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Review of 139 Hospitalized Cases and Analysis of Prognostic Factors

Dennis J. White, PhD; John Talarico, DO; Hwa-Gan Chang, MS; Guthrie S. Birkhead, MD, MPH; Tracey Heimberger, MD; Dale L. Morse, MD, MS

Arch Intern Med. 1998;158:2149-2154.

Background  Babesiosis infections are infrequent, occur in limited geographic locations, and range from asymptomatic infection to severe illness and death.

Methods  Descriptive clinical and epidemiological information on human babesiosis cases was collated from state communicable disease reports and medical records of patients hospitalized from 1982 to 1993. Univariate and multivariate analyses were performed to determine prognostic factors associated with severe disease outcome (hospitalization ending in death, duration of hospitalization >14 days, or intensive care unit stay >2 days).

Results  Between 1982 and 1993, 139 patients were hospitalized with babesiosis in New York State. Nine patients (6.5%) died, 35 (25.2%) were admitted to the intensive care unit, and 35 (25.2%) required hospitalization for more than 14 days. Mean age at first hospitalization was 62.5 years. Sixty-two percent were male, and 91% resided in Suffolk County, Long Island. The most common symptoms were fatigue/malaise/weakness (91%), fever (91%), shaking chills (77%), and diaphoresis (69%). Past medical records showed that 52% of patients had a history of chronic disease; 12% had a history of Lyme disease; 12% had undergone a splenectomy; and 2% had undergone a blood transfusion. There was a 12- to 14-day delay between onset of symptoms and initiation of appropriate antibiotic treatment. Univariate analyses showed alkaline phosphatase levels greater than 125 U/L, white blood cell counts greater than 5x10⁹/L, history of cardiac abnormality, history of splenectomy, presence of heart murmur, and parasitemia values of 0.04 or higher to be significantly associated with disease severity. Multiple logistic regression analyses indicated that male sex, alkaline phosphatase values greater than 125 U/L, and white blood cell counts greater than 5x10⁹/L remained strong predictors of severe outcome.

Conclusions  Human babesiosis is a rare but debilitating and potentially fatal illness, especially in the elderly. Prompt disease diagnosis and treatment are essential but are often delayed, as seen in our series. This delay reinforces the need for enhanced public and physician education targeted toward residents and visitors to the few high-risk geographic areas where disease and Ixodes scapularis ticks are endemic. Patients presenting with certain prognostic indicators (male sex, alkaline phosphatase values >125 U/L, and white blood cell counts >5x10⁹/L) require comprehensive and aggressive medical care to prevent further deterioration. Since babesiosis is only 1 of 3 currently recognized diseases transmitted by I scapularis ticks, primary prevention recommendations will also reduce human exposure to Lyme disease and human granulocytic ehrlichiosis.

From the Division of Infectious Disease, Wadsworth Center, New York State Department of Health (Drs White and Morse), the Bureau of Communicable Disease Control (Drs Talarico, Birkhead, and Heimberger and Ms Chang), and the Department of Epidemiology, School of Public Health, University at Albany (Drs White, Talarico, Birkhead, and Morse), Albany, NY. Dr Heimberger is now with Abbott Laboratories, Abbott Park, Ill.

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