Babesia

Summary

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Key Points

• Babesia
  • Includes Babesia divergens and Babesia microti
  • Characteristics
    • Protozoan parasite
  • Transmission
    • Transmitted by Ixodes tick
      • same tick as B. burgdorferi (Lyme disease)
        • Babesia and Borrelia often coinfect
      • Predominantly in Northeastern US
        • Seen with outdoor activities (camping, hiking, etc.)
    • Asplenia increases risk of severe disease
      • Since splenic macrophages clear infected RBCs
  • Presentation: Babesiosis
    • Non-specific flu-like symptoms
      • Fever, chills, fatigue, myalgia, headache
      • Caused by a host inflammatory response producing cytokines in the bloodstream
    • Hepatosplenomegaly
      • Icterus and jaundice may be seen
    • Anemia
      • Caused by both hemolysis and by reactive oxygen species produced by Babesia infection
  • Diagnosis
    • Blood smear with Giemsa stain
      • Ring-shaped or Maltese Cross inclusions in RBC
        • Maltese cross is less common than rings but pathognomonic for babesiosis
    • PCR may also be used
  • Treatment
    • Atovaquone + Azithromycin
      • Clindamycin and oral quinine is a second-line treatment that may be added in severe cases