Prolonged Babesia infection in patient with asplenia

In their study “Trust the Process: Prolonged Babesia Parasitemia in an Elderly Man with Asplenia from the American Midwest,” Ivancich and colleagues describe an 89-year-old man with multiple comorbidities and splenectomy, who required 8 weeks of treatment for his Babesia infection to clear.¹

The man was evaluated after a fall at home. Prior to the fall, he reportedly had a fever for 2 to 3 days, a loss of appetite, and generalized weakness for one week.

“The patient had thrombocytopenia, leukocytosis with neutrophilia, transaminitis, hyperbilirubinemia, and elevated creatine kinase level consistent with tick-borne illness,” wrote the authors.

The patient lived in rural Wisconsin and had 2 cats, one of whom lived outdoors.

“We present a case of Babesia parasitemia lasting more than 6 weeks and requiring almost 8 weeks of parasite specific therapy in a patient with asplenia.”

The man was initially treated empirically with doxycycline and intravenous ceftriaxone for a tick-borne infection.

Tests reveal Lyme disease and Babesia infection

The patient tested positive for Lyme disease, as well as Babesia, based on a blood smear and positive PCR test and antibody test.

His treatment was switched to azithromycin (1,500 mg) and intravenous atovaquone (500 mg) daily.

The Babesia parasitemia increased to 7.37% during treatment. The Babesia parasite was still present in the red blood cells at 6 weeks.

“After an extended 8-week treatment with azithromycin and atovaquone, the patient demonstrated clinical resolution of babesiosis with a negative blood smear,” the authors wrote.

The typical treatment duration is 7-10 days, the authors explained. “Some commonly used alternatives [to azithromycin and atovaquone] include atovaquone-proguanil, clindamycin, quinine, and artemisinin.”

“Cases of prolonged parasitemia, such as in the case presented, have been known to relapse, sometimes even 2 years later.”

“Therefore, we suggest that providers consider follow-up examination after the apparent clearance of babesiosis,” the authors wrote.

Editor’s note: The 89-year-old man’s case was caught early. The authors did not address treatment for individuals who are not diagnosed until after the parasite clears from the red blood cells.