Treatment of Severe Babesiosis Requiring Hospital Admission

Clinical Scenario

Severe babesiosis presenting with features that necessitate hospital admission. This presentation can be complicated by marked anemia, acute respiratory distress syndrome, disseminated intravascular coagulation, congestive heart failure, renal and liver impairment or failure, shock, splenic infarct or rupture, warm autoimmune hemolytic anemia, and in some cases fatal outcome.

Treatment Goals

Resolution of symptoms; reduction of Babesia parasitemia on peripheral blood smear to below 4%; clearance of fever and parasites on blood smear, typically within about a week.

Approach (partial overview)

Inpatient management relies on combination antibiotic therapy. The preferred approach begins with an intravenous component that is subsequently stepped down to an all-oral regimen. An alternative combination exists for cases where the preferred option is not appropriate.

Full regimen, dosing schedule, step-down details, and paediatric dosing are available in the complete structured protocol →

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References

DOI: 10.1093/cid/ciab275

Severe babesiosis requires hospital admission and can be complicated by marked anemia, acute respiratory distress syndrome, disseminated intravascular coagulation, congestive heart failure, renal and liver impairment/failure, shock, splenic infarct or rupture, warm autoimmune hemolytic anemia, and/or fatal outcome.

Patients admitted to the hospital for severe B. microti infection are best treated with IV azithromycin plus oral atovaquone.

Fever and parasites on blood smear usually clear within a week.

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