 babesiosis are very similar to Plasmodium infection. Thus malaria is often evoked even in travelers who have never visited a malarious area because of the rare “airport malaria” . This case underline that the diagnosis of babesiosis should be considered in patients who traveled in endemic areas, especially North America, for the most common agent Babesia microti. Babesia microti infection cannot be ruled out in patients with intact spleen in contrary to the European Babesia species (Babesia divergens and Babesia venatorum). Moreover in some rare cases spontaneous splenic rupture secondary to babesia microti infection have been reported . Babesiosis has been reported to be associated to reactive hemophagocytosis in few cases [7, 8] however regenerative hemolytic anemia is the most usual presentation . In the present case the unusual severe neutropenia and non-regenerative anemia led to the bone marrow aspiration analysis. Typical hemophagocytosis was seen however without evidence of phagocytosis of babesia infected red blood cells.
Diagnosis of babesia is usually strongly evoked by the blood smear analysis and can be confirmed by specific PCR, allowing to identify Babesia species and to exclude plasmodium infection. Despite some similarities with plasmodium, babesiosis does not respond to chloroquine. The use of clindamycin with quinine have been shown to be effective as the combination of atovaquone and azithromycin [2, 9]. Because Borrelia burgdorferi, the agent of Lyme disease, is transmitted by the same tick and is endemic in North America it should systematically be screened by serology in these patients.
The diagnosis of babesiosis should be considered in patients who traveled in endemic areas especially North America for the most common agent Babesia microti. Blood analyses usually show regenerative hemolytic anemia, thrombocytopenia, and elevated liver enzymes. In case of pancytopenia associated with non-regenerative anemia reactive hemophagocytosis should be evoked. Diagnosis of babesiosis can be made on blood smear analysis but needs usually more specific tests, as PCR, to be confirmed.
The patient has given his consent for the publication of this case report.
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- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/13/99/prepub
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