1
|
Patel KM, Johnson JE, Reece R, Mermel LA. Babesiosis-associated Splenic Rupture: Case Series From a Hyperendemic Region. Clin Infect Dis 2020; 69:1212-1217. [PMID: 30541016 DOI: 10.1093/cid/ciy1060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/07/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spontaneous splenic rupture is an increasingly reported complication of babesiosis and has been described as a severe complication. METHODS We performed a retrospective chart review in a high-prevalence area to identify 7 cases of babesiosis-related splenic rupture between 2014 and 2016. RESULTS Splenic rupture occurred in approximately 1% of babesiosis cases. Compared to cases without splenic rupture, these patients were younger (by >10 years), healthier (most with ≤1 comorbidity), had a lower degree of parasitemia (<10%), and were less likely to have end-organ dysfunction other than their splenic involvement. CONCLUSIONS Younger, healthier patients may be more prone to develop splenic rupture, as splenic histiocytes engage in more robust erythrophagocytosis, leading to pathological mechanical strain and rupture.
Collapse
Affiliation(s)
- Kavin M Patel
- Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence
| | - Jennie E Johnson
- Division of Infectious Disease, Rhode Island Hospital and Alpert Medical School of Brown University, Providence
| | - Rebecca Reece
- Division of Infectious Disease, Rhode Island Hospital and Alpert Medical School of Brown University, Providence
| | - Leonard A Mermel
- Department of Medicine, Rhode Island Hospital and Alpert Medical School of Brown University, Providence.,Division of Infectious Disease, Rhode Island Hospital and Alpert Medical School of Brown University, Providence
| |
Collapse
|
2
|
Splenic Complications of Babesia microti Infection in Humans: A Systematic Review. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2020; 2020:6934149. [PMID: 32566058 PMCID: PMC7275217 DOI: 10.1155/2020/6934149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/25/2020] [Indexed: 11/18/2022]
Abstract
Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.
Collapse
|
3
|
Gupta A, Patel P, Manvar K, Kellner T, Guevara E. Splenic infarction in babesiosis: A rare presentation. Clin Case Rep 2019; 7:1591-1595. [PMID: 31428398 PMCID: PMC6692990 DOI: 10.1002/ccr3.2301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/06/2019] [Indexed: 02/01/2023] Open
Abstract
Babesiosis is a protozoan parasitic infection transmitted by the Ixodes tick. Splenic infarction is a rare, but potentially life-threatening complication of babesiosis; it is therefore vital that this complication is recognized.
Collapse
Affiliation(s)
- Ashish Gupta
- Internal MedicineThe Brooklyn Hospital CenterNew YorkNYUSA
| | - Poras Patel
- Hematology OncologyThe Brooklyn Hospital CenterNew YorkNYUSA
| | - Kapil Manvar
- Internal MedicineThe Brooklyn Hospital CenterNew YorkNYUSA
| | | | | |
Collapse
|
4
|
Kwon HY, Im JH, Park YK, Durey A, Lee JS, Baek JH. Two Imported Cases of Babesiosis with Complication or Co-Infection with Lyme Disease in Republic of Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2018; 56:609-613. [PMID: 30630283 PMCID: PMC6327201 DOI: 10.3347/kjp.2018.56.6.609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 11/23/2022]
Abstract
Babesiosis, caused by Babesia microti and B. divergens, is transmitted by Ixodid ticks. Symptoms of babesiosis vary from a mild flu-like illness to acute, severe, and sometimes fatal and fulminant disease. In Korea, 7 imported babesiosis cases and 1 endemic case have been reported. We report 2 cases of severe babesiosis initially mistaken as malaria. The first patient was complicated by shock and splenic infarction, the other co-infected with Lyme disease. As the population traveling abroad increases every year, physicians should be aware of babesiosis which mimics malaria, co-infection with other diseases, and its complications.
