babesiosis

Babesiosis is a malaria-like illness is caused by a parasite which lives in the infected host's reb blood cells. It is transmitted by the hard-bodied ticks, members of the genera Dermacentor, Ixodes, and Rhipicephalus. There are over 70 species of the organism, usually found only in one specific host such as cattle, deer, or mice. A few are able to infect humans incidentally. Additionally, babesiosis may be acquired through blood transfusion from an infected person who has no symptoms.

The primary endemic area of babesiosis in the United States occurs along the northeast coastal area, centering around Nantucket Island, Martha's Vineyard, Cape Cod, Massachusetts; Long Island and Shelter Island, New York. Cases have also been reported from Georgia and California, and most recently, New Jersey. The small deer tick, Ixodes dammini, serves as the carrier or vector for both B. microti, and the agent of Lyme disease (Borrelia burgdorferi).

The infection is introduced by tick bites and rapidly invades the red blood cells, eventually rupturing them. The daughter forms of the parasite that are released then infect other red blood cells, and the cycle continues.

The incubation period is 1 to 6 weeks. A sudden or gradual onset of chills and fever is preceded by malaise, muscle aches, and fatigue. Jaundice, dark urine, nausea, and vomiting occur as blood cells rupture and release free hemoglobin into the bloodstream hemolysis. Mild enlargement of the spleen and/or liver may occur. Fulminant, even fatal cases rarely occur, most often in patients who have had the spleen removed or have a non-functional spleen.

Complete recovery occurs in several weeks, with or without antibiotics. Babesiosis may be underdiagnosed in children since it is generally less severe than in adults.

Babesiosis is to be suspected in febrile children with a history of a tick bite who live in or have traveled to an endemic area or have had a recent blood transfusion. It is usually diagnosed by microscopic identification of the parasites in a blood smear. A serologic blood test with good reliability is available at the Centers for Disease Control (CDC). The possibiity of co-infection with Lyme disease should be considered as well, because the two organisms share the same tick vector.

The recommended therapy for babesiosis is clindamycin and quinine in combination for 5 to 10 days. For life-threatening situations, exchange blood transfusions may be required.

Prevention of babesiosis involves avoidance of tick-infested areas, use of protective clothing and insect repellents, and a careful search for and removal of ticks.

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