Methods: We retrospectively collected and analyzed data from 38 patients with babesiosis from 1990-2015.
Results: Mean age of patients was 63 years. 68% of patients required hospitalization with 21% requiring intensive care unit (ICU) stay. Mean length of illness before diagnosis was 15.6 days and symptoms comprised of malaise (82%), subjective fever (71%), chills (55%), anorexia (29%), arthralgia (29%), and nausea (16%). Only 47% of the patients recalled tick bites. Mean hemoglobin in the outpatients was 12.4 g/dL compared to 9.8 g/dL in the hospitalized patients (p <0.01). Among hospitalized patients, mean hemoglobin for ICU admissions was 7.5 g/dL vs 10.9 g/dL (p<0.01) for those without ICU stay. Mean parasitemia was 10.1% in those requiring ICU compared to 1.4% in those admitted to the medical floor (p<0.01). 28.9% had Lyme disease, and 10.5% had anaplasma coinfection. Co-morbidities included diabetes mellitus (n=3), asplenia (n=5), and immunosuppression (n=3). Diagnosis was made with PCR and peripheral smear in 50% of patient whereas 50% were diagnosed with PCR alone. In 27% of patients with positive PCR, peripheral smear was negative. All patients with asplenia required hospitalization with 3/5 requiring ICU with initial parasitemia ranging from 2.5-28% and duration of parasitemia ranging from 10-142 days. Initial treatment comprised of clindamycin plus quinine in 31% of patients whereas combination of atovaquone and azithromycin was used in 69% of patients. Median duration of treatment was 10 days. Overall three patients underwent exchange transfusion with parasitemias ranging from 12.3-28.5%. None of the patients died during hospitalization.
Conclusion: Less than half of the patients with babesiosis recall tick bites. There is usually a delay in diagnosis of up to 2 weeks due to nonspecific nature of symptoms. In more than ¼ of patients with babesiosis peripheral smear may be falsely negative. Hemoglobin and percentage parasitemia seemed to correlate with severity of illness.
O. Abu Saleh, None
J. O'Horo, None