Volume 10, Number 4—April 2004
Research
Babesia divergens–like Infection, Washington State
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.