Treatment of babesiosis by red blood cell exchange in an HIV‐positive, splenectomized patient

Machtinger, Larry; Telford, Sam R.; Inducil, Chat; Klapper, Ellen; Pepkowitz, Samuel H.; Goldfinger, Dennis

doi:10.1002/jca.2920080205

Cited by 44 publications

(17 citation statements)

References 15 publications

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“…The clinical course in such patients can often be prolonged (402). A severe case of babesiosis in an HIV-positive individual eventually responded to RBC exchange transfusion (265). A combination of azithromycin and atovaquone for 7 to 10 days is the recommended initial regimen for treatment of B. microti infections (238).…”

Section: Babesiosismentioning

confidence: 99%

Infections of People with Complement Deficiencies and Patients Who Have Undergone Splenectomy

2010

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SUMMARY The complement system comprises several fluid-phase and membrane-associated proteins. Under physiological conditions, activation of the fluid-phase components of complement is maintained under tight control and complement activation occurs primarily on surfaces recognized as “nonself” in an attempt to minimize damage to bystander host cells. Membrane complement components act to limit complement activation on host cells or to facilitate uptake of antigens or microbes “tagged” with complement fragments. While this review focuses on the role of complement in infectious diseases, work over the past couple of decades has defined several important functions of complement distinct from that of combating infections. Activation of complement in the fluid phase can occur through the classical, lectin, or alternative pathway. Deficiencies of components of the classical pathway lead to the development of autoimmune disorders and predispose individuals to recurrent respiratory infections and infections caused by encapsulated organisms, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. While no individual with complete mannan-binding lectin (MBL) deficiency has been identified, low MBL levels have been linked to predisposition to, or severity of, several diseases. It appears that MBL may play an important role in children, who have a relatively immature adaptive immune response. C3 is the point at which all complement pathways converge, and complete deficiency of C3 invariably leads to severe infections, including those caused by meningococci and pneumococci. Deficiencies of the alternative and terminal complement pathways result in an almost exclusive predisposition to invasive meningococcal disease. The spleen plays an important role in antigen processing and the production of antibodies. Splenic macrophages are critical in clearing opsonized encapsulated bacteria (such as pneumococci, meningococci, and Escherichia coli) and intraerythrocytic parasites such as those causing malaria and babesiosis, which explains the fulminant nature of these infections in persons with anatomic or functional asplenia. Paramount to the management of patients with complement deficiencies and asplenia is educating patients about their predisposition to infection and the importance of preventive immunizations and seeking prompt medical attention.

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Section: Babesiosismentioning

confidence: 99%

Infections of People with Complement Deficiencies and Patients Who Have Undergone Splenectomy

2010

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“…Patients who are iatrogenically immunosuppressed (23), HIV infected (117), or severely infected with Babesia sometimes do not respond to antimicrobial therapy and require extra treatment. Alternative combinations for treatment are being investigated because of the occasional failure and frequent toxicity of quinine and clindamycin.…”

Section: Treatmentmentioning

confidence: 99%

Babesiosis

Homer¹,

Aguilar-Delfín²,

Telford³

et al. 2000

Clinical Microbiology Reviews

520

402

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“…Exchange transfusions are used in profoundly ill patients with high levels of parasitemia and hemolysis [38]. Used concurrently with chemotherapy, exchange transfusion reduces the level of parasitemia [39].…”

Section: Treatmentmentioning

confidence: 99%

Babesiosis: An update on epidemiology and treatment

Gelfand

Callahan²

2003

Curr Infect Dis Rep

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Babesiosis is caused by a tick-borne hemoparasite that, like malaria, can cause fever, hemolysis, and anemia. Typically self-limited, in the asplenic, immunocompromised, or elderly, disease can be severe or deadly. US cases have been primarily due to Babesia microti; WA-1, which may be related to Babesia gibsoni; and MO-1, related to Babesia divergens. European infections are usually due to B. divergens. North American cases are treated either with quinine and clindamycin or with atovaquone and azithromycin. The latter regimen appears less toxic.

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Treatment of babesiosis by red blood cell exchange in an HIV‐positive, splenectomized patient

Cited by 44 publications

References 15 publications

Infections of People with Complement Deficiencies and Patients Who Have Undergone Splenectomy

Infections of People with Complement Deficiencies and Patients Who Have Undergone Splenectomy

Babesiosis

Babesiosis: An update on epidemiology and treatment

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