Collapse
Affiliation(s)
- Hea Yoon Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon 22212,
Korea
| | - Jae Hyoung Im
- Department of Internal Medicine, Inha University School of Medicine, Incheon 22212,
Korea
| | - Yun-Kyu Park
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22212,
Korea
| | - Areum Durey
- Department of Tropical Medicine and Parasitology, Inha University School of Medicine, Incheon 22212,
Korea
| | - Jin-Soo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon 22212,
Korea
| | - Ji Hyeon Baek
- Department of Internal Medicine, Inha University School of Medicine, Incheon 22212,
Korea
| |
Collapse
|
5
|
Blackwood B, Binder W. Unusual Complications From Babesia Infection: Splenic Infarction and Splenic Rupture in Two Separate Patients. J Emerg Med 2018; 55:e113-e117. [DOI: 10.1016/j.jemermed.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 12/15/2022]
|
6
|
Li S, Goyal B, Cooper JD, Abdelbaki A, Gupta N, Kumar Y. Splenic rupture from babesiosis, an emerging concern? A systematic review of current literature. Ticks Tick Borne Dis 2018; 9:1377-1382. [PMID: 29954722 DOI: 10.1016/j.ttbdis.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/17/2023]
Abstract
Babesiosis is a relatively common tick-borne parasitic infection of erythrocytes primarily affecting the northeastern United States. Babesiosis' prevalence and presentation have earned it the monikers "malaria of the northeast" and "Nantucket fever". Clinical presentation ranges from asymptomatic infection to severe infection including acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) or death. Since 2008, there have been a number of reports of splenic rupture in patients with the disease. We seek to provide a further understanding of this process, with the report of a case of splenic rupture followed by a systematic review of the current literature. We found that 87% of splenic rupture secondary to babesiosis occurred in male patients who are otherwise healthy, with an average of 56 years. Computed tomography is a reliable mode of diagnosis, and hemoperitoneum is the most common imaging finding. Patients with splenic rupture due to human babesiosis were successfully treated by various management strategies, such as conservative non-operative approach, splenic artery embolization, and splenectomy. The modality of treatment depends on patient's clinical course and hemodynamic stability, although spleen conserving strategy should be considered first whenever possible.
Collapse
Affiliation(s)
- Shuo Li
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| | - Bobby Goyal
- St. George's University School of Medicine, Grenada, West Indies.
| | - Joseph D Cooper
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY, 10467, United States.
| | - Ahmed Abdelbaki
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, United States.
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| |
Collapse
|
7
|
Dumic I, Patel J, Hart M, Niendorf ER, Martin S, Ramanan P. Splenic Rupture as the First Manifestation of Babesia Microti Infection: Report of a Case and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:335-341. [PMID: 29567936 PMCID: PMC5878539 DOI: 10.12659/ajcr.908453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient: Female, 79 Final Diagnosis: Splenic rupture due to babesia microti infection Symptoms: Abdominal discomfort • chest pain • fever • tachycardia Medication: — Clinical Procedure: Splenectomy Specialty: Infectious Diseases
Collapse
Affiliation(s)
- Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Janki Patel
- Division of Infectious Disease, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Melissa Hart
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Pathology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Eric R Niendorf
- Department of Radiology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Scott Martin
- Department of Pathology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Poornima Ramanan
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Akel T, Mobarakai N. Hematologic manifestations of babesiosis. Ann Clin Microbiol Antimicrob 2017; 16:6. [PMID: 28202022 PMCID: PMC5310009 DOI: 10.1186/s12941-017-0179-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/03/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Babesiosis, a zoonotic parasitic infection transmitted by the Ixodes tick, has become an emerging health problem in humans that is attracting attention worldwide. Most cases of human babesiosis are reported in the United States and Europe. The disease is caused by the protozoa of the genus Babesia, which invade human erythrocytes and lyse them causing a febrile hemolytic anemia. The infection is usually asymptomatic or self-limited in the immunocompetent host, or follows a persistent, relapsing, and/or life threatening course with multi-organ failure, mainly in the splenectomized or immunosuppressed patients. Hematologic manifestations of the disease are common. They can range from mild anemia, to severe pancytopenia, splenic rupture, disseminated intravascular coagulopathy (DIC), or even hemophagocytic lymphohistiocytosis (HLH). CASE PRESENTATION A 70 year old immunocompetent female patient living in New York City presented with a persistent fever, night sweats, and fatigue of 5 days duration. Full evaluation showed a febrile hemolytic anemia along with neutropenia and thrombocytopenia. Blood smear revealed intraerythrocytic Babesia, which was confirmed by PCR. Bone marrow biopsy was remarkable for dyserythropoiesis, suggesting possible HLH, supported by other blood workup meeting HLH-2004 trial criteria. CONCLUSION Human babesiosis is an increasing healthcare problem in the United States that is being diagnosed more often nowadays. We presented a case of HLH triggered by Babesia microti that was treated successfully. Also, we presented the hematologic manifestations of this disease along with their pathophysiologies.
