Persistent parasitemia after acute babesiosis.

Krause PJ, Spielman A, Telford SR 3rd, Sikand VK

N Engl J Med 1998 Jul 16;339(3):160-5
PMID: 9664092 PDF (free after registration)

Citation of case description:

The experience of one initially asymptomatic subject is instructive. Bab. microti DNA was amplified from his blood during the 5th and 17th months after parasites were first detected. He then had his first apparent episode of babesial illness and was hospitalized with 3 percent parasitemia. He was febrile and had rigors, sweats, anorexia, nausea, and stupor. During hospitalization, a primary intracapsular renal tumor was identified. After a standard one-week course of clindamycin and quinine therapy, he became asymptomatic and microscopically detectable parasites disappeared from his blood. Parasites were discovered once again, however, in about 1 percent of his erythrocytes 6 weeks later (27 months after the initial parasitemia), when the affected kidney had been scheduled for removal. Therapy with clindamycin and quinine was reinstituted for another week. One week, three months, and one year after surgery, neither microscopy nor DNA amplification revealed babesial parasites. This experience indicates that babesial infection may recrudesce after many months of asymptomatic parasitemia and that, although a standard course of clindamycin and quinine therapy usually is effective, it may fail.