Babesiosis-associated Splenic Rupture: Case Series From a Hyperendemic Region
Clinical Infectious Diseases
Clin Infect Dis. 2019 Sep 13;69(7):1212-1217
Patel KM, Johnson JE, Reece R, Mermel LA
Human babesiosis is a zoonotic infection caused primarily by Babesia microti and transmitted in most cases by the tick Ixodes scapularis. The peak infection time and location are dictated by the tick’s habitat and feeding time: the northeastern to upper midwestern United States and May to September, respectively . Clinical presentation ranges from a mild, influenza-like illness, usually in the young and immunocompetent, to a severe illness with end-organ dysfunction, usually in patients who are asplenic, otherwise immunocompromised, or elderly. Complications include acute respiratory distress syndrome, congestive heart failure, renal failure, liver failure, and disseminated intravascular coagulation. Spontaneous splenic rupture is also an occasionally reported complication of babesiosis. Interestingly, and paradoxically, case studies detailing this phenomenon describe patients who are relatively young, immunocompetent, without comorbidities, and lacking the typical warning signs reflecting the high levels of parasitemia that
precede a severe babesiosis presentation [2–12]. Given these emerging differences described in case reports, we set out to assess cases of babesiosis-related splenic rupture in our hospital system, located in a highly endemic region, in an attempt to confirm these findings to identify the subgroup of patients with babesiosis who are at the greatest risk for splenic rupture.