Collapse
Affiliation(s)
- Tamer Akel
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305 USA
| | - Neville Mobarakai
- Department of Infectious Diseases, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305 USA
| |
Collapse
|
9
|
Moniuszko-Malinowska A, Swiecicka I, Dunaj J, Zajkowska J, Czupryna P, Zambrowski G, Chmielewska-Badora J, Żukiewicz-Sobczak W, Swierzbinska R, Rutkowski K, Garkowski A, Pancewicz S. Infection with Babesia microti in humans with non-specific symptoms in North East Poland. Infect Dis (Lond) 2016; 48:537-43. [PMID: 27118086 DOI: 10.3109/23744235.2016.1164339] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM The aim of the study was to evaluate the clinical course and effectiveness of diagnostics tools for Babesia spp. infection in patients bitten by ticks. MATERIALS AND METHODS Five hundred and forty-eight patients hospitalised or seen in outpatients department because of various symptoms after a tick bite were included in the study. PCR, nucleotide sequencing of Babesia 18S rRNA gene fragment, blood smears and serological tests for Babesia spp., TBEV, A. phagocytophilum and B. burgdorferi were performed in all patients. Six patients infected with Babesia were included in the final analysis. They had PCR, Babesia 18S rRNA gene fragment nucleotide sequencing, blood smears and serological tests for Babesia spp., TBEV, A. phagocytophilum and B. burgdorferi performed twice. RESULTS Tick-borne infection with Babesia microti in six immunocompetent patients with non-specific symptoms was confirmed for the first time in Poland. No severe course of the disease was seen. No piroplasm forms were noticed within erythrocytes on blood smear. Three patients developed a serological response. CONCLUSIONS Immunocompetent patients may be unaware of infection with Babesia microti after a tick bite. It must be included in the differential diagnosis after the tick bite. In patients with low parasitaemia PCR and serology seem useful when blood smear is negative. Self-elimination of Babesia spp. is possible, especially in cases with low parasitaemia.
Collapse
Affiliation(s)
| | - Izabela Swiecicka
- b Department of Microbiology, Faculty of Biology and Chemistry , University of Białystok , Bialystok , Poland
| | - Justyna Dunaj
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| | - Joanna Zajkowska
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| | - Piotr Czupryna
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| | - Grzegorz Zambrowski
- b Department of Microbiology, Faculty of Biology and Chemistry , University of Białystok , Bialystok , Poland
| | | | | | - Renata Swierzbinska
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| | - Krzysztof Rutkowski
- d Department of Allergy , Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Adam Garkowski
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| | - Sławomir Pancewicz
- a Department of Infectious Diseases and Neuroinfections , Medical University of Bialystok , Poland
| |
Collapse
|
10
|
Spontaneous splenic rupture due to Babesia microti infection: Case report and review of the literature. IDCases 2014; 1:63-5. [PMID: 26839774 PMCID: PMC4735021 DOI: 10.1016/j.idcr.2014.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/20/2014] [Accepted: 08/28/2014] [Indexed: 11/23/2022] Open
Abstract
This article describes the case of spontaneous splenic rupture as a rare complication of infection with Babesia species. We will discuss the symptomatology that this disease could present along with both surgical and non-surgical management approaches. Babesia infection often presents with mild to moderate symptoms, but can rapidly progress to significant injury including splenic rupture. The first case reported in a medical journal was in 2007. Treatment usually involves a two-drug regimen; clindamycin plus quinine, or atovaquone plus azithromycin (as in our patient). If hemodynamic stability is present, a primary non-surgical treatment may be especially beneficial since splenectomy may worsen optimal immunologic function and the infection itself.
Collapse
|
11
|
Leinwand JC, Arroyo JP, Solomon D, Kaplan LJ. Babesia microti infection presenting as acute splenic laceration. Surg Infect (Larchmt) 2013; 14:412-4. [PMID: 23859679 DOI: 10.1089/sur.2012.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Blunt abdominal trauma leading to splenic injury can cause substantial morbidity, particularly in patients with established splenic pathology. In such cases, the extant pathology may increase a patient's susceptibility to blunt injury, most notably by inducing hypersplenism; Babesia microti may create such a condition. METHODS Case report and English language-based literature review. RESULTS Obtaining an appropriate travel history and understanding endemic infectious conditions will better enable the clinician to establish readily treatable concomitant diagnoses in the setting of injury. CONCLUSIONS Failure to treat such infections may delay solid organ healing, leading to the patient being released to unrestricted and therefore risky activity with persistently abnormal splenic architecture.
Collapse
Affiliation(s)
- Joshua C Leinwand
- Yale School of Medicine, Surgical Critical Care, and Surgical Emergencies, New Haven, Connecticut, USA
| | | | | | | |
Collapse
|
12
|
El Khoury MY, Gandhi R, Dandache P, Lombardo G, Wormser GP. Non-surgical management of spontaneous splenic rupture due to Babesia microti infection. Ticks Tick Borne Dis 2011; 2:235-8. [PMID: 22108020 DOI: 10.1016/j.ttbdis.2011.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/20/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Babesiosis is an emerging tick-borne infection. We describe 2 hospitalized patients from the United States with spontaneous splenic rupture attributable to Babesia microti infection. The first patient was a 36-year-old previously healthy man with a low-grade splenic rupture not requiring surgical intervention. The second was a 70-year-old healthy man whose splenic rupture required proximal splenic artery embolization. Since the spleen is an important organ involved in controlling Babesia infection, management of splenic rupture in an infected patient using an organ preserving approach when appropriate may be preferred.
Collapse
Affiliation(s)
- Marc Y El Khoury
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA.
| | | | | | | | | |
Collapse
|