Babesiosis

White NJ, Breman JG. Malaria and babesiosis Diseases caused by red blood cell parasites. In Harrison s Principles of Internal Medicine. 16th ed. New York McGraw-Hill 2005 1218-1232. 

Suggested Alternatives for Differential Diagnosis Babesiosis, bacillary angiomatosis, cryptococcosis, Lyme disease, non-Hodgkin lymphoma, relapsing fever, Rocky Mountain spotted fever, tuberculosis, Ebstein-Barr virus, AIDS. 

A. Liposomal amphotericin B was approved by the US. Food and Drug Administration to treat visceral leishmaniasis. Pentavalent antimony compounds, pentamidine, amphotericin B, and aminosi-dine (paromomycin) have all been demonstrated efficacious here. The liposomal amphotericin appears to be better taken up by the reticuloendothelial system, where the parasite resides, and partitions less in the kidney, where amphotericin B traditionally manifests its toxicity. In addition to being better tolerated by patients, it has proved to be very effective in India, where resistance to antimony drugs is widespread. This patient appears to have acquired his infection there, where many infected patients develop darkening of the skin, hence the name kala-azar, or black sickness. Albendazole, an anthelmintic, has no role here. Atovaquone, a naphthoquinone, is used to treat malaria, babesiosis, and pneumocystosis. Pyrimethamine-sulfadoxine is used to treat malaria and toxoplasmosis. Proguanil inhibits the dihydrofolate reductase of malaria parasites and is used in combination with atovaquone. 

Unlabeled Uses Treatment of actinomycosis, babesiosis, erysipelas, malaria, otitis media, Pneumocystis carinii pneumonia, sinusitis, toxoplasmosis... 

It is used in the treatment of cerebral falciparum malaria and multidrug resistant strains of cerebral malaria. It is also used along with clindamycin in the treatment of babesiosis. It is also effective in myotonia congenita and nocturnal muscle cramps. 

Antibiotics also are active against other protozoans. Tetracycline and erythromycin are alternative therapies for the treatment of intestinal amebiasis. Clindamycin, in combination with other agents, is effective therapy for toxoplasmosis, pneumocystosis, and babesiosis. Spiramycin is a macrolide antibiotic that is used to treat primary toxoplasmosis acquired during pregnancy. Treatment lowers the risk of the development of congenital toxoplasmosis. 

Theileriosis is a tick-borne disease of cattle and sheep. The parasites are intracorpuscular but, unlike in babesiosis, the blood cells are not destroyed. The major symptoms are those of toxaemia and once the parasite has invaded the blood, there is high, rapid mortality. 

B-81MU0808 K. L. Kuttler in Babesiosis, Proc. Int. Conf. Malar. Babesiosis , ed. M. Ristic... 

Wormser GP, Dattwyler RJ. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplas-mosis, and babesiosis clinical practice guidelines by the Infectious Diseases Society of America. Chn Infect Dis 2006 43 1089-1134. 

Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, Telford SR 3rd, Brassard P, Pearl D, Azlanzadeh J, Christianson D, McGrath D, Spielman A. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 2000 343(20) 1454-8. 

Human babesiosis has been traditionally treated with quinine plus clindamycin, a combination that has been compared with atovaquone plus azithromycin in a randomized, multicenter, unblinded study (7). The treatments... 

In a prospective, open, randomized trial clindamycin (600 mg tds) and quinine (650 mg tds) were compared with atovaquone (750 mg bd) plus azithromycin (500 mg on day 1 followed by 250 mg/day) in 58 patients with non-life-threatening babesiosis (3). Bacterial response was complete 3 months after the end of treatment. Adverse effects were reported by 72% of those who received clindamycin and quinine compared with 15% of those who received atovaquone and azithromycin. The most common adverse effects with clindamycin and quinine were tinnitus (39%), diarrhea (33%), and impaired hearing (28%) the symptoms had resolved in 73% of the patients assigned to clindamycin/quinine 3 months after the start of therapy and in 100% after 6 months. 

Tick-borne Lyme disease is a serious threat to humans in many parts of the USA. In the Northeastern states, other tick-borne diseases including babesiosis and human granulocytic ehrlichiosis fHGE have been repotted regularly, with over 100 cases in 1995. In addition, ticks are the vectors of Rocky Mountain Fever. 

Ioxides also transmits Babesia microtic (babesiosis) and Anaplasma phagocytophilium (ehrlichiosis) which can cause coinfection with Lyme disease... 

Ristic, M., Ambroise-Thomas, P. and Kreier, J., (eds). Malaria and Babesiosis, Martinus Nijhoff, Dordrecht (1984). 

Torres-Velez FJ, Nace EK, Won KY, et al. Development of an immunohistochemical assay for the detection of babesiosis in formalin-fixed, paraffin-embedded tissue samples. Am J Clin Pathol. 2003 120 833-838. 

The taxon Apicomplexa includes members of a number of significant human parasites, including Babesiosis (Babesia), Toxoplasmosis (Toxoplasma) and Malaria (Plasmodium). Whilst each parasite is an important vector for human disease, we will focus on Plasmodium, and particularly P. falciparum in this review. 

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