title: Severe human Babesia divergens infection in Norway.
abstract: Human babesiosis is a rare but potentially life-threatening parasitic disease transmitted by ixodid ticks, and has not previously been reported in Norway. We report a case of severe babesiosis that occurred in Norway in 2007. The patient had previously undergone a splenectomy. He was frequently exposed to tick bites in an area endemic for bovine babesiosis in the west of Norway. The patient presented with severe haemolysis and multiorgan failure. Giemsa-stained blood smears revealed 30% parasitaemia with Babesia spp. He was treated with quinine in combination with clindamycin, apheresis, and supportive treatment with ventilatory support and haemofiltration, and made a complete recovery. This is the first case reported in Norway; however Babesia divergens seroprevalence in cattle in Norway is high, as is the risk of Ixodes ricinus tick bite in the general population. Babesiosis should be considered in the differential diagnosis of unexplained febrile haemolytic disease.
authors.affiliation: National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway. Electronic address: Kristine.moerch@helse-bergen.no.
authors.forename: K
authors.initials: K
authors.lastname: Mørch
authors.affiliation: Department of Surgical Services, Haukeland University Hospital, Bergen, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Holmaas
authors.affiliation: Department of Surgical Services, Haukeland University Hospital, Bergen, Norway.
authors.forename: P S
authors.initials: PS
authors.lastname: Frolander
authors.affiliation: Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, and Institute of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: E K
authors.initials: EK
authors.lastname: Kristoffersen
mesh_terms: D001403:Babesia / Q000302:isolation & purification; D001404:Babesiosis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway
keywords: Apheresis; Babesia divergens; Babesiosis; Ixodes ricinus; Splenectomized; Tick