Abstract
Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.
Highlights
Babesiosis, known as “Nantucket fever” or “malaria of the United States,” refers to an emerging vector-borne zoonosis caused by intraerythrocytic protozoans of the genus Babesia which infect and lyse red blood cells
Its geographic distribution mimics that of Lyme disease, anaplasmosis, Powassan virus, and Borrelia miyamotoi infections, as all these pathogens are transmitted to humans through the same vector, Ixodes scapularis [1, 2]. e vast majority of cases in the US are caused by B. microti, with a smaller percentage of cases caused by B. duncani, found primarily in the NW US, and the recently reported B. divergens-like organisms [2, 3]. e first documented case in the US occurred in 1969, when an immunocompetent man from Massachusetts’ Nantucket Island was diagnosed with B. microti infection [1, 4]
Climate change is predicted to have a significant impact on the incidence of tick-borne infections in endemic regions, with one study estimating a greater than 20% increase in the incidence of Lyme disease assuming a 2°C increase in the annual average temperature in the coming decades [10]
Summary
Babesiosis, known as “Nantucket fever” or “malaria of the United States,” refers to an emerging vector-borne zoonosis caused by intraerythrocytic protozoans of the genus Babesia which infect and lyse red blood cells. Babesiosis is transmitted mainly through bites from infected I. scapularis ticks; in rare cases, transmission may occur via the transplacental route, blood transfusion, or by organ transplant [5,6,7,8]. Climate change is predicted to have a significant impact on the incidence of tick-borne infections in endemic regions, with one study estimating a greater than 20% increase in the incidence of Lyme disease assuming a 2°C increase in the annual average temperature in the coming decades [10]. Severe complications of B. microti infection include acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and liver or renal failure [12,13,14]. Splenic rupture is a severe but rarely reported complication of B. microti infection
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