title: Babesiosis in Wisconsin: a potentially fatal disease.
abstract: Babesiosis is emerging as an important tick-borne zoonosis in the United States. Most reported cases of this parasitic disease have been acquired in the Northeast. To date, only two clinical cases of Babesia microti infection acquired in the upper Midwest have been described. We report eight more cases. Most if not all of the 10 total cases probably were acquired in northwestern Wisconsin. Three cases (30% of 10) we now report were fatal and occurred in elderly patients (65-75 years old) who died after complicated hospital courses. One patient probably had had a latent Babesia infection that activated because of immunosuppression attributable to high-dose corticosteroid therapy and to splenic infarctions caused by cholesterol emboli. All three fatal cases were diagnosed incidentally and highlight the importance of considering the diagnosis of babesiosis in febrile patients who have been in babesiosis-endemic areas; examining their blood smears carefully; and treating promptly with clindamycin and quinine, and, if indicated, exchange transfusion. Medical personnel should be knowledgeable about this zoonosis, which is not limited to the northeastern United States, and is potentially serious, sometimes fatal.
authors.affiliation: Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Herwaldt
authors.forename: F E
authors.initials: FE
authors.lastname: Springs
authors.forename: P P
authors.initials: PP
authors.lastname: Roberts
authors.forename: M L
authors.initials: ML
authors.lastname: Eberhard
authors.forename: K
authors.initials: K
authors.lastname: Case
authors.forename: D H
authors.initials: DH
authors.lastname: Persing
authors.forename: W A
authors.initials: WA
authors.lastname: Agger
mesh_terms: D000368:Aged; D000818:Animals; D001403:Babesia / Q000235:genetics / Q000302:isolation & purification; D001404:Babesiosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D002981:Clindamycin / Q000627:therapeutic use; D006224:Cricetinae; D016054:DNA, Protozoan / Q000032:analysis; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000627:therapeutic use; D012377:Rodentia; D014922:Wisconsin / Q000453:epidemiology; D015047:Zoonoses / Q000453:epidemiology
chemical_list: D016054:DNA, Protozoan; D002981:Clindamycin; D011803:Quinine