title: Treatment of refractory Babesia microti infection with atovaquone-proguanil in an HIV-infected patient: case report.
abstract: A patient with acquired immune deficiency syndrome presented with babesiosis 6 months after presumed tick exposure. Despite initial treatment with azithromycin and atovaquone, followed by quinine and clindamycin, he experienced an increasing parasite load. Finally, red blood cell exchange transfusion, anti-Babesia therapy, and the addition of atovaquone-proguanil to the treatment regimen led to symptomatic improvement and elimination of parasitemia. Low-level parasitemia recurred 20 weeks later and was eradicated by administration of atovaquone-proguanil monotherapy. Atovaquone-proguanil appears to have activity against babesiosis and should be studied as a potential therapy for patients with refractory babesiosis.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. jvyas@partners.org
authors.forename: Jatin M
authors.initials: JM
authors.lastname: Vyas
authors.forename: Sam R
authors.initials: SR
authors.lastname: Telford
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Robbins
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology; D000818:Animals; D053626:Atovaquone / Q000008:administration & dosage / Q000627:therapeutic use*; D041001:Babesia microti; D001404:Babesiosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D004338:Drug Combinations; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D002727:Proguanil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D002727:Proguanil; D053626:Atovaquone