Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases

ABSTRACT

Objectives: The characteristics of patients with Acute Respiratory Distress Syndrome (ARDS) as a complication of Babesia microti infection have not been systematically described.

Methods: Adult patients admitted to the medical intensive care unit (MICU) of a tertiary care hospital in the Lower Hudson Valley of New York from 1/1/2008 to 8/1/2016 were evaluated for ARDS complicating babesiosis.

Results: Of 22 patients with babesiosis in the MICU, eight (36.4%; 95% CI: 19.7–57.0%) had ARDS. Six patients (75%) developed ARDS following initiation of anti-babesia drug therapy; however, the mean duration of symptoms in these patients exceeded that of patients who developed ARDS prior to initiation of treatment (7.50 ± 3.83d vs. 4.50 ± 0.71d, p = 0.34). Three patients (37.5%; 95% CI: 13.7–69.4%) expired without recovery from ARDS. In comparison, the mortality rate for the 14 MICU babesiosis patients without ARDS was 14.3% (p = 0.31). There was a trend toward younger age in survivors relative to non-survivors (mean age 54.6 ± 13.8y vs. 74.0 ± 6.24y, p = 0.07). Three of the five survivors did not require mechanical ventilation. The mean sequential organ failure assessment score of non-survivors was significantly higher than that of survivors (12.3 ± 1.15 vs. 6.0 ± 1.4, p = 0.0006).

Conclusion: Among 22 critically ill adult patients with B. microti infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy.

KEYWORDS:

• Babesiosis
• tick-borne infection
• acute respiratory distress syndrome
• ARDS

Acknowledgments

The authors thank Dr. Paul Visintainer for assistance.

Disclosure of interest

Dr. Wormser reports receiving research grants from Immunetics, Inc., Institute for Systems Biology, Rarecyte, Inc., and Quidel Corporation. He owns equity in Abbott/AbbVie, has been an expert witness in malpractice cases involving babesiosis and Lyme disease, and is an unpaid board member of the American Lyme Disease Foundation. The other authors have no relevant disclosures. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships to disclose.

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Additional information

Funding

This manuscript was not funded.

Notes on contributors

Silvia Alvarez De Leon

Dr. Silvia Alvarez De Leon, M.D., is a clinical fellow in the division of Pulmonary, Critical Care and Sleep Medicine at Westchester Medical Center.

Priyasha Srivastava

Dr. Priyasha Srivastava, M.D., is a clinical fellow in the division of Pulmonary, Critical Care and Sleep Medicine at Westchester Medical Center.

Alberto E. Revelo

Dr. Alberto E. Revelo, M.D., is a clinical fellow in the division of Pulmonary, Critical Care and Sleep Medicine at Westchester Medical Center.

Aparna Kadambi

Dr. Aparna Kadambi, M.D., is a clinical fellow in the division of Pulmonary, Critical Care and Sleep Medicine at Westchester Medical Center.

Marc Y. El Khoury

Dr. Marc Y. El Khoury, M.D., is Associate Fellowship Program Director for the Infectious Disease Fellowship at Westchester Medical Center/New York Medical College. He is an Associate Professor of Medicine at New York Medical College.  His research interests include Powassan meningoencephalitis (deer tick virus) as well as babesiosis.

Gary P. Wormser

Dr. Gary P. Wormser, M.D., is the chief of the division of Infectious Diseases at New York Medical College. He is Professor of Medicine and a world-renowned authority on Lyme disease and other tick-borne infections.

Oleg Epelbaum

Dr. Oleg Epelbaum, M.D., is Associate Fellowship Program Director for the Pulmonary and Critical Care Medicine Fellowship at Westchester Medical Center. He is a Clinical Associate Professor of Medicine at New York Medical College.  His research interests include the Acute Respiratory Distress Syndrome and pulmonary infections.