774 - Bedbound from Babesiosis

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

KK

Karthik B. Kamath, DO

PM&R Resident
Nassau University Medical Center
Coram, New York, United States

Co-Author(s)

ML

Michael Lem, MD

Family Medicine Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
VD

Victoria D’Costa, DO

Primary Care
Catholic Health
Westbury, New York, United States
LK

Larisa Kleymenova, DO

Family Medicine Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Debility secondary to Babesiosis

Case Description: A 57-year-old Ecuadorian male with hypertension presented with 15 days of widespread pain, weakness, yellowing of the eyes, blood in urine and stool, and recent headache, sweating, chest pain, shortness of breath, abdominal pain, and diarrhea. He had a 15-year history of heavy alcohol consumption, reducing it over the past two years. Upon admission, labs showed thrombocytopenia, elevated liver enzymes, increased LDH, elevated bilirubin, normal white blood cell count with high monocytes, increased immature granulocytes, and decreased haptoglobin. Urinalysis showed blood, nitrates, and bilirubin. An abdominal CT scan revealed splenomegaly with suspicious hypodensities. A blood smear confirmed intra-erythrocytic parasites, highly suggestive of Babesia, later confirmed with PCR testing. Treatment involved IV fluids, Tylenol, transfusions, atovaquone, azithromycin, and plasmapheresis. The patient's condition gradually improved, with sepsis, direct bilirubin levels, and platelets showing improvement, along with a resolution of the parasitic burden. The patient was discharged with no recurrent symptoms upon follow-up.

Discussions: Babesiosis, caused by the protozoan Babesia, lyses red blood cells. In 2019, the US reported 2,418 cases, primarily from B. Microti transmitted by Ixodes Scapularis ticks. Symptoms include fever, chills, myalgia, and dark urine. Diagnosis involves blood smear or a PCR test to detect the presence of the parasite and treatment typically includes antiparasitic medications such as atovaquone and azithromycin.

Conclusions: Babesiosis leads to hemolytic anemia, which can cause debility and hinder activities of daily living. Untreated or inadequately treated Babesiosis can worsen, leading to prolonged symptoms. Prompt diagnosis and treatment as seen in this case, can reduce long-term fatigue, muscle aches, and mental fog, sustaining adequate quality of life.