blood products. Clinical presentations similar to that of our patient have been reported in children with malignancies infected with E. chaffeensis and Ehrlichia ewingii.…”

“…Interestingly, many cases have been reported involving symptomatic neonates in the first month of life with presumed or proven congenital infection (ie, transplacental acquisition),9–18 or with infection acquired from tick bites early in life 19,20. Babesiosis has occurred in neonates21–28 and immunocompromised children with congenital cardiac disease29–31 because of transfusion of infected blood products.…”