Volume 18, Number 8—August 2012
Dispatch
Vertical Transmission of Babesia microti, United States
Julie T. Joseph
, 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
, 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. WormserTable
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.
1Current affiliation: New York University School of Medicine, New York, New York, USA.
