Risk Factors for Severe Infection, Hospitalization, and Prolonged Antimicrobial Therapy in Patients with Babesiosis

Neeharik Mareedu Marshfield Clinic Health System, Marshfield, Wisconsin;

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Anna M. Schotthoefer Marshfield Clinic Research Institute, Marshfield, Wisconsin;

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Jason Tompkins Marshfield Clinic Health System, Marshfield, Wisconsin;

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Matthew C. Hall Marshfield Clinic Health System, Marshfield, Wisconsin;

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Thomas R. Fritsche Marshfield Clinic Health System, Marshfield, Wisconsin;
University of Wisconsin, La Crosse, Wisconsin;

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Holly M. Frost Marshfield Clinic Research Institute, Marshfield, Wisconsin;
Marshfield Clinic Health System, Minocqua, Wisconsin

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Babesiosis is an emerging tick-borne disease transmitted by the hard tick Ixodes scapularis, which also transmits Lyme disease. Better gradation of prognostic indicators are needed to determine which patients may develop serious complications requiring hospitalization, and to provide early guidance on appropriate therapy. In this study, we evaluated 128 patients with smear or real time polymerase chain reaction-confirmed Babesia microti infections over a period of 16 years. Patients with asplenia or immunocompromising conditions were more likely to have severe infection (P < 0.01), require hospitalization (P < 0.01), or receive prolonged courses of antimicrobials (P < 0.01). Nausea or vomiting (P < 0.01) and diarrhea (P < 0.01) along with hyperbilirubinemia (P < 0.01) were predictive of severe infection, hospitalization, and prolonged antimicrobial therapy. Patients with concurrent Lyme disease were less likely to require hospitalization and had similar severity of disease and length of antibiotic treatment compared with those without Lyme disease.

Author Notes

Address correspondence to Holly M. Frost, Department of Pediatrics, Marshfield Clinic Minocqua Center, 9601 Townline Road, Minocqua, WI 54548. E-mail: frost.holly@marshfieldclinic.org

Financial support: Financial support was provided by Marshfield Clinic Research Institute.

Authors’ addresses: Neeharik Mareedu, Jason Tompkins, Matthew C. Hall, and Thomas R. Fritsche, Marshfield Clinic Health System, Marshfield, WI, E-mails: mareedu.neeharik@marshfieldclinic.org, tompkins.jason@marshfieldclinic.org, hall.matthew@marshfieldclinic.org, and fritsche.thomas@marshfieldclinic.org. Anna M. Schotthoefer, Marshfield Clinic Research Institute, Marshfield, WI, E-mail: schotthoefer.anna@mcrf.mfldclin.edu. Holly M. Frost, Marshfield Clinic Health System and Marshfield Clinic Research Institute, Minocqua, WI, E-mail: frost.holly@marshfieldclinic.org.

  • 1.

    Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE Jr, Fritsche TR, 1993. Tick-borne diseases in the United States. N Engl J Med 329: 936947.

  • 2.

    Vannier EG, Diuk-Wasser MA, Ben Mamoun C, Krause PJ, 2015. Babesiosis. Infect Dis Clin North Am 29: 357370.

  • 3.

    Lemieux JE et al.., 2016. A global map of genetic diversity in Babesia microti reveals strong population structure and identifies variants associated with clinical relapse. Nat Microbiol 1: 16079.

    • Search Google Scholar
    • Export Citation
  • 4.

    Belongia EA, 2002. Epidemiology and impact of coinfections acquired from Ixodes ticks. Vector Borne Zoonotic Dis 2: 265273.

  • 5.

    Joseph JT et al.., 2012. Vertical transmission of Babesia microti, United States. Emerg Infect Dis 18: 13181321.

  • 6.

    Moritz ED, Winton CS, Tonnetti L, Townsend RL, Berardi VP, Hewins ME, Weeks KE, Dodd RY, Stramer SL, 2016. Screening for Babesia microti in the U.S. Blood Supply. N Engl J Med 375: 22362245.

    • Search Google Scholar
    • Export Citation
  • 7.

    Centers for Disease Control and Prevention, 2012. Babesiosis surveillance: 18 states, 2011. MMWR Morb Mortal Wkly Rep 61: 505509.

  • 8.

    Eisen RJ, Eisen L, Beard CB, 2016. County-scale distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the continental United States. J Med Entomol 53: 349386.

    • Search Google Scholar
    • Export Citation
  • 9.

    Mead PS, 2015. Epidemiology of Lyme disease. Infect Dis Clin North Am 29: 187210.

  • 10.

    Hatcher JC, Greenberg PD, Antique J, Jimenez-Lucho VE, 2001. Severe babesiosis in Long Island: review of 34 cases and their complications. Clin Infect Dis 32: 11171125.

    • Search Google Scholar
    • Export Citation
  • 11.

    Knapp KL, Rice NA, 2015. Human coinfection with Borrelia burgdorferi and Babesia microti in the United States. J Parasitol Res 2015: 587131.

    • Search Google Scholar
    • Export Citation
  • 12.

    Kuwayama DP, Briones RJ, 2008. Spontaneous splenic rupture caused by Babesia microti infection. Clin Infect Dis 46: e92e95.

