Journal Article

Persistent and Relapsing Babesiosis in Immunocompromised Patients

Peter J. Krause, Benjamin E. Gewurz, David Hill, Francisco M. Marty, Edouard Vannier, Ivo M. Foppa, Richard R. Furman, Ellen Neuhaus, Gail Skowron, Shaili Gupta, Carlo McCalla, Edward L. Pesanti, Mary Young, Donald Heiman, Gunther Hsue, Jeffrey A. Gelfand, Gary P. Wormser, John Dickason, Frank J. Bia, Barry Hartman, Sam R. Telford, Diane Christianson, Kenneth Dardick, Morton Coleman, Jennifer E. Girotto and Andrew Spielman

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 3, pages 370-376
Published in print February 2008 | ISSN: 1058-4838
Published online February 2008 | e-ISSN: 1537-6591 | DOI:
Persistent and Relapsing Babesiosis in Immunocompromised Patients

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Background.Human babesiosis is a tickborne malaria-like illness that generally resolves without complication after administration of atovaquone and azithromycin or clindamycin and quinine. Although patients experiencing babesiosis that is unresponsive to standard antimicrobial therapy have been described, the pathogenesis, clinical course, and optimal treatment regimen of such cases remain uncertain.

Methods.We compared the immunologic status, clinical course, and treatment of 14 case patients who experienced morbidity or death after persistence of Babesia microti infection, despite repeated courses of antibabesial treatment, with those of 46 control subjects whose infection resolved after a single course of standard therapy. This retrospective case-control study was performed in southern New England, New York, and Wisconsin.

Results.All case patients were immunosuppressed at the time of acute babesiosis, compared with <10% of the control subjects. Most case patients experienced B cell lymphoma and were asplenic or had received rituximab before babesial illness. The case patients were more likely than control subjects to experience complications, and 3 died. Resolution of persistent infection occurred in 11 patients after 2–10 courses of therapy, including administration of a final antimicrobial regimen for at least 2 weeks after babesia were no longer seen on blood smear.

Conclusions.Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for ⩾6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.

Journal Article.  3816 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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