SHM Converge Scientific Abstract ePoster Gallery-Remembering Endemic Disease in the Time of a Pandemic

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This case report describes a 73-year-old man from Central Maine with a month of dizziness, fatigue, dyspnea on exertion, syncope, poor appetite, taste changes, and 25-pound weight loss. On presentation, he was hypotensive and appeared pale and fatigued. Labs showed pancytopenia and hemolytic anemia, including low hemoglobin, elevated LDH, low haptoglobin, and elevated bilirubin. A peripheral smear revealed intraerythrocytic parasites with ring forms and Maltese cross forms, and Babesia PCR was positive. He also tested positive for COVID-19.<br /><br />He was initially treated empirically with azithromycin and atovaquone for babesiosis, plus doxycycline for possible anaplasmosis, despite no known tick bite. He did not require oxygen or specific COVID-19 therapy. Tick-borne co-infection testing was otherwise negative, and he was discharged to complete a 10-day course of azithromycin and atovaquone, recovering well.<br /><br />The authors emphasize several points: babesiosis is common in the Northeast and Midwest, where co-infection with other illnesses should be considered; COVID-19 symptoms can overlap with those of babesiosis and distract clinicians from identifying concurrent infections; and severe babesiosis often causes hemolytic anemia. They also note that COVID-19 itself has been associated with hemolytic anemia in some reports. Because both babesiosis and COVID-19 can affect older patients more severely, clinicians should maintain a high index of suspicion for tick-borne disease in endemic areas, even when another diagnosis such as COVID-19 is present.

Asset Subtitle

Sarah Gray

Meta Tag

Author List Claudia K. Geyer, Sarah Gray

Category Clinical Vignettes

Concept Babesiosis

Concept COVID-19

Concept Hemolytic Anemia

Concept Peripheral Smear

Concept Babesia PCR

Distinguished Non-Finalist

Presenter Organization Central Maine Medical Center

Presenting Author Sarah Gray

Track Adult

Keywords

babesiosis

COVID-19

hemolytic anemia

pancytopenia

tick-borne disease

Babesia PCR

Maltese cross forms

azithromycin

atovaquone

co-infection

Babesiosis

COVID-19

Hemolytic Anemia

Peripheral Smear

Babesia PCR