PDF(Pubmed)
Abstract：
Babesiosis is a potentially life-threatening tick-borne parasitic infection. Severe disease in splenectomized individuals may require exchange transfusion. A 58-year-old male with a history of splenectomy presented with 2 weeks of subjective fever, weakness, and abdominal pain. He denied any rashes, tick bites, or recent travel. He had a motor vehicle accident a few years ago and had undergone an emergency splenectomy. On examination, the patient was febrile (39.3 °C), tachycardic (106/min), and jaundiced. Labs revealed anemia and thrombocytopenia. Computed tomography (CT) abdomen revealed asplenia. As it was summer, there was concern for a tick-borne illness. A peripheral smear showed schistocytes, and labs revealed hyperbilirubinemia, high lactate dehydrogenase (LDH), low haptoglobin, and reticulocytosis (13%), consistent with hemolysis. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Ehrlichia, Borrelia, Anaplasma, and viral hepatitis was negative. Antibody testing for Babesia microti was positive. A blood parasite smear confirmed Babesia microti with a parasitemia of 9.5%. The patient received intravenous azithromycin and atovaquone for severe babesiosis. On day 2 of hospitalization, parasitemia increased to 14.7%. Hemoglobin and platelets dropped further on day 3. His parasite load remained consistently above 10% despite medical treatment. A decision was made for a red blood cell (RBC) exchange transfusion for severe disease, which was performed on the fourth day of hospitalization. Clinical improvement was seen after one session of exchange RBC transfusion. Hemoglobin remained stable, and thrombocytopenia improved 1 day after RBC exchange transfusion. Parasitemia dropped to 1.2% after 4 days of exchange transfusion, and azithromycin was switched to oral. He received 9 days of inpatient azithromycin and atovaquone. He was discharged with a plan to continue the oral antimicrobials for 3 more weeks. Asplenia and parasitemia > 10% are associated with severe babesiosis. Asplenia, in particular, is associated with severe infection, hospitalization, and prolonged duration of therapy. Exchange transfusion in severe babesiosis can be lifesaving.
摘要：
Babesiosis是一种潜在的威胁生命的蜱传寄生虫感染。脾切除患者的严重疾病可能需要换血。一名58岁的男性，有脾切除术史，表现为2周的主观发烧，弱点,和腹痛。他否认有皮疹,蜱叮咬，或最近的旅行。几年前，他发生了一起机动车事故，并接受了紧急脾切除术。在检查中，患者发热（39.3°C），心动过速（106/min），和黄疸。实验室显示贫血和血小板减少症。腹部计算机断层扫描（CT）显示无脾。因为是夏天，有人担心蜱传疾病。外周涂片显示血吸细胞,实验室发现高胆红素血症,高乳酸脱氢酶（LDH），低触珠蛋白，网织红细胞增多症（13%），与溶血一致。检测严重急性呼吸系统综合症冠状病毒2（SARS-CoV-2），埃里希亚,疏螺旋体,解脲脲,病毒性肝炎呈阴性。微巴贝斯虫抗体检测呈阳性。血液寄生虫涂片证实了微小巴贝斯虫的寄生虫血症为9.5％。患者接受静脉注射阿奇霉素和阿托瓦醌治疗严重的巴贝斯虫病。住院第2天,寄生虫血症增加到14.7%。血红蛋白和血小板在第3天进一步下降。尽管接受了治疗，但他的寄生虫负荷始终保持在10％以上。决定对严重疾病进行红细胞（RBC）交换输血，在住院的第四天进行。一次交换红细胞输血后，临床症状有所改善。血红蛋白保持稳定,红细胞交换输血后1天血小板减少改善。交换输血4天后，寄生虫血症降至1.2%，阿奇霉素改为口服.他接受了9天的住院阿奇霉素和阿托瓦醌。他出院后计划继续口服抗微生物药物3周。无脾和寄生虫血症>10％与严重的巴贝斯虫病有关。Asplenia,特别是,与严重感染有关，住院治疗,和延长治疗时间。严重巴贝斯虫病的交换输血可以挽救生命。