  • 13.

    Meldrum SC, Birkhead GS, White DJ, Benach JL, Morse DL, 1992. Human babesiosis in New York state: an epidemiological description of 136 cases. Clin Infect Dis 15: 10191023.

    • Search Google Scholar
    • Export Citation
  • 14.

    Rosner F, Zarrabi MH, Benach JL, Habicht GS, 1984. Babesiosis in splenectomized adults. Review of 22 reported cases. Am J Med 76: 696701.

  • 15.

    Sanchez E, Vannier E, Wormser GP, Hu LT, 2016. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. JAMA 315: 17671777.

    • Search Google Scholar
    • Export Citation
  • 16.

    White DJ, Talarico J, Chang HG, Birkhead GS, Heimberger T, Morse DL, 1998. Human babesiosis in New York state: review of 139 hospitalized cases and analysis of prognostic factors. Arch Intern Med 158: 21492154.

    • Search Google Scholar
    • Export Citation
  • 17.

    Krause PJ et al.., 2008. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis 46: 370376.

  • 18.

    Cunha BA, Raza M, Schmidt A, 2015. Highly elevated serum ferritin levels are a diagnostic marker in babesiosis. Clin Infect Dis 60: 827829.

  • 19.

    Teal AE, Habura A, Ennis J, Keithly JS, Madison-Antenucci S, 2012. A new real-time PCR assay for improved detection of the parasite Babesia microti. J Clin Microbiol 50: 903908.

    • Search Google Scholar
    • Export Citation
  • 20.

    Centers for Diseae Control and Prevention, 1995. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. JAMA 274: 937.

    • Search Google Scholar
    • Export Citation
  • 21.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG, 2009. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377381.

    • Search Google Scholar
    • Export Citation
  • 22.

    Centers for Disease Control and Prevention, 2016. Parasites-Babesiosis. Available at: https://www.cdc.gov/parasites/babesiosis/data-statistics/maps/maps.html. Accessed September 1, 2016.

  • 23.

    Hersh MH, Ostfeld RS, McHenry DJ, Tibbetts M, Brunner JL, Killilea ME, LoGiudice K, Schmidt KA, Keesing F, 2014. Co-infection of blacklegged ticks with Babesia microti and Borrelia burgdorferi is higher than expected and acquired from small mammal hosts. PLoS One 9: e99348.

    • Search Google Scholar
    • Export Citation
  • 24.

    Coleman JL, LeVine D, Thill C, Kuhlow C, Benach JL, 2005. Babesia microti and Borrelia burgdorferi follow independent courses of infection in mice. J Infect Dis 192: 16341641.

    • Search Google Scholar
    • Export Citation
  • 25.

    Diuk-Wasser MA, Vannier E, Krause PJ, 2016. Coinfection by Ixodes tick-borne pathogens: ecological, epidemiological, and clinical consequences. Trends Parasitol 32: 3042.

    • Search Google Scholar
    • Export Citation
  • 26.

    Wang TJ, Liang MH, Sangha O, Phillips CB, Lew RA, Wright EA, Berardi V, Fossel AH, Shadick NA, 2000. Coexposure to Borrelia burgdorferi and Babesia microti does not worsen the long-term outcome of lyme disease. Clin Infect Dis 31: 11491154.

    • Search Google Scholar
    • Export Citation
  • 27.

    Lin MY, Huang HP, 2010. Use of a doxycycline-enrofloxacin-metronidazole combination with/without diminazene diaceturate to treat naturally occurring canine babesiosis caused by Babesia gibsoni. Acta Vet Scand 52: 27.

    • Search Google Scholar
    • Export Citation
  • 28.

    Matsuu A, Yamasaki M, Xuan X, Ikadai H, Hikasa Y, 2008. In vitro evaluation of the growth inhibitory activities of 15 drugs against Babesia gibsoni (Aomori strain). Vet Parasitol 157: 18.

    • Search Google Scholar
    • Export Citation
  • 29.

    Vercammen F, De Deken R, Maes L, 1996. Prophylactic treatment of experimental canine babesiosis (Babesia canis) with doxycycline. Vet Parasitol 66: 251255.

    • Search Google Scholar
    • Export Citation
  • 30.

    Vannier E, Borggraefe I, Telford SR 3rd, Menon S, Brauns T, Spielman A, Gelfand JA, Wortis HH, 2004. Age-associated decline in resistance to Babesia microti is genetically determined. J Infect Dis 189: 17211728.

    • Search Google Scholar
    • Export Citation
  • 31.

    Menis M et al.., 2015. Babesiosis occurrence among the elderly in the United States, as recorded in large Medicare Databases during 2006–2013. PLoS One 10: e0140332.

    • Search Google Scholar
    • Export Citation
  • 32.

    Krause PJ et al.., 2000. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 343: 14541458.

  • 33.

    Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB, 2006. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43: 10891134.

    • Search Google Scholar
    • Export Citation
  • 34.

    Silva JC et al.., 2016. Genome-wide diversity and gene expression profiling of Babesia microti isolates identify polymorphic genes that mediate host-pathogen interactions. Sci Rep 6: 35284.

    • Search Google Scholar
    • Export Citation
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