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    Babesiosis

    Babesiosis is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    Description

    • Tick-borne, infectious disease caused by intraerythrocytic protozoa of the genus Babesia, infects wide array of vertebrate animals, causes lysis of host RBCs
    • Asymptomatic to severe, life-threatening infection depending on the species of Babesia and the immune status of the patient
      • Asymptomatic infection:
        • 50% of children and 25% of adults with infection have no symptoms
      • Mild–moderate disease:
        • Usually immune competent patients
        • Infections typically self-limited or resolve with antibiotic therapy
        • Mortality usually <5%
      • Severe disease:
        • Defined as hospitalization >2 wk, ICU stay >2 days, or ending in death
        • Typically associated with immune compromise: Splenectomy; cancer; HIV; hemoglobinopathy; chronic heart, lung, or liver disease
        • Other groups at higher risk for severe disease: Neonates, >50 yr old, on immune-suppressive drugs (e.g., rituximab or anticytokine therapy [e.g., etanercept, infliximab])
        • Mortality can be as high as 21% among immune-suppressed patients
    • Complications develop in approximately one-half of the hospitalized patients:
      • ARDS, DIC most common
      • Can also see CHF, coma, liver failure, renal failure, splenic rupture
    • Co-occurrence with other tick-borne diseases should be considered in endemic regions under the following conditions:
      • Lyme disease (Borrelia burgdorferi) – associated rash
      • Human granulocytic anaplasmosis (Anaplasma phagocytophilum) – protracted symptoms with leukopenia

    Etiology

    • Babesia:
      • Species causing human disease:
        • Babesia microti – Northern and Midwestern US (most common cause of disease in US)
        • Babesia divergens – Europe
        • Babesia duncani – Northern US Pacific coast
      • Case reports of Babesiosis in Asia, Africa, Australia, and South America
      • Animal reservoirs:
        • B. microti – white-footed mouse, white-tailed deer
        • B. divergens – cattle, rats
    • Transmission via Ixodes tick vector:
      • Most common vector for transmission of babesiosis to humans
      • Ixodes requires blood meal from a vertebrate host to pass through each stage of life cycle (larva, nymph, adult)
        • Most cases result from nymphal tick bites in late spring through summer, adult ticks can also transmit disease
    • Pathogen life cycle, pathogenesis:
      • Protozoa pass from tick salivary glands to mammalian bloodstream where they penetrate erythrocytes, mature and divide.
      • Mature protozoa exit from RBC resulting in membrane damage, lysis, hemolytic anemia, and hemoglobinuria.
      • Damaged RBCs become less deformable, enhancing removal by spleen; however, asplenic patients less able to clear infected RBCs, leading to more severe disease.
      • Damaged RBCs may result in microvascular stasis with secondary ischemic organ injury to liver, spleen, heart, kidney, or brain.
    • Transmission via transfusion of RBCs, platelets:
      • >150 cases since 1979, 75% of these since 2000
      • B. microti is the most common pathogen
      • Low-level parasitemia may not be visible on donor blood smears, yet can still transmit disease
      • Often results in severe cases as recipients of blood products often immune compromised or have significant comorbidities

    Pediatric Considerations
    Transmission can occur in utero and during delivery; youngest reported case was a 4-wk-old infant.

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    Citation

    Rosen, Peter, et al., editors. "Babesiosis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307286/all/Babesiosis.
    Babesiosis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307286/all/Babesiosis. Accessed April 20, 2019.
    Babesiosis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307286/all/Babesiosis
    Babesiosis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307286/all/Babesiosis.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Babesiosis ID - 307286 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307286/all/Babesiosis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -