RISK FACTORS: Exposure to endemic areas, Transfusion-associated babesiosis and transplacental/perinatal transmission have been reported
DRUG(S) OF CHOICE:
β’ Atovaquone (Mepron) suspension 750 mg twice daily plus azithromycin (Zithromax) 500-1,000 mg per day
β’ Combination of quinine (Quinamm) 650 mg of salt orally, three times daily and clindamycin (Cleocin) 600 mg orally, three times daily, or 1.2 g parenterally, twice daily for 7-10 days is the most commonly used treatment.
The pediatric dosage is 20-40 mg/kg per day for quinine and 25 mg/kg per day for clindamycin.
β’ In areas endemic for Lyme disease and ehrlichiosis:- may be advisable to add doxycycline (Vibramycin)
100 mg twice a day by mouth in the management of patients with babesiosis until serologic testing is completed
β’ Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients.
This treatment is usually reserved for patients who are extremely ill - with blood parasitemia of more than 10
percent, massive hemolysis and asplenia.
ALTERNATIVE DRUGS:
β’ Several other drugs have been evaluated, including tetracycline, primaquine, sulfadiazine (Microsulfon)
and pyrimethamine (Fansidar). Results have varied. Pentamidine (Pentam) has proved to be moderately
effective in diminishing symptoms and decreasing parasitemia.
PATIENT MONITORING: Monitor for complications (congestive heart failure, etc.) and follow parasitemia as needed
PREVENTION/AVOIDANCE: Avoid endemic regions during the peak transmission months of May through September (especially relevant for asplenic or immunocompromised persons in whom babesiosis can be a devastating illness).
β’ Using insect repellant is advised during outdoor activities, especially in wooded or grassy areas. Products
with 10 to 35 percent DEET will provide adequate protection under most conditions.
β’ Early removal of ticks is important; the tick must remain attached for at least 24 hours before the transmission
of B. microti occurs. Daily self-examination is recommended for persons who engage in outdoor activities in
endemic areas.
β’ Pets must be examined for ticks because they may carry ticks into the home
POSSIBLE COMPLICATIONS
β’ Congestive heart failure
β’ Disseminated intravascular coagulation
β’ Acute respiratory distress syndrome (that can occur even a few days after the onset of effective antimicrobial
treatment)
β’ Renal failure and myocardial infarction also have been associated with severe babesiosis
EXPECTED COURSE/PROGNOSIS:
β’ When left untreated, silent babesial infection may persist for months or even years
β’ Alkaline phosphatase levels greater than 125 U per L, white blood cell counts greater than 5 X 109 per L,
history of cardiac abnormality, history of splenectomy, presence of heart murmur and parasitemia values of 4
percent or higher were associated with disease severity
High-level parasitemia is more common in asplenic patients. Such patients have been treated successfully with exchange transfusion in addition to drugs.