Epidemiology

Babesiosis has some similarities to malaria, but much rarer. Seroprevalence estimated at 3-8%.[3] Common in coastal areas in the northeastern United States, especially the offshore islands of New York and Massachusetts.[2] Incidence and prevalence difficult to know as many cases of babesiosis are misdiagnosed as malaria where the latter is endogenous and many cases are self-limiting.[3]

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Is being increasingly recognised in patients who receive blood transfusion.[3] The incubation period is typically 1 to 4 weeks, but may be longer. Severe symptoms occur in elderly, immunocompromised or asplenic.

Symptoms and signs

Most cases are asymptomatic Those who are symptomatic may have anorexia, fever,fatigue, myalgia Examination may reveal jaundice, hepatosplenomegaly,haemolytic anaemia, haemoglobinuria and renal failure

Investigations and diagnosis Babesial parasites invade the red cells directly, and multiply there - there is no exo-erythrocytic liver stage as required by human malarial parasites.

Full blood count may reveal anaemia, thrombocytopenia, atypical lymphocytes andleucopenia. Diagnosis depends on microscopy of Giemsa-stained thin and thick films (the intracellular parasite resembles plasmodia). Several smears may be needed before diagnosis is apparent.

ESR, bilirubin, LDH and transaminases may be elevated. Urine may be dark and urinalysis may show haemoglobinuria and proteinuria.[2] Immunofluorescence antibody testing or PCR may confirm diagnosis when blood films are negative. ELISA IgM for Lyme disease may also be positive - it is important to treat both conditions where they co-exist.

Differential diagnosis

Malaria Lyme disease Q-fever Tularaemia Other tick-borne infections

Treatment

Supportive care is the only treatment required if the patient is young and otherwise healthy. Elderly, immunocompromised patients, and splenectomised patients should be treated with immediate intravenous clindamycin and oral quinine to avoid acute renal failure.[2] Atovaquone with azithromycin is an alternative treatment used.[4] Azithromycin alone or trimethoprim-sulfamethoxazole may be tried if the above regime is ineffective.[2] Consider exchange transfusion in severe cases - to reduce the level of parasitaemia.[5]

Complications

Acute respiratory distress syndrome (ARDS) Pulmonary oedema - most frequent lung complication and rarely fatal[6] Renal failure Multi-organ failure Coma

Prognosis

Mortality rate estimated at 5%.[3] Poor outcomes are associated with hospitalisation for more than 14 days, an intensive care unit stay more than 2 days, male sex and raised white cell count and alkaline phosphatase. However, this is based on a very small number of patients and thus must be interpreted cautiously.[3]

Prevention

No vaccine is available When outside wear a hat, long sleeves and long pants to cover legs Use insecticides to repel or kill ticks Check for and remove ticks using tweezers, eg between the fingers and toes (common areas)

Prevention of Transfusion-associated Babesiosis In the pre-donation interview, potential blood donors are asked if they have ever been diagnosed with babesiosis. If the answer is "yes," they are indefinitely deferred from donating blood. To date, no Babesia tests have been licensed for screening U.S. blood donors, who can feel fine despite being infected. Also, Babesia parasites appear to survive well during typical blood storage conditions. Prevention of transfusion-associated babesiosis largely depends on intervening before donation. If you have a patient who has (or had) laboratory evidence of Babesia infection, advise the patient to refrain indefinitely from donating blood. If the patient recently donated blood, alert the appropriate bloo

Human babesiosis is a tick-borne infectious disease caused by intraerythrocytic protozoan species of the genus Babesiatransmitted by Ixodes. Babesia microti is the most common cause of human babesiosis endemic in USA on the northeastern seabord and the upper midwest. The first confirmed case was a normosplenic individual on Nantucket Island published in 1970.[1] After additional cases the disease became known as Nantucket fever. The incubation period may last from 1 to 9 weeks and c