Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 18, Number 8—August 2012

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)

Main Article


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.

Main Article

  1. Vannier  E, Gewurz  BE, Krause  PJ. Human babesiosis. Infect Dis Clin North Am. 2008;22:46988. DOIPubMedGoogle Scholar
  2. de Vos  AJ, Imes  GD, Cullen  JSC. Cerebral babesiosis in a new-born calf. Onderstepoort J Vet Res. 1976;43:758.PubMedGoogle Scholar
  3. Fukumoto  S, Suzuki  H, Igarashi  I, Xuan  X. Fatal experimental transplacental Babesia gibsoni infections in dogs. Int J Parasitol. 2005;35:10315. DOIPubMedGoogle Scholar
  4. Chisholm  ES, Ruebush  TK II, Sulzer  AJ, Healy  GR. Babesia microti infection in man: evaluation of an indirect immunofluorescent antibody test. Am J Trop Med Hyg. 1978;27:149.PubMedGoogle Scholar
  5. Persing  DH, Mathiesen  D, Marshall  WF, Telford  SR, Spielman  A, Thomfod  JW, Detection of Babesia microti by polymerase chain reaction. J Clin Microbiol. 1992;30:2097103.PubMedGoogle Scholar
  6. Teal  AE, Habura  A, Ennis  J, Keithly  J, Madison-Antenucci  S. A new real-time PCR assay for improved detection of the parasite Babesia microti. J Clin Microbiol. 2012;50:9038. DOIPubMedGoogle Scholar
  7. Esernio-Jenssen  D, Scimeca  PG, Benach  JL, Tenenbaum  MJ. Transplacental/perinatal babesiosis. J Pediatr. 1987;110:5702. DOIPubMedGoogle Scholar
  8. New  DL, Quinn  J, Qureshi  MZ, Sigler  S. Vertically transmitted babesiosis. J Pediatr. 1997;131:1634. DOIPubMedGoogle Scholar
  9. Sethi  S, Alcid  D, Kesarwala  H, Tolan  RW Jr. Probable congenital babesiosis in infant, New Jersey, USA. Emerg Infect Dis. 2009;15:78891. DOIPubMedGoogle Scholar
  10. Aderinboye  O, Syed  S. Congenital babesiosis in a four-week old female infant. Pediatr Infect Dis J. 2010;29:188. DOIPubMedGoogle Scholar
  11. Vottier  G, Arsac  M, Farnoux  C, Mariani-Kurddjian  P, Baud  O, Aujard  Y. Congenital malaria in neonates: two case reports and review of the literature. Acta Paediatr. 2008;97:5058. DOIPubMedGoogle Scholar
  12. Malhotra  I, Mungai  P, Muchiri  E, Kwiek  JJ, Meshnick  SR, King  CL. Umbilical cord-blood infections with Plasmodium falciparum malaria are acquired antenatally in Kenya. J Infect Dis. 2006;194:17683. DOIPubMedGoogle Scholar
  13. Lesko  CR, Arguin  PM, Newman  RD. Congenital malaria in the United States. A review of cases from 1966 to 2005. Arch Pediatr Adolesc Med. 2007;161:10627. DOIPubMedGoogle Scholar
  14. Hagmann  S, Khanna  K, Niazi  M, Purswani  M, Robins  EB. Congenital malaria, an important differential diagnosis to consider when evaluating febrile infants of immigrant mothers. Pediatr Emerg Care. 2007;23:3269. DOIPubMedGoogle Scholar
  15. Joseph  JT, Roy  SS, Shams  N, Visintainer  P, Nadelman  RB, Hosur  S, Babesiosis in Lower Hudson Valley, New York, USA. Emerg Infect Dis. 2011;17:8437.PubMedGoogle Scholar

Main Article

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

Page created: July 23, 2012
Page updated: July 23, 2012
Page reviewed: July 23, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.