Management strategies for human babesiosis

ABSTRACT

Introduction

Human babesiosis is reported throughout the world and is endemic in the northeastern and northern Midwestern United States and northeastern China. Transmission is primarily through hard bodied ticks. Most cases of severe disease occur in immunocompromised individuals and may result in prolonged relapsing disease or death.

Areas covered

We provide a summary of evidence supporting current treatment recommendations for immunocompetent and immunocompromised individuals experiencing babesiosis.

Expert opinion

Most cases of human babesiosis are successfully treated with atovaquone and azithromycin or clindamycin and quinine. Severe disease may require prolonged treatment.

KEYWORDS:

• Babesia
• human babesiosis
• zoonosis
• hemolysis
• blood transfusion
• immunocompromised
• drug therapy
• ticks
• asplenia
• disease management

Article highlights

• Multiple species of Babesia infect humans but Babesia microti is far more prevalent than other Babesia species.

• Atovaquone and azithromycin or clindamycin and quinine are the antimicrobial agents of choice for treating human babesiosis.

• Atovaquone and azithromycin are as effective as clindamycin and quinine with fewer side effects and are indicated for initial treatment of B. microti infections.

• Clindamycin and quinine usually have been used for non-B. microti infections.

• Immunocompromised hosts often require higher dosage of antimicrobials for longer duration.

• Despite the absence of clinical trials, exchange transfusion may be used in severe infections.

Declaration of interest

The authors have no 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper is funded by the Gordon and Llura Gund Foundation.