[Babesiosis in an immunocompromised German patient].
BACKGROUND
Babesiosis is a tick-borne zoonosis. Human cases of babesiosis occur worldwide but have been mainly described in North America and rarely in Europe. The disease manifestations show a broad clinical spectrum including a malaria-like syndrome. Fulminant and life-threatening infections have been described in the setting of asplenia and/or immunosuppression.


METHODS
A 63-year-old splenectomized patient had been treated with rituximab because of B cell lymphoma. 4 weeks later, he developed signs of infection, anemia, subicterus, and dark urine. Laboratory investigation revealed hemolytic anemia, hemoglobinuria, and renal insufficiency. Blood smears showed Plasmodium-like intraerythrocytic parasites. He had not been exposed to malaria. He had taken frequent walks in the woods around Lake Constance in the south of Germany, where tick-borne diseases are endemic. Babesiosis was confirmed by polymerase chain reaction (PCR) and the parasite was identified as EU1. Serology was negative. Therapy with clindamycin and quinine induced remission. Following a relapse, retreatment with atovaquone and azithromycin was initiated. After several months, seroconversion occurred and the patient cleared the parasite 8 months after first admission.


CONCLUSIONS
Human babesiosis does occur in Germany. Patients with splenectomy and/or immunosuppression and malaria-like symptoms should be evaluated for babesiosis by blood smear and PCR.
Häselbarth
Katja
K
II. Medizinische Klinik, Hegau-Klinikum Singen, Virchowstrasse 10, Singen.
Kurz
Michael
M
Hunfeld
Klaus-Peter
KP
Krieger
Gerhard
G
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000962:Antimalarials / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D053626:Atovaquone / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D001404:Babesiosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D004359:Drug Therapy, Combination; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000139:chemically induced / Q000150:complications* / Q000276:immunology; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D000069283:Rituximab; D013156:Splenectomy
D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000962:Antimalarials; D000970:Antineoplastic Agents; D000069283:Rituximab; D017963:Azithromycin; D053626:Atovaquone