Abstract
Babesiosis is a blood-borne disease found mainly in the United States caused by a parasitic piroplasm. While most infections are mild to moderate in immunocompetent hosts, life-threatening complications can occur in those with significant comorbidities like congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). There is sparse literature discussing the complications of Babesia microti infection or the pathophysiology and management thereof. A literature review was conducted to consolidate the current knowledge about the disease, pathophysiology, and proposed management of all potential complications based on risk factors and other clinical information. A MeSH cross-references strategy was employed in PubMed using the search terms “babesia” and “babesiosis” and the established associated conditions, and the search expanded to increase capture. Only papers written in the English language and discussing human subjects in the North American patient population were included. The initial search yielded 315 papers and, after applying the inclusion/exclusion criteria, a final number of 18 was reviewed. The various complications and pathophysiology thereof are then discussed according to organ system. Babesia is a subversive parasite associated with a variety of conditions. We hope a better appreciation of all potential presentations and complications will help clinicians manage this increasingly common zoonosis and reduce adverse effects. More research is recommended into the pathophysiology and prevention of complications following this and other tick-borne illnesses.
Highlights
IntroductionThe agent typically associated with infection in this area is Babesia microti, a parasitic blood-borne piroplasm that infects erythrocytes [1]
BackgroundBabesiosis is a malaria-like infectious disease endemic to the Northeast and Upper Midwest regions of the United States and increasingly on the Pacific Coast
The associated conditions can be broadly categorized into cardiac, pulmonary, renal, and hematologic, with the latter comprising the largest group. While conditions such as acute respiratory distress syndrome (ARDS), congestive heart failure (CHF), disseminated intravascular coagulation (DIC), hemolytic anemia, splenic rupture, and renal failure are frequently cited complications, the incidence varies, and many times what is thought to be sequela may be an exacerbation of an underlying disease process
Summary
The agent typically associated with infection in this area is Babesia microti, a parasitic blood-borne piroplasm that infects erythrocytes [1]. This protozoan accounted for the greatest number of fatalities associated with transfusion-transmitted microbial infections reported to the Food and Drug Administration (FDA) over the five-year reporting period ending 2014 (four out of 15 or 27%) [2]. From 2011 to 2015, the United States Centers for Disease Control and Prevention (CDC) reported a total of 7,612 cases in the following seven states: Wisconsin, Rhode Island, New York, New Jersey, Minnesota, Massachusetts, and Connecticut [1,3]. Physical examination findings depend on disease severity and comprise hepatosplenomegaly, retinal hemorrhage, and pharyngeal erythema. Diagnosis is made by microscopic visualization of Babesia parasites in red blood cells on a blood smear [5]
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