免疫功能低下和非免疫功能低下宿主中 babesiosis 的比较结果：一项多中心队列研究。

Comparative Outcomes of Babesiosis in Immunocompromised and Non-Immunocompromised Hosts: A Multicenter Cohort Study.

作者信息

Kakoullis Loukas, Alonso Carolyn D, Burns Rebecca, Aleissa Muneerah M, Haddad Esther Arbona, Kim Andy J, Rooks Rebecca, Yates Bridget, Kanwal Urwah, Morreale Nicholas P, Morgan Alexandra, Arnaout Ramy, Tong Alexandra, Izaguirre Natalie E, Little Jessica S, Hammond Sarah P, Montgomery Mary W, Sherman Amy C, Maguire James H, Woolley Ann E, Baden Lindsey R, Issa Nicolas C, Harris Courtney E

机构信息

Mount Auburn Hospital, Cambridge, MA.

Harvard Medical School, Boston, MA.

出版信息

Clin Infect Dis. 2025 Jan 28. doi: 10.1093/cid/ciaf034.

DOI:10.1093/cid/ciaf034

PMID:39873391

Abstract

BACKGROUND

Babesiosis poses significant risks of adverse outcomes in individuals with immunocompromising conditions (IC) and asplenia/hyposplenia (AH). This study compares clinical outcomes between these vulnerable groups and immunocompetent patients.

METHODS

A multicenter retrospective cohort study included adult patients with laboratory-confirmed babesiosis from 2009 to 2023. Complications, management, and outcomes were compared between patients with IC/AH (ICAH) and without ICAH (immune intact cohort).

RESULTS

Of 225 patients (mean age 66 years, 36% female), 112 were ICAH. ICAH patients had higher median peak parasitemia (2.8% vs. 0.9%, p<0.0001) and higher rates of complications, including acute kidney injury (24% vs. 11%, p=0.016), acute respiratory distress syndrome (11% vs. 4%, p=0.041), and were more likely to undergo packed red blood cell transfusion (31% vs. 17%, p=0.023) and exchange transfusion (18% vs. 6%, p=0.008). Treatment duration was longer in the ICAH cohort (median 27 vs. 10 days, p<0.001), particularly in those with both IC and AH (median 43 days, p=0.003). ICAH patients had higher 12-month all-cause mortality (7% vs. 1%, p=0.019) and recurrence rates (8% vs. 0%, p=0.001). Hematologic malignancy (OR=7.0, p=0.023) and B-cell-depleting therapies (OR=9.4, p=0.015) were significant predictors of recurrence. Despite most patients undergoing follow-up testing with blood smears and PCR, these did not reliably predict recurrence.

CONCLUSION

Patients with ICAH with babesiosis experience more severe disease and higher complication rates. Follow-up testing, including blood smear and PCR, did not reliably predict recurrence, highlighting the need for more effective monitoring strategies in these high-risk populations.

摘要

背景

巴贝斯虫病对免疫功能低下（IC）和无脾/脾功能低下（AH）的个体具有显著的不良后果风险。本研究比较了这些弱势群体与免疫功能正常患者的临床结局。

方法

一项多中心回顾性队列研究纳入了2009年至2023年实验室确诊为巴贝斯虫病的成年患者。比较了IC/AH患者（ICAH）和无IC/AH患者（免疫功能正常队列）的并发症、治疗和结局。

结果

在225例患者（平均年龄66岁，36%为女性）中，112例为ICAH。ICAH患者的中位最高寄生虫血症水平更高（2.8%对0.9%，p<0.0001），并发症发生率更高，包括急性肾损伤（24%对11%，p=0.016）、急性呼吸窘迫综合征（11%对4%，p=0.041），并且更有可能接受浓缩红细胞输血（31%对17%，p=0.023）和换血治疗（18%对6%，p=0.008）。ICAH队列的治疗持续时间更长（中位27天对10天，p<0.001），特别是在同时患有IC和AH的患者中（中位43天，p=0.003）。ICAH患者的12个月全因死亡率更高（7%对1%，p=0.019），复发率更高（8%对0%，p=0.001）。血液系统恶性肿瘤（OR=7.0，p=0.023）和B细胞清除疗法（OR=9.4，p=0.015）是复发的显著预测因素。尽管大多数患者接受了血液涂片和PCR的随访检测，但这些检测并不能可靠地预测复发。