目的:通过回顾性估计一组活动性巴贝虫感染患者腹部和盆腔CT上急性脾损伤的频率,以更好地了解脾脏疾病作为巴贝虫病的潜在表现的发生。
方法:在搜索我们的单一机构时,郊区教学社区医院数据库,在2021年至2023年之间,有57例患者被发现感染阳性。其中29例患者接受了腹部和盆腔CT(22例,7例无静脉造影),3例接受腹部超声检查,无CT检查。影像学检查是否存在脾异常,和后续成像。还审查了成像时的寄生虫血症水平;<4%的寄生虫血症水平与轻度至中度疾病有关。而>4%的寄生虫血症与严重疾病相关。
结果:21/32(66%)接受任何类型腹部成像(超声,MRI,和CT)有脾肿大。在22例接受了静脉CT增强扫描的患者中,6例患者发现脾梗死(27%)。这22例患者中有一例在CT和MRI上有多个圆形非周围增强灶,不符合梗死标准。与脾肿大有关,治疗后解决了。0/6的脾梗死组患者寄生虫血症水平大于4%,而16例无梗死的患者中有4例(4/16)的寄生虫血症水平超过4%。
结论:我们的研究表明,巴贝斯病患者的脾疾病主要表现为脾肿大,在相当少的患者中,脾梗死。在我们的病例系列中,没有脾破裂和脾周围血肿的病例。可能反映了研究规模相对较小的局限性。与先前的研究一致,我们没有发现寄生虫血症水平与脾梗死之间的相关性.
OBJECTIVE: To better understand the occurrence of splenic disease as a potential manifestation of babesiosis by retrospectively estimating the frequency of acute splenic injury on abdominal and pelvic CT in a cohort of patients with active babesia infection.
METHODS: In a search of our single institution, suburban teaching community hospital database, 57 patients were found to have positive babesia infection between the years 2021-2023. 29 of these patients underwent abdominal and pelvic CT (22 with and 7 without intravenous contrast), and 3 underwent abdominal ultrasound without any CT. The imaging was reviewed for the presence or absence of splenic abnormalities, and for follow-up imaging. Parasitemia levels at the time of imaging were also reviewed; parasitemia levels < 4% are associated with mild to moderate disease, whereas parasitemia levels > 4% are associated with severe disease.
RESULTS: 21/32 (66%) patients who underwent any type of abdominal imaging (ultrasound, MRI, and CT) had splenomegaly. Of the 22 patients who had IV contrast-enhanced CT scans, 6 were found to have splenic infarction (27%). One of these 22 patients had multiple rounded non-peripheral hypoenhancing foci on both CT and MRI which did not meet criteria for infarction, in association with splenomegaly, and which resolved after treatment. 0/6 patients in the splenic infarction group had parasitemia levels greater than 4%, while 4 of the 16 patients (4/16) without infarction had parasitemia levels of greater than 4%.
CONCLUSIONS: Our study showed that splenic disease in patients with babesiosis mostly took the form of splenomegaly, and in a substantial minority of patients as splenic infarction. There were no cases of splenic rupture and perisplenic hematoma in our case series, likely reflecting a limitation of the relatively small study size. Concordant with prior studies, we found no identifiable association between parasitemia levels and the presence of splenic infarction.