Treatment of Babesiosis in Patients Receiving Rituximab for B Cell Lymphoma or in a Highly Immunocompromised State
Babesiosis in a highly immunocompromised patient follows a more severe course and requires a more intensive, prolonged treatment approach than in immunocompetent hosts. Several specific clinical contexts place patients in this high-risk category.
Clinical Scenario
This protocol addresses patients in a highly immunocompromised state. This includes those who have received or are receiving rituximab for B cell lymphoma or an autoimmune disorder, those on other immunosuppressive regimens for solid organ or bone marrow transplantation or malignancy, patients with malignancy and asplenia, and individuals with HIV infection and low CD4 T cell counts (AIDS).
Treatment Approach
Management requires a combination antimicrobial regimen — starting with an intensive initial phase and transitioning to a step-down course. Treatment must be continued for an extended duration, substantially longer than in non-immunocompromised patients. The complete regimen, step-down criteria, and sequencing are available in the full protocol.
Treatment Goal
The primary endpoint is confirmed clearance of Babesia parasites on peripheral blood smear, sustained across the final weeks of the treatment course.
References
DOI: 10.1093/cid/ciab275
- They include those who (i) have received or are receiving rituximab for B cell lymphoma or an autoimmune disorder, (ii) are receiving other immunosuppressive regimens for solid organ or bone marrow transplantation or malignancy, (iii) have malignancy and are asplenic, or (iv) have HIV infection with low CD4 T cell counts (AIDS).
- Start with one of the regimens recommended for hospitalized patients: acute severe disease and follow with one of the step-down therapies but treat for at least 6 consecutive weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear [3].
- A retrospective case-control study of 14 such patients who were infected with B. microti has shown that complete cure typically requires ≥6 consecutive weeks of antimicrobial treatment, including 2 final weeks during which parasites are no longer detected on peripheral blood smear [29].
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