SHM Converge Scientific Abstract ePoster Gallery-Parasites Amongst Us: A Case of Babesiosis With High Grade Parasitemia and Lyme Coinfection

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This case report describes an 82-year-old woman who developed severe babesiosis after traveling from Wisconsin to Georgia, where babesiosis is rarely reported. She presented with cough, exertional shortness of breath, high fever, and fatigue. Initial testing showed anemia, thrombocytopenia, elevated bilirubin, worsening kidney function, and elevated LDH. A peripheral blood smear revealed Babesia parasitemia of 19%, and PCR confirmed Babesia microti infection. She was started on atovaquone and azithromycin. Because she also had signs of volume overload, Infectious Disease and Hematology were consulted to determine whether exchange transfusion was necessary.<br /><br />Although IDSA guidelines suggest considering red cell exchange transfusion in patients with high parasitemia or severe organ dysfunction, the team opted for close monitoring, supportive care, and simple packed red blood cell transfusions instead. Her parasitemia steadily declined from 19% to 16% to 8.3%, and she improved clinically without exchange transfusion. She received three units of packed red blood cells for ongoing hemolysis. Additional testing showed Lyme disease coinfection, with positive IgG and IgM antibodies, and she completed a 14-day course of doxycycline.<br /><br />The authors conclude that even severe babesiosis with hemolytic anemia and coinfection can sometimes be managed successfully without red cell exchange transfusion. They emphasize the importance of individualized decision-making, especially with hematology input, based on the patient’s clinical status and comorbidities.

Asset Subtitle

Julia Ossi

Meta Tag

Author List Gabriela Diaz, Grace Promer, Huey Huynh, Julia Ossi, Justin Liu, Noble M. Maleque, Tamia Ross

Category Clinical Vignettes

Concept Babesiosis

Concept Parasitemia

Concept Exchange Transfusion

Concept Lyme Disease

Concept Peripheral Blood Smear

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Julia Ossi

Track Adult

Keywords

babesiosis

Babesia microti

exchange transfusion

hemolytic anemia

parasitemia

atovaquone

azithromycin

Lyme disease coinfection

thrombocytopenia

elderly patient

Babesiosis

Parasitemia

Exchange Transfusion

Lyme Disease

Peripheral Blood Smear