White D J, Talarico J, Chang H G, Birkhead G S, Heimberger T, Morse D L
Division of Infectious Disease, Wadsworth Center, New York State Department of Health, Albany 12201-0509, USA.
Arch Intern Med. 1998 Oct 26;158(19):2149-54. doi: 10.1001/archinte.158.19.2149.
Babesiosis infections are infrequent, occur in limited geographic locations, and range from asymptomatic infection to severe illness and death.
Descriptive clinical and epidemiological information on human babesiosis cases was collated from state communicable disease reports and medical records of patients hospitalized from 1982 to 1993. Univariate and multivariate analyses were performed to determine prognostic factors associated with severe disease outcome (hospitalization ending in death, duration of hospitalization > 14 days, or intensive care unit stay > 2 days).
Between 1982 and 1993, 139 patients were hospitalized with babesiosis in New York State. Nine patients (6.5%) died, 35 (25.2%) were admitted to the intensive care unit, and 35 (25.2%) required hospitalization for more than 14 days. Mean age at first hospitalization was 62.5 years. Sixty-two percent were male, and 91% resided in Suffolk County, Long Island. The most common symptoms were fatigue/malaise/weakness (91%), fever (91%), shaking chills (77%), and diaphoresis (69%). Past medical records showed that 52% of patients had a history of chronic disease; 12% had a history of Lyme disease; 12% had undergone a splenectomy; and 2% had undergone a blood transfusion. There was a 12- to 14-day delay between onset of symptoms and initiation of appropriate antibiotic treatment. Univariate analyses showed alkaline phosphatase levels greater than 125 U/L, white blood cell counts greater than 5 x 10(9)/L, history of cardiac abnormality, history of splenectomy, presence of heart murmur, and parasitemia values of 0.04 or higher to be significantly associated with disease severity. Multiple logistic regression analyses indicated that male sex, alkaline phosphatase values greater than 125 U/L, and white blood cell counts greater than 5 x 10(9)/L remained strong predictors of severe outcome.
Human babesiosis is a rare but debilitating and potentially fatal illness, especially in the elderly. Prompt disease diagnosis and treatment are essential but are often delayed, as seen in our series. This delay reinforces the need for enhanced public and physician education targeted toward residents and visitors to the few high-risk geographic areas where disease and Ixodes scapularis ticks are endemic. Patients presenting with certain prognostic indicators (male sex, alkaline phosphatase values > 125 U/L, and white blood cell counts >5 x 10(9)/L) require comprehensive and aggressive medical care to prevent further deterioration. Since babesiosis is only 1 of 3 currently recognized diseases transmitted by I scapularis ticks, primary prevention recommendations will also reduce human exposure to Lyme disease and human granulocytic ehrlichiosis.
巴贝斯虫感染并不常见，发生在有限的地理位置，范围从无症状感染到严重疾病甚至死亡。
从1982年至1993年的州传染病报告和住院患者的病历中整理出关于人类巴贝斯虫病病例的描述性临床和流行病学信息。进行单变量和多变量分析以确定与严重疾病结局（住院以死亡告终、住院时间>14天或重症监护病房停留>2天）相关的预后因素。
1982年至1993年期间，纽约州有139例患者因巴贝斯虫病住院。9例（6.5%）死亡，35例（25.2%）入住重症监护病房，35例（25.2%）需要住院超过14天。首次住院时的平均年龄为62.5岁。62%为男性，91%居住在长岛的萨福克县。最常见的症状是疲劳/不适/虚弱（91%）、发热（91%）、寒战（77%）和出汗（69%）。既往病历显示，52%的患者有慢性病病史；12%有莱姆病病史；12%接受过脾切除术；2%接受过输血。症状出现与开始适当抗生素治疗之间有12至14天的延迟。单变量分析显示，碱性磷酸酶水平大于125 U/L、白细胞计数大于5×10⁹/L、心脏异常病史、脾切除术病史、心脏杂音的存在以及寄生虫血症值为0.04或更高与疾病严重程度显著相关。多因素逻辑回归分析表明，男性、碱性磷酸酶值大于125 U/L以及白细胞计数大于5×10⁹/L仍然是严重结局的有力预测因素。
人类巴贝斯虫病是一种罕见但使人衰弱且可能致命的疾病，尤其是在老年人中。及时的疾病诊断和治疗至关重要，但正如我们系列研究中所见，往往会延迟。这种延迟强化了对少数疾病和肩突硬蜱流行的高风险地理区域的居民和访客加强公众和医生教育的必要性。出现某些预后指标（男性、碱性磷酸酶值>125 U/L和白细胞计数>5×10⁹/L）的患者需要全面且积极的医疗护理以防止病情进一步恶化。由于巴贝斯虫病只是目前已知由肩突硬蜱传播的三种疾病之一，一级预防建议也将减少人类接触莱姆病和人类粒细胞埃立克体病的机会。
