INTRODUCTION: Babesiosis is a tick-borne disease caused by parasites of the genus Babesia resulting in an intraerythrocytic infection that ranges from an asymptomatic state to a life-threatening illness. Human disease in the United States is most commonly due to B. microti. Transmission usually occurs via a bite from the Ixodid tick. We present a rare case of transfusion-associated babesiosis.
CASE PRESENTATION: A 57-year-old male was brought to our facility with complaints of chest and abdominal pain for 3-4 days. He also complained of passing melenic stools and having dark urine. His past medical history was significant for hepatitis C, cirrhosis, hypertension, and coronary artery disease. Six weeks earlier, the patient had been hospitalized with an upper GI bleed at which time he received several units of packed red blood cells. Upper endoscopy revealed the presence of a gastric ulcer. Current review of systems was remarkable for fever, chills, dyspnea, anorexia, and fatigue. He denied any travel outside of Texas within the past five years. Exam was notable for mild to moderate distress, jaundice, tachycardia, and diffuse abdominal tenderness without rebound or guarding. Laboratory studies revealed a white count of 6.5 with left shift, hemoglobin of 8, platelets of 12, INR of 2.7, LDH of 5539, total bilirubin of 8.7, and unconjugated bilirubin of 4.2. The patient was started on proton pump inhibitor therapy and transfusion of blood products was initiated. Given the elevation of bilirubin and the likelihood of hemolysis, the peripheral smear was reviewed. The presence of intraerythrocytic parasites was noted (see image). Based on the appearance of the parasites, the patient was started on multi-drug treatment for babesiosis. Despite aggressive therapy, his condition continued to deteriorate and he expired. Serologic testing confirmed the diagnosis of babesiosis postmortem. Transfusion-related transmission was confirmed after contact was made with the CDC. Of the three donors from whom the patient had received blood products on prior admission, one had positive serology for B. microti. Although this donor was not from an endemic region, he did have frequent travel to the northeast where babesiosis more frequently occurs.
DISCUSSIONS: Babesiosis is a disease that is mostly found in the United States and Europe. Despite its rarity, the incidence appears to be increasing in part due to expansion of endemic regions and migration of animal as well as human hosts. Of major concern is the effect that this entity has on the blood supply. Those most likely to be affected are immunocompromised hosts, asplenic individuals, and the elderly. In the case of our patient, he appeared to be more susceptible to fulminant infection because of his cirrhotic state. The keys to management remain early recognition and implementation of appropriate therapy. In most individuals infected with B. microti, clinical findings are mild. Severe manifestations are usually only observed with infection of high-risk individuals.
CONCLUSION: Babesiosis is a rare disease that is growing in incidence due to several factors including increased recognition and better diagnostic measures. It remains the most important transfusion-related tick-borne disease. More judicious use of transfusion is advisable in order to limit the possibility of infections. Better preventive strategies need to be implemented to protect both our blood supply and high-risk transfusion recipients.
DISCLOSURE: Rajesh Babu, None.