Severe babesiosis presenting as acute respiratory distress syndrome in an immunocompetent patient.
Panduranga V, Kumar A.
Abstract
Babesiosis is a tick-borne illness caused by the intraerythrocytic parasite Babesia microti. Adult respiratory distress syndrome (ARDS) is a complication of B. microti infection and generally presents later in the course of the disease. We present a case of babesiosis presenting with ARDS.
A 59-year-old male with history of hypertension and atrial fibrillation presented with one day of progressive shortness of breath. The patient returned from a trip to Massachusetts one day prior. On arrival to the emergency department (ED) the patient was noted to be febrile with tachycardia, tachypnea, and hypoxia and was intubated for respiratory failure.
A computed tomography angiography (CTA) was negative for pulmonary embolism and showed bilateral infiltrates. The Berlin criteria for severe ARDS were met.
Tick-borne illness was suspected and Wright-Giemsa stained thin blood smear confirmed the diagnosis of babesiosis.
The patient was treated with atovaquone and azithromycin for seven days and was successfully extubated on day four of hospitalization. He continued to clinically improve and was discharged home four days later.
The case highlights the importance of physicians being aware of the manifold ways in which babesiosis can manifest.
PMID: 24974563 [PubMed - indexed for MEDLINE]
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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posted
Fortunately in this case the patient was diagnosed and treated for babesia.
I found an email address for one of the authors but it has been a couple of weeks and they have not responded.
The authors are with the University of Connecticut Internal Medicine Residency Program.
I would like to obtain a copy of the full journal article - am willing to pay for it.
Can anyone help me find a contact phone number for the Connecticut Medicine journal in which this article was published?
Thanks. Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Rumigirl
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Bea, why don't you first resend the email? And look for the phone number as well. It is summer, so people may be away, etc.
I wish that Steve had had enlightened doctors like this! Plus, it sounds like he had acute Babesiosis,which would respond more quickly.
CT doctors are not often that enlightened, even though they are smack dab in the middle of an epidemic in such an endemic state.
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Razzle
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You can order reprints of any article in Conn. Med. by going here:
Thanks so much - I sent in the $25 payment before I found the link on the page you provided that let me print the article for free. But the print quality is not that great.
Where it says view current article - click on that and then follow the link to the issue 5 pages 289 - 291.
Thanks again. Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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posted
Very upsetting to read. Hubby presented with 3 days of shortness of breath and pulse ox of 85 and also bilateral infiltrates suggestive of pneumonia on CT exactly the same as the patient in the article. Hubby was 57 and the patient was 59.
Very interesting to note that the patient in the case only had less than 1 percent of babesia infected cells.
Hubby's atrial fibrillation did not occur until 2 or 3 days after admission and that is when he was transferred to the teaching hospital that stopped his antibiotics and antimalarials and started steroids and it was all downhill from there until his death a month later.
Bea Seibert
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Keebler
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- Bea,
There are no words that I can pull out of any hat to express all the thoughts I have around this. So . . . Hugs. Just hugs. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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The unusual thing is that the ARDS in the case presented so quickly. It generally comes after several days of babs treatment.
With hubby he had added a pulse of flagyl 2 days per week to his other babesia meds and was on the 2nd pulse of that med when the fevers increased and the shortness of breath started. So actually his presentation of ARDS due to babesia was a more typical presentation than in the case study.
Bea Seibert
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Judie
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Oh Bea, that's so sad to hear about the last month of your husband's death. I'm mad at the "teaching" hospital. What are they teaching???
Thanks for sharing your info. I'm still at the beginning of babs treatment. If I experience shortness of breath, I'm going to take if very seriously.
I had horrible chest tightness and constriction before starting treatment. It seems to have eased up a bit since treatment began.
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surprise
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Good thoughts to you Bea.
Always appreciative of the intelligence you provide here.
-------------------- Lyme positive PCR blood, and positive Bartonella henselae Igenex, 2011. low positive Fry biofilm test, 2012. Update 7/16- After extensive treatments, doing okay! Posts: 2518 | From USA | Registered: Nov 2011
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poppy
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Surprising on two counts: that they suspected tickborne disease at all, and that they did a blood smear to diagnose. And really, amazing that someone actually found it in the smear with such low level parasitemia. That patient hit the jackpot. Rare, rare, rare.
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Catgirl
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Ditto Poppy.
-------------------- --Keep an open mind about everything. Also, remember to visit ACTIVISM (we can change things together). Posts: 5418 | From earth | Registered: Mar 2011
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ARDS is a very rare complication of babesia. Shortness of breath or air hunger or dyspnea is much more common, although only LLMD's would know that. That symptom does not make it into much of the medical literature.
For some reason babesia is known to go to the lungs - has been found there on autopsies. Actually some people think that hyperbaric oxygen should not be used in treatment for patients with babesia because supposedly the increased oxygen makes babesia worse.
