Role of quinine in life-threatening Babesia divergens infection successfully treated with clindamycin

Abstract

Reported here is a case of life-threatening infection due to Babesia divergens that was initially treated with quinine and clindamycin, but in which quinine was discontinued after the patient developed severe cardiac toxicity. Despite the fact that therapeutic levels of quinine were not reached prior to discontinuation, the patient recovered on clindamycin therapy. A 51-year-old splenectomized male (weight 95.6 kg) was admitted to our hospital in Nevers, central France, with a 2-day history of fever, chills, abdominal pain, vomiting, cough and jaundice. The patient was a butcher and had been in contact with a red deer’s carcass 2 weeks previously in the countryside near Nevers. On admission, examination revealed jaundice, oliguria due to hemolytic anemia (hemoglobin, 9.8 g/dl; normal range, 14–15 g/dl), and acute renal failure. Blood smear examination revealed intraerythrocytic ring forms consistent with Babesia spp. Parasites affected 60% of erythrocytes (Fig. 1). Babesia divergens was identified by gerbil inoculation, indirect immunofluorescent antibody tests, and PCR assays (Prof. A. Gorenflot). The patient was given oral quinine (120 mg) and clindamycin (300 mg) and was immediately transferred to the intensive care unit (ICU) of the university hospital of Clermont-Ferrand. At admission to the ICU, the patient had shock, acute respiratory failure due to adult respiratory distress syndrome,