Akel Tamer, Mobarakai Neville
Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
Department of Infectious Diseases, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
Ann Clin Microbiol Antimicrob. 2017 Feb 15;16(1):6. doi: 10.1186/s12941-017-0179-z.
Babesiosis, a zoonotic parasitic infection transmitted by the Ixodes tick, has become an emerging health problem in humans that is attracting attention worldwide. Most cases of human babesiosis are reported in the United States and Europe. The disease is caused by the protozoa of the genus Babesia, which invade human erythrocytes and lyse them causing a febrile hemolytic anemia. The infection is usually asymptomatic or self-limited in the immunocompetent host, or follows a persistent, relapsing, and/or life threatening course with multi-organ failure, mainly in the splenectomized or immunosuppressed patients. Hematologic manifestations of the disease are common. They can range from mild anemia, to severe pancytopenia, splenic rupture, disseminated intravascular coagulopathy (DIC), or even hemophagocytic lymphohistiocytosis (HLH).
A 70 year old immunocompetent female patient living in New York City presented with a persistent fever, night sweats, and fatigue of 5 days duration. Full evaluation showed a febrile hemolytic anemia along with neutropenia and thrombocytopenia. Blood smear revealed intraerythrocytic Babesia, which was confirmed by PCR. Bone marrow biopsy was remarkable for dyserythropoiesis, suggesting possible HLH, supported by other blood workup meeting HLH-2004 trial criteria.
Human babesiosis is an increasing healthcare problem in the United States that is being diagnosed more often nowadays. We presented a case of HLH triggered by Babesia microti that was treated successfully. Also, we presented the hematologic manifestations of this disease along with their pathophysiologies.
巴贝斯虫病是一种由硬蜱传播的人畜共患寄生虫感染病，已成为一个在全球范围内受到关注的新兴人类健康问题。大多数人类巴贝斯虫病病例在美国和欧洲被报道。该疾病由巴贝斯虫属的原生动物引起，它们侵入人类红细胞并使其裂解，导致发热性溶血性贫血。在免疫功能正常的宿主中，感染通常无症状或为自限性，而在脾切除或免疫抑制患者中，感染通常会呈现持续、复发和/或危及生命的病程，并伴有多器官功能衰竭。该疾病的血液学表现很常见，范围从轻度贫血到严重全血细胞减少、脾破裂、弥散性血管内凝血（DIC），甚至噬血细胞性淋巴组织细胞增生症（HLH）。
一名居住在纽约市的70岁免疫功能正常女性患者，持续发热、盗汗及疲劳5天。全面评估显示发热性溶血性贫血伴中性粒细胞减少和血小板减少。血涂片显示红细胞内有巴贝斯虫，经聚合酶链反应（PCR）确诊。骨髓活检显示有红细胞生成异常，提示可能为HLH，其他血液检查符合HLH - 2004试验标准，支持这一诊断。
人类巴贝斯虫病在美国正成为一个日益严重的医疗问题，如今其诊断频率越来越高。我们报告了一例由微小巴贝斯虫引发的HLH病例，该病例得到了成功治疗。此外，我们还介绍了该疾病的血液学表现及其病理生理学。
