Babesiosis
can be transmitted by a tick bite, blood transfusion, or perinatally,
from mother to child. Classical treatment may consist of drug regimens
like Mepron and Zithromax, or Clindamycin and Quinine. Treatment does
not usually require a blood transfusion among those who are
immunocompetent with an intact spleen, despite the fact that classical
regimens may not fully eradicate the parasite. In this clinical study
published in Case Reports in Infectious Diseases, the patient
was found to have B. microti on a blood smear, and was reported to have
been successfully treated with an exchange transfusion and IV Cleocin
and Quinine after failing Mepron and Zithromax. No long term follow-up
however was reported, and the majority of my patients with chronic Lyme
disease and Babesiosis have evidence of persistent infection and
relapsing disease (Krause, P.J. et al. Persistent Parasitemia After
Acute Babesiosis. NEJM 1998; Horowitz, R. Chronic Persistent Babesiosis
after Clindamycin and Quinine/ Mepron +Zithromax. Abstract 12th Int
Conference on Lyme Borreliosis, April 1999 NYC). There is known Mepron
resistance in the United States although it has only been reported in
the literature in immuncompromised patients (Krause, PJ et al. Emergence
of Resistance to Azithromycin-Atovaquone in Immunocomprised patients
with Babesia microti infections. Clin Inf Dis. 2010 Jan 4) and severe
hemolytic anemia as a presenting complaint in immunocompetent patients
with intact spleens has been reported (Iacopino, et al. Life threatening
babesiosis in a woman from Wisconsin; Arch Intern Med 1990
Jul;150(7):1527-8). No evidence of other immune testing (for example,
immunoglobulin levels and subclasses) or associated tick-borne
infections (i.e., Lyme, Bartonella, Ehrlichia, Anaplasma, rickettsial
infections) was discussed in this case report (despite low platelet
counts and elevated liver functions, which can be seen with these
co-infections), and multiple co-infections have been known to cause
increased severity of illness. http://www.hindawi.com/journals/criid/2015/405263/
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