LymeNet Flash: Fever of unknown origin (FUO) due to babesiosis in a immunocompetent host

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Posted by AliG (Member # 9734) on :

Fever of unknown origin (FUO) due to babesiosis in a immunocompetent host

Burke A. Cunha MD, a, Yehuda Z. Cohen MDa and Brian McDermott DOa

Infectious Disease Division, Winthrop-University Hospital, Mineola, New York and State University of New York School of Medicine, Stony Brook, New York

Available online 30 September 2008.

Fevers of unknown origin (FUOs) are defined as prolonged fevers of 101�F or greater lasting 3 or more weeks that remain undiagnosed after comprehensive inpatient/outpatient laboratory testing.

Tick-borne infections are uncommon causes of FUOs.

Any infectious disease accompanied by prolonged fevers can present as an FUO if the diagnosis is not suspected or if specific laboratory testing is not done to confirm the diagnosis.

Babesiosis is transmitted by the Ixodes scapularis ticks endemic to areas in the northeastern United States.

We present the case of a 73-year-old, non-human immunodeficiency virus, male from Long Island who presented with FUO for 6 weeks.

As with malaria, there are usually few or no localizing signs in babesiosis.

During the patient's hospitalization, babesiosis was suspected on the basis of nonspecific laboratory findings, that is, relative lymphopenia, thrombocytopenia, thrombocytopenia, and an elevated lactate dehydrogenase.

When babesiosis was considered in the differential diagnosis, stained blood smears demonstrated the red blood cell inclusions of babesiosis.

In the hospital, the patient developed noncardiac pulmonary edema, which rapidly resolved which has been described as a rare complication of babesiosis.

He also had an elevated immunoglobulin-M Lyme titer indicating coinfection with Lyme disease.

Although his hemolytic anemia persisted for weeks, he only had 3% parasitemia and intact splenic function.

We believe this to be the first case of babesiosis presenting as an FUO in a normal host.

Posted by merrygirl (Member # 12041) on :

Ali thank you very much for this post. I am considered to have FUO and I find this very interesting.

Thanks for your hard work
Melissa

Posted by AliG (Member # 9734) on :

I was chasing FUOs back in 2002, before some nice ID kindly pointed out that my 20-30 symptoms were somatoform and recommended that I seek alternative therapy. [shake]

Posted by mcoLyme08 (Member # 17650) on :

I was discharged from Mayo Clinic with "Fevers of Unknown Origin" ....I am positive for Babesiosis through Stonybrook and the Igenex FISH Test. Very interesting.

Posted by AliG (Member # 9734) on :

Melissa,

Have you been tested/Txd for Babesiosis yet?

I do believe that Babesia & the "BLO" can both cause FUOs.

[confused]

Posted by merrygirl (Member # 12041) on :

Hey Ali.

I was tested months ago by quest, and I was negative.

I was treated for only 6 weeks. I am going to push for some more treatment.

My fever at the pcp office thursday was 101.1 !!

I have also done riampin, zith for Bart and BLO

Currently on my 2nd dose of Bicillin.

I may print this article out to give to my pcp and LLMD.

Thanks again.
Melissa

Posted by AliG (Member # 9734) on :

FYI-

I was positive for Babesiosis AB through Quest (they only do microti, I believe)

After Txing & taking down those titres, I had another flare.

I tested negative for B. microti & positive for B.duncani through MDL.

Perhaps you have a different strain.

....of course there's always the possibility of it being one of the many strains they can't test for yet. [Roll Eyes]

Posted by AliG (Member # 9734) on :

^

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