SHM Converge Scientific Abstract ePoster Gallery-Ticks and Transfusions- Unraveling a Challenging Case of Severe Babesiosis

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This case report describes severe babesiosis in a man in his late 70s with a history of CKD, hypertension, hyperlipidemia, and prior anaplasmosis. He presented after multiple falls and new altered mental status, with fever, hypoxia, jaundice, tachycardia, tachypnea, abdominal tenderness, anemia, thrombocytopenia, elevated liver enzymes, acute kidney injury, and high lactate. Because his initial presentation suggested sepsis or hepatobiliary disease, he was empirically treated with broad-spectrum antibiotics, but imaging did not support cholecystitis or another clear abdominal source.<br /><br />Laboratory findings and evidence of hemolysis raised concern for a tick-borne illness. A tick-borne panel sent on admission later returned positive for babesiosis, and peripheral blood smear confirmed intraerythrocytic parasites. His parasite burden was high at 8%, with worsening anemia and multiorgan involvement. He was started on atovaquone and azithromycin, and due to the severity of illness, transfusion medicine recommended red blood cell exchange transfusion. After exchange transfusion, his parasite level fell to 1.6% and his anemia improved significantly.<br /><br />The report emphasizes several key points: babesiosis can present in many ways and may be missed or delayed because of nonspecific symptoms; clinicians should have a low threshold to test for tick-borne diseases in endemic areas; exchange transfusion can be highly effective in severe babesiosis with high parasitemia or end-organ dysfunction; and antibiotic duration may need adjustment in patients with heavy parasite burden.

Asset Subtitle

Ivy M. Mwangi

Meta Tag

Author List Ivy M. Mwangi, Kanav Gupta, Meghna Trivedi, Ron Baazov, Talia Campbell

Category Clinical Vignettes

Concept Babesiosis

Concept Hemolytic Anemia

Concept Red blood cell exchange transfusion

Concept Tick-Borne Disease

Concept Intraerythrocytic parasitic infection

Distinguished Non-Finalist

Presenter Organization University of Massachusetts T.H. Chan School of Medicine

Presenting Author Ivy M. Mwangi

Track Adult

Keywords

babesiosis

tick-borne disease

exchange transfusion

parasitemia

hemolysis

anemia

acute kidney injury

altered mental status

atovaquone

azithromycin

Babesiosis

Hemolytic Anemia

Red blood cell exchange transfusion

Tick-Borne Disease

Intraerythrocytic parasitic infection