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Volume 10, Number 4—April 2004

Research

Babesia divergens–like Infection, Washington State

Barbara L. Herwaldt*, Guy de Bruyn†, Norman J. Pieniazek*, Mary Homer‡, Kathryn H. Lofy*§, Susan B. Slemenda*, Thomas R. Fritsche†, David H. Persing‡, and Ajit P. Limaye†Comments to Author 
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †University of Washington, Seattle, Washington, USA; ‡Corixa Corporation, Seattle, Washington, USA; §Washington State Department of Health, Olympia, Washington, USA

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Table 1

Clinical data on selected dates for a patient in Washington State infected with a Babesia divergens-like parasite, 2002a

Date Temperature (°C) Hematocrit (%)b Leukocyte count (109/L) Platelet count (109/L) Parasitemia level (%)c Creatinine level (mg/dL)d Total/direct bilirubin levels (mg/dL) Lactate dehydrogenase level (U/L) Comments
July 30
38.5
43
19.6
34
25.5 c
8.5
10.2
4,283
Admitted to a community hospital
July 31e

40
21.2f
21
41.4 c
10.3
8.2/2.9

Babesiosis diagnosed; antibabesial therapy started (see text)g
July 31h
39.9
36
18.5
25
28.2
11.1i
9.9/3.1
6,674
6 U platelets transfused
August 1
37.7
27
21.6
57
24.7
6.4
6.7/2.3
2,898
Began hemodialysis; 2 U packed erythrocytes transfused
August 2
36.9
32
22.1
67
17.9
4.2
3.3/2.1
5,802

August 3
37.5
29
17.2
96
13.6
7.3

2,423

August 4
36.9
27
10.4
110

6.4
1.3/0.7


August 5
37.6
26
9.9
135
11.9
9.0



August 6
37.5
24
9.5
149
13.2
11.0


2 U packed erythrocytes transfused
August 7
37.5
30
9.9
149

8.8



August 8
37.9
30
9.2
204
7.7
11.2



August 9
36.7
28
9.2
161j

8.2


Discharged home










September 13

28
7.3
179

2.8



November 1 39 6.0 1.7

aNormal ranges for laboratory values at community hospital (July 30–31): creatinine, 0.7–1.5 mg/dL; total bilirubin, 0.1–1.0 mg/dL; lactate dehydrogenase, 100–200 U/L. Normal ranges at University of Washington Medical Center (July 31–Aug. 9): creatinine, 0.3–1.2 mg/dL; total bilirubin, 0.1–1.0 mg/dL; direct bilirubin, 0.0–0.3 mg/dL; lactate dehydrogenase, 0–190 U/L.
bHematocrit normalized to values of 42% (Feb. 3, 2003) and 45% (June 27, 2003).
cAll parasitemia levels were determined by the same person at the Centers for Disease Control and Prevention. Level for July 30 was determined from a peripheral smear made the next day (i.e., blood not fresh). The other pretreatment parasitemia level (i.e., from July 31 at community hospital) was determined from a smear made from fresh blood.
dBaseline and posthospitalization creatinine values include: 1.6 mg/dL (Sept. 2001), 1.7 mg/dL (Feb. 3, 2003), and 1.6 mg/dL (June 27, 2003).
eData obtained at community hospital.
fLeukocyte differential: 74% segmented neutrophils, 9% lymphocytes, 8% atypical lymphocytes (including immunoblasts and plasmacytoid forms), 7% monocytes, 1% eosinophils, and 1% metamyelocytes.
gOn Aug. 1, dosage regimen changed from clindamycin (1.2 g twice daily, by IV infusion) and quinine sulfate (650 mg thrice daily, by mouth), to clindamycin (600 mg four times daily, by IV infusion) and quinine (650 mg daily, by mouth). After patient was discharged from hospital on Aug. 9, therapy continued through Aug. 26; regimen: clindamycin (600 mg four times daily, by mouth) and quinine (650 mg daily, by mouth). Patient also treated with erythropoietin until Nov. 2002.
hData obtained at University of Washington Medical Center.
iDipstick analysis of urine specimen showed 3+ protein, 3+ blood, 3+ bilirubin, and 1+ ketones; and was positive for nitrites and leukocyte esterase. Microscopic examination showed granular casts and 1+ leukocytes. Culture demonstrated >105 colonies of Escherichia coli per milliliter of urine. The urinary tract infection was treated with ceftriaxone.
jValue could be inaccurate; platelets clumped on blood smear.

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