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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