As for the air hunger - a couple of possible causes. One is anemia and iron deficiency. A second potential cause is that the babesia parasites cause mild pulmonary edema - fluid in the lungs. Pulmonary edema can be related to cardiac function (cardiogenic) or to other causes (noncardiogenic).
Poppy,
Yes, even good microbiologists can miss babesia with very low levels of parasites. The first Clongen slide hubby had done in the hospital was negative and the 2nd slide was positive but those results did not get reported until the morning of his death.
Of course both slides done by the hospital were negative - one the day after admission and the 2nd one after death.
And the hospital initially was only testing for babesia microtti which hubby had never had antibodies to. Eventually they were forced to test for babesia duncani as well which was also negative. But after death and a week of mepron and Zithromax Fry Lab found 3 different unknown babesia species by PCR.
Recently I have been reading several babesia textbooks online with the Amazon look inside the book feature and the latest literature definitely confirms that babesia can be chronic and also that it can go dormant and become active again.
You are not supposed to give blood if you have ever had babesia for that reason. Even a low level dormant infection could be passed to someone who has a weakened immune system.
The reality is that babesia testing is not much more reliable than lyme testing - especially when you consider they generally only test for one or two of the known 100 plus strains. One old textbook I acquired recently listed 89 strains of babesia - 32 of those infected mice and about half a dozen infected deer.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Amanda
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Bea,
I have not been here for a while. I am so very sorry about your husband.
My own battle is not going so well.
Do you have a post somwhere here, where you list everything tried, and things that did and did not help? Am at my wits end...
If you felt ok about it, do you know someone willing to write up/publish a case study concerning your husband?
God Bea, I am really sad for you and your husband. And thanks, btw, for keeping up the hard work for the rest of us...
-------------------- "few things are harder to put up with than the annoyance of a good example" - Mark Twain Posts: 1008 | From US | Registered: Dec 2007
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Hubby died from ARDS and a splenic infarction (blood clot in the spleen) on 10/9/12. Both are rare complications of babesia. Even though it has been almost 2 years sometimes it seems like it was just yesterday.
I am in the process of filing a medical malpractice lawsuit against the hospital where he died.
I would love his case to get published someday, but right now I need to get the legal stuff out of the way and that includes follow-up discussions with the state department of health and the CDC since his case was never officially reported.
I am also pursuing research with Columbia Presbyterian University in New York where I had his brain and other specimens donated. There are some other tickborne researchers that want to be involved as well once I can get things coordinated.
I have been taking a break from the boards for several months now.
Anyway, to answer you question. Here are 2 links that may help in your babesia treatment.
The first link was posted several years ago by another LymeNet patient who has since died from their own babesia and tickborne infections.
The second link includes most of the general details on hubby's babesia treatment. He was doing really well in the spring of 2012 but then got 2 new tickbites and died 3.5 months after the 2nd new tickbite.
I should add that hubby did just about every potential malaria med and herb that was available during the 12 years he was sick. Unfortunately we thought for 10 years that he was allergic to mepron so he did not do that med except for low dose for 10 days.
Eventually we found a doc brave enough to prescribe malarone which was very helpful. Apparently hubby was not really allergic to the mepron, but had a very severe die off/ herx reaction.
I just found another journal article yesterday that says that babesia microti infection can interfere with liver detox. Will post that later today when I find the printout in my stack.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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poppy
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I know you are occupied at this time, but at some future time, maybe you could put all the info you have accumulated into a file. You know things about babesia, and have gathered a lot of info, that beginning lyme docs do not know and maybe even some with more experience. Certainly not the average non-lyme doc will know any of this.
Nice to have the case written up by a professional but sometimes a patient or patient caregiver can provide a very useful service. If it gets posted on various threads over the years on forums, it is hard to locate later. An assembled file would be more accessible. Not talking necessarily about your husband's case, but all that you have found in papers and books, etc. Just gathering them up in one place would be useful to many.
Posts: 2888 | From USA | Registered: Mar 2004
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I have seriously considered setting up a website devoted to babesia exclusively. Want to discuss with my future lawyers first to make sure whatever I write regarding Steve's case will not impact any legal actions.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Poppy - Another thing many people may not be aware of. I have found quite a few references that state that the severity of babesia symptoms is not related to the quantity of parasites - don't think this applies to people who have no spleen.
Apparently babesia produces cytokine reactions that can cause extreme symptoms even with low levels of parasites.
The case I presented here obviously seems to support that viewpoint.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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Amanda
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Thanks Bea, good ideas. Especially starting a new thread. might take some time to list (or just remember) everything I took.
I actually tried mepron, for two years, it sorta, kinda helped. But it just quit working all together after 2 years, and I was up to 3 Tablespoons a day. malarone never worked for me.
-------------------- "few things are harder to put up with than the annoyance of a good example" - Mark Twain Posts: 1008 | From US | Registered: Dec 2007
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