Falagas M E, Klempner M S
Department of Medicine, New England Medical Center, Boston, Massachusetts 02111, USA.
Clin Infect Dis. 1996 May;22(5):809-12. doi: 10.1093/clinids/22.5.809.
Babesiosis is a malaria-like, tick-transmitted zoonosis caused by protozoa of the family Piroplasmorida, which includes Babesia and Theileria species. In the United States, the infection is endemic in the Northeast and upper Midwest, although cases have recently been described in Northern California and Washington State. We report a case of babesiosis in a patient infected with HIV who presented with a prolonged fever of unknown origin; the patient had not undergone splenectomy. Parasitemia persisted despite initial clinical improvement after treatment with quinine and clindamycin. Babesiosis was controlled with a maintenance regimen consisting of clindamycin, doxycycline, and high-dose azithromycin, but the infection was not eradicated. Babesiosis should be considered in the differential diagnosis of HIV-infected patients with fevers and/or anemia in areas where the infection is endemic. HIV-infected patients who are severely immunosuppressed, even those without a history of splenectomy, may present with severe manifestations of babesiosis and develop a chronic infection, which may require therapy to prevent relapse of disease.
巴贝斯虫病是一种类似疟疾、由蜱传播的人畜共患病，由梨浆虫科的原生动物引起，该科包括巴贝斯虫属和泰勒虫属。在美国，这种感染在东北部和中西部上游地区呈地方性流行，尽管最近在北加利福尼亚州和华盛顿州也有病例报道。我们报告了一例感染HIV的患者发生巴贝斯虫病，该患者出现不明原因的长期发热；患者未接受过脾切除术。尽管在用奎宁和克林霉素治疗后最初临床症状有所改善，但寄生虫血症仍持续存在。通过由克林霉素、强力霉素和高剂量阿奇霉素组成的维持治疗方案控制了巴贝斯虫病，但感染未被根除。在该感染呈地方性流行的地区，对于发热和/或贫血的HIV感染患者进行鉴别诊断时应考虑巴贝斯虫病。严重免疫抑制的HIV感染患者，即使没有脾切除术史，也可能出现巴贝斯虫病的严重表现并发展为慢性感染，这可能需要进行治疗以防止疾病复发。
