402: FATAL TICK BITE

Abstract

Introduction: As of 2022, there has been no fatality reported in NJ from severe Babesiosis. We present a case of Babesiosis with rapid clinical deterioration to shock and death in an immunocompetent patient despite early recognition and proper recommended treatment through multidisciplinary approach. Description: 48-year-old obese male with Diabetes Mellitus and Hypertension presented to emergency department two weeks after hiking, with epigastric, non-radiating pain associated with fevers, headache, worsening fatigue, poor intake, and watery diarrhea for a week. Patient was febrile, tachypneic, hypoxic, and jaundiced. Initial bloodwork reflected leukocytosis, anemia, elevated reticulocyte count, thrombocytopenia, elevated indirect bilirubinemia, acute kidney Injury and lactic acidosis. Chest radiograph with bilateral lower lobe infiltrates. Babesia microti IgG and IgM were detected with intra and extra cellular paracitemia of 9.9%. Patient was admitted to intensive care unit for Acute respiratory, renal and liver failure. Initially started on Intravenous Azithromycin, Atovaquone and later Doxycycline and Zosyn were added given continued deterioration. Patient required mechanical ventilation and hemodialysis, steroids, Intravenous immunoglobulin. Red blood exchange therapy was completed within 12 hours of admission given high parasitemia. Despite aggressive measures during ICU stay, patient declined and expired 72 hours into hospital course. Discussion: Babesia are intraerythrocytic protozoan parasites of animals and humans, a disease transmitted by infected tick, Ixodes scapularis, which also transmits other causative agents of Lyme Disease. Babesiosis can range from mild to severe disease and death. Severity depends on babesia species, age, host immune status, route of transmission, and parasitemia level. Incidence is highest in summer months, middle-aged patients. Fatality rate reported at 3-9% in hospitalized patients, 20% among immunosuppressed or disease acquisition via blood transfusion. Clinicians need to be aware of the risk of fulminant illness when practicing in known endemic regions. It is important to keep zoonotic infections as part of differential in patient presenting with multi organ failure.