Severe Babesiosis in Hospital: Next-Line Management When Initial Treatment Fails to Resolve Infection
Severe babesiosis requiring hospital admission is a serious condition that can be complicated by marked anaemia, acute respiratory distress syndrome, disseminated intravascular coagulation, congestive heart failure, renal and liver impairment, shock, and other life-threatening complications. When hospitalised patients do not respond adequately to initial therapy, escalation to an alternative regimen is necessary.
First-line management for hospitalised patients with acute severe babesiosis uses either atovaquone plus azithromycin or clindamycin plus quinine. The expected response is resolution of symptoms, a decrease in Babesia parasitaemia on peripheral blood smear to below 4%, and clearance of fever and parasites on smear within approximately one week. When symptoms worsen, parasitaemia increases, or these goals are not achieved, the first-line regimen is considered to have failed and an alternative approach is required.
- 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.
- Worsening of symptoms or increasing parasitemia despite azithromycin plus atovaquone followed by clindamycin and quinine should prompt consideration of an alternative antimicrobial regimen (Table 3).