Krause Peter J, Gewurz Benjamin E, Hill David, Marty Francisco M, Vannier Edouard, Foppa Ivo M, Furman Richard R, Neuhaus Ellen, Skowron Gail, Gupta Shaili, McCalla Carlo, Pesanti Edward L, Young Mary, Heiman Donald, Hsue Gunther, Gelfand Jeffrey A, Wormser Gary P, Dickason John, Bia Frank J, Hartman Barry, Telford Sam R, Christianson Diane, Dardick Kenneth, Coleman Morton, Girotto Jennifer E, Spielman Andrew
Division of Infectious Diseases, Connecticut Children's Medical Center, and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut 06106, USA.
Clin Infect Dis. 2008 Feb 1;46(3):370-6. doi: 10.1086/525852.
Human babesiosis is a tickborne malaria-like illness that generally resolves without complication after administration of atovaquone and azithromycin or clindamycin and quinine. Although patients experiencing babesiosis that is unresponsive to standard antimicrobial therapy have been described, the pathogenesis, clinical course, and optimal treatment regimen of such cases remain uncertain.
We compared the immunologic status, clinical course, and treatment of 14 case patients who experienced morbidity or death after persistence of Babesia microti infection, despite repeated courses of antibabesial treatment, with those of 46 control subjects whose infection resolved after a single course of standard therapy. This retrospective case-control study was performed in southern New England, New York, and Wisconsin.
All case patients were immunosuppressed at the time of acute babesiosis, compared with <10% of the control subjects. Most case patients experienced B cell lymphoma and were asplenic or had received rituximab before babesial illness. The case patients were more likely than control subjects to experience complications, and 3 died. Resolution of persistent infection occurred in 11 patients after 2-10 courses of therapy, including administration of a final antimicrobial regimen for at least 2 weeks after babesia were no longer seen on blood smear.
Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.
人类巴贝斯虫病是一种由蜱传播的类似疟疾的疾病，通常在给予阿托伐醌和阿奇霉素或克林霉素和奎宁后可无并发症地痊愈。虽然已有对标准抗菌治疗无反应的巴贝斯虫病患者的描述，但此类病例的发病机制、临床病程和最佳治疗方案仍不明确。
我们比较了14例尽管反复接受抗巴贝斯虫治疗但微小巴贝斯虫感染仍持续存在并出现发病或死亡的病例患者与46例接受单疗程标准治疗后感染得到解决的对照患者的免疫状态、临床病程和治疗情况。这项回顾性病例对照研究在新英格兰南部、纽约和威斯康星州进行。
与不到10%的对照患者相比，所有病例患者在急性巴贝斯虫病发作时均存在免疫抑制。大多数病例患者患有B细胞淋巴瘤，无脾或在患巴贝斯虫病前接受过利妥昔单抗治疗。病例患者比对照患者更易出现并发症，3例死亡。11例患者在接受2 - 10个疗程的治疗后持续感染得到解决，包括在血涂片上不再看到巴贝斯虫后给予至少2周的最终抗菌治疗方案。
感染微小巴贝斯虫的免疫功能低下者有持续复发疾病的风险。此类患者通常需要接受抗巴贝斯虫治疗≥6周以实现治愈，包括在血涂片上不再检测到寄生虫后2周。
