SHM Converge Scientific Abstract ePoster Gallery-Babesiosis by Geocaching: Severe Babesiosis Treated With Exchange Transfusion

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This case describes severe babesiosis in a 65-year-old woman from Pennsylvania with type 1 diabetes who presented with 4 days of fever, malaise, fatigue, jaundice, and dark urine. She denied known tick exposure but spent substantial time geocaching in wooded areas. Initial labs showed hemolysis and organ dysfunction, including thrombocytopenia, anemia, and elevated bilirubin. Imaging showed gallstones, mild splenomegaly, and hepatomegaly.<br /><br />Babesia microti DNA was confirmed by PCR, and peripheral smear demonstrated parasitemia that later worsened to 8–10%. Despite treatment with atovaquone and azithromycin, her condition deteriorated with increasing dyspnea and encephalopathy. Clindamycin and doxycycline were added, but the patient continued to worsen.<br /><br />Because of her severe disease and high parasitemia, she underwent red blood cell exchange transfusion (RBCE). Following exchange transfusion, her mental status improved significantly and no parasites were seen on smear. Her platelet count, hemoglobin, and bilirubin gradually improved, and she was discharged in stable condition on hospital day 13.<br /><br />The report emphasizes that babesiosis is an emerging tick-borne infection, increasingly recognized in Pennsylvania, and can range from mild or asymptomatic illness to life-threatening multiorgan disease. Risk factors for severe babesiosis include older age, asplenia, malignancy, HIV, immunosuppression, and high parasitemia. While the IDSA only weakly recommends RBCE for selected severe cases and there are no universally accepted criteria, this case supports considering exchange transfusion when patients deteriorate or have marked parasite burden. Prompt recognition and early escalation of therapy are essential.

Asset Subtitle

Patrick Kukulich

Meta Tag

Author List Patrick Kukulich, Rebecca Vento

Category Clinical Vignettes

Concept Babesiosis

Concept Babesia microti

Concept Hyperparasitemia

Concept Asplenia

Concept Tick-Borne Infection

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University Hospitals

Presenting Author Patrick Kukulich

Track Adult

Keywords

babesiosis

Babesia microti

red blood cell exchange transfusion

tick-borne infection

parasitemia

hemolysis

thrombocytopenia

encephalopathy

Pennsylvania

atovaquone azithromycin

Babesiosis

Babesia microti

Hyperparasitemia

Asplenia

Tick-Borne Infection