Atypical Babesia symptoms in elderly man

In the article “An Atypical Case Presentation of Babesiosis,” Allen and colleagues describe a unique patient who contracted Babesiosis but did not exhibit many of the typical Babesia symptoms, such as night sweats, chills, shortness of breath and weight loss.¹ Instead, his symptoms were limited to weakness, fever, tachycardia and leg pain.

CASE REPORT

A 75-year-old man was admitted to the emergency department with generalized weakness that had been ongoing for one week, a fever and tachycardia. He also had mild swelling of his left leg and leg pain, which he described as intermittent stabbing pain in his left thigh.

The man had a past medical history of hypertension and hyperlipidemia. His initial laboratory test results revealed mild anemia, thrombocytopenia, and renal dysfunction. All other testing was normal.

The patient was treated empirically with acetaminophen and intravenous ceftriaxone and vancomycin.

“On the first day of hospitalization, blood parasites were noted to be present on the patient’s complete blood count (CBC),” the authors’ state.

His treatment was switched and he was prescribed a 10-day course of azithromycin and atovaquone for a possible diagnosis of Babesiosis. However, the patient’s condition deteriorated rapidly.

“The patient’s renal function, anemia, thrombocytopenia and mental status progressively worsened and by hospital day 3 the patient was transferred to the Intensive Care Unit.”

He was then treated successfully with a red blood cell exchange and plasma exchange therapy.

“The patient’s kidney function improved, along with his anemia and thrombocytopenia,” the authors’ state. “The percentage of parasitemia had decreased to 1% from a maximum of 22% on Day 1 of admission.”

Subsequently, PCR testing for Babesiosis was positive for Babesia microti.

Authors’ conclude:

• “Tick-borne illnesses should be included in the differential even in low-risk populations and non-endemic regions due to the severity of disease complications.”
• “When patients present with vague symptoms, it is important to keep a broad differential.”
• “In this case, it could have been beneficial to inquire if the patient spent time outdoors or had any pets or other means by which he may have been exposed to a tick.”