What are the approach considerations for the treatment of babesiosis?

Updated: Apr 01, 2021
  • Author: Rachel E Strength, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Suspicion of babesiosis in a patient with a history of exposure in an endemic area, tick bite, fever, chills, and fatigue is crucial. Peripheral blood smear or PCR is necessary to make the diagnosis. [3] A complete blood count (CBC) count with differential may be helpful for determining the severity of infection.

Patients with congenital or acquired asplenia can have severe or fulminant babesiosis. In patients with fever of unknown origin (FUO), consider babesiosis as a diagnosis if the patient lives in an endemic area, has traveled to an endemic area, or received a blood transfusion in the past. [41]

If a patient is otherwise healthy and asymptomatic, no treatment is required. [3]  Most of the otherwise healthy patients infected by B. microti appear to have a mild illness and recover without specific chemotherapy. Asymptomatic, immunocompetent patients do not require monitoring for clearance of parasitemia.

The IDSA recommends starting symptomatic patients on a combination treatment regimen of  atovaquone and azithromycin (first line) or a combination of clindamycin and quinine (alternative therapy).

Immunocompromised patients should be monitored for parasitemia on blood smears until the blood smears are negative, regardless of symptoms.  Symptomatic immunocompetent patients should have blood smears monitored for parasitemia during acute illness. Once symptoms have resolved, the IDSA recommends against monitoring blood smears for parasitemia. [3]

Intubation and mechanical ventilation may be required for patients who develop respiratory distress or failure.  Other supportive care may be necessary in some patients; this could include vasopressors for hypotensive patients, blood transfusions, and dialysis. [7]

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