Babesiosis: Difference between revisions
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**May need large smear as parasitemia can be as low as 1% | **May need large smear as parasitemia can be as low as 1% | ||
**Can often be confused for malaria parasites | **Can often be confused for malaria parasites | ||
*Urine - hemolysis | |||
*CXR - rare but possible ARDS | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Tick borne illnesses DDX}} | {{Tick borne illnesses DDX}} | ||
==Work Up== | |||
*CBC | |||
**Often with depressed white count | |||
*Peripheral Blood Smears | |||
*Electrolytes and renal function | |||
*LFTs | |||
**Total bilirubin and haptoglobin values reflect the intensity of the infection (hemolysis) | |||
*Lyme | |||
==Management== | ==Management== | ||
Revision as of 15:13, 4 June 2015
Background
- Spread by the deer tick (Ixodes scapularis)
- People often unaware they are bitten
- Natural reservior is the white footed mouse
- Endemic in US, Europe, parts of Russia and China
- Babesia Microti is pathogen in US
- Possible to have co-infection with Lyme (same tick family)
Symptoms
- Fever, hemolytic anemia, chills, thrombocytopenia, DIC
- More severe disease in immunocompromized patients (HIV, Elderly, Asplenic)
Diagnosis
- Peripheral blood smear
- Shows intracellular parasites
- Maltese Cross sign
- May need large smear as parasitemia can be as low as 1%
- Can often be confused for malaria parasites
- Shows intracellular parasites
- Urine - hemolysis
- CXR - rare but possible ARDS
Differential Diagnosis
Tick Borne Illnesses
- Babesiosis
- Colorado tick fever
- Ehrlichiosis
- Heartland virus
- Lyme
- Murine typhus
- Rocky mountain spotted fever
- Southern tick-associated rash illness (STARI)
- Tick paralysis
- Tularemia
Work Up
- CBC
- Often with depressed white count
- Peripheral Blood Smears
- Electrolytes and renal function
- LFTs
- Total bilirubin and haptoglobin values reflect the intensity of the infection (hemolysis)
- Lyme
Management
- 2 drug regimen for 7-10 days
Option 1
- Atovaquone (750mg BID) and Azithromycin (500-1000mg on first day, 250-1000mg on subsequent days)[1]
Option 2
- Clindamycin 600mg PO q8hrs x 7-10 days (or 300-600mg IV q6hrs)
- Give with Quinine 650mg TID
Pediatrics
- Clindamycin 20 mg/kg/day for children and 25 mg/kg/day for children for 7-10 days
See Also
Sources
- ↑ Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med. Nov 16 2000;343(20):1454-8.