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Volume 18, Number 8—August 2012

Dispatch

Vertical Transmission of Babesia microti, United States

Julie T. JosephComments to Author , Kerry Purtill, Susan J. Wong, Jose Munoz, Allen Teal, Susan Madison-Antenucci, Harold W. Horowitz1, Maria E. Aguero-Rosenfeld1, Julie M. Moore, Carlos Abramowsky, and Gary P. Wormser
Author affiliations: New York Medical College, Valhalla, New York, USA (J.T. Joseph, K. Purtill, J. Munoz, H.W. Horowitz, M.E. Aguero-Rosenfeld, G.P. Wormser); New York State Department of Health, Albany, New York, USA (S.J. Wong, A. Teal, S. Madison-Antenucci); University of Georgia, Athens, Georgia, USA (J.M. Moore); and Emory University School of Medicine, Atlanta, Georgia, USA (C. Abramowsky)

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Table

Comparison of selected clinical and laboratory data from reported cases of congenital babesiosis in 5 infants*

Clinical data Reference
(7) (8) (9) (10) This study
Year of diagnosis/ location Not given/Long Island, New York Not given/Long Island, New York Not given/New Jersey Not given/Long Island, New York 2002/Westchester County, New York
Infant age at time of symptom onset, d 30 32 19 27 41
Clinical findings Fever, irritability, pallor, hepatosplenomegaly Fever, lethargy, poor feeding, pallor, scleral icterus, hepatomegaly Fever, poor feeding, gagging, irritability, pallor, scleral icterus, hepato-splenomegaly Fever, pallor Fever, decreased oral intake, irritability, scleral icterus, pallor, hepatosplenomegaly
Initial babesia parasitemia level, % 5 4.4 15 2 4
Hospitalization, d 6 5 8 NA 5
Maternal tick bite 1 wk before delivery 7 wk before delivery 4 wk before delivery None known None known
Babesia spp. serologic and PCR results for infant 30 d after birth: IgM+/IgG+ (128/128) by IFA; 32 d after birth: IgM+/IgG+ (256/512) by IFA; PCR ND At illness onset: IgG IFA 160; IgM/IgG immunoblot +; PCR ND At illness onset: IgM+/IgG+ (40/256) by IFA; PCR ND NA Newborn screening (heel stick): IgM– (<16); total antibody + (>128) by IFA; PCR–; 6 wks after birth: IgM– (<16); total antibody + (>256) by IFA; PCR+
Babesia spp. evaluation results for mother 30 d after birth: IgM+/IgG+ (2,048/1,024); 32 d after birth: IgM+/ IgG+ (4,096/1,024); peripheral smear – at time of delivery and at 30 and 32 d after birth 7 wk before birth: IgG IFA <40; IgM/IgG immunoblot –; 2 mo after birth: IgG IFA 640; IgM/IgG immunoblot +; peripheral smear – at delivery and at infant illness onset At infant illness onset: IgM+/IgG+ (80/>1,024) by IFA; peripheral smear negative at time of infant illness onset At infant illness onset: PCR+ Birth: placenta PCR+; 6 wk after birth: IgM ND; total antibody + (>256) by
IFA; PCR–; peripheral smear –
HGB, g/dL 9.3 10.8 8.8 NA; HCT 24.3% 7.1
Platelets, x 103/μL 38 87 34 101 100
Leukocytes/PMN leukocytes, cells/μL 6,500/1,170 NA 9,000/1,890 NA 19,700/788
LDH, U/L 894 NA 2535 NA NA
Bilirubin indirect, mg/dL 3.6 9.7 5.9 NA 1.6
AST, U/L 90 NA 53 NA 66
ALT, U/L 90 NA 18 NA 50
Treatment CLI and quinine for 10 d CLI and quinine with AZT added on day 3; on day 5 changed to AZT plus quinine for additional 7 d AZT and ATO for 10 d AZT and ATO, duration not given AZT and ATO for 9 d
Follow-up Well at 6 mo posttreatment Improved at 2 wk Lost to follow-up NA 22 mo
Blood transfusion for anemia Yes, for HCT of 18% Yes, for HGB of 7.3 g/dL Yes, for HGB of 7.0 g/dL Yes, for HCT of 17.3% Yes, for HGB of 5.2 g/dL with HCT of 15.8%

*No mothers became ill. PMN, polymorphonuclear; AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase level; HCT, hematocrit; HGB, hemoglobin; IFA, indirect immunofluorescence assay. CLI, clindamycin; AZT, azithromycin; ATO, atovaquone. NA, not available; ND, not done. +, positive; –, negative.

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1Current affiliation: New York University School of Medicine, New York, New York, USA.

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