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Volume 22, Number 11—November 2016
CME ACTIVITY - Synopsis

Transmission of Babesia microti Parasites by Solid Organ Transplantation

Meghan B. BrennanComments to Author , Barbara L. Herwaldt, James J. Kazmierczak, John W. Weiss, Christina L. Klein, Catherine P. Leith, Rong He, Matthew J. Oberley, Laura Tonnetti, Patricia P. Wilkins, and Gregory M. Gauthier
Author affiliations: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA (M.B. Brennan, J.W. Weiss, C.L. Klein, C.P. Leith, R. He, M.J. Oberley, G.M. Gauthier); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.L. Herwaldt, P.P. Wilkins); Wisconsin Division of Public Health, Madison (J.J. Kazmierczak); American Red Cross Badger–Hawkeye Blood Service Region, Madison (J.W. Weiss); American Red Cross Jerome H. Holland Laboratories for the Biomedical Sciences, Rockville, Maryland, USA (L. Tonnetti)

Main Article

Table

Characteristics of 2 patients who received renal allografts from the same organ donor and became infected with Babesia microti parasites, 2008*

Characteristic
 Patient A (index case-patient)
 Patient B
Type of kidney transplant Left Right
Age, y/sex 65/M 41/M
Residence†
 Southcentral Wisconsin (urban, nonwooded area of Sauk County)
 Iowa (semirural area bordering southwestern Wisconsin)
Cause of end-stage nephropathy Type 2 diabetes mellitus Type 1 diabetes mellitus
Pretransplant dialysis Peritoneal dialysis in Wisconsin Hemodialysis in Iowa
Other medical history
 Diabetic retinopathy; coronary artery disease
 Diabetic retinopathy (legally blind); hypertension
Duration of hospitalization for renal transplantation, d‡ 6 (late Aug–early Sep) 10 (late Aug–early Sep; patient had moderate delay in graft function)
Clinical manifestations potentially attributable to babesiosis
 Fever (39.4°C), sweats, fatigue, anorexia, dark urine
 Fever (38°C), fatigue, abdominal pain
Babesia blood-smear examination
Date of first positive blood smear Oct 20 Oct 23
Initial parasitemia level, % 8 1
Context for diagnosis Platelet clumping prompted manual (nonautomated) review of blood smear Diagnosis of case in patient A prompted evaluation of patient B during a routine clinic visit
Date of last positive blood smear
 Oct 24
 Oct 23
Date of last B. microti PCR-positive blood specimen§
 Nov 7
 Nov 21
B. microti IFA titer (date)
Pretransplant serum sample <8 (Jul 30) <8 (Aug 11)
Posttransplant serum sample
 4,096 (Oct 21)
 1,024 (Oct 23)
Laboratory values when babesiosis was diagnosed (2, 6, and 16 wks after initiation of therapy)¶
Hematocrit, %# 21 (21, 45, 49) 35 (41, 37, 44)
Reticulocyte, % 11.7 4.3
Leukocyte count, x 109/L** 6.7 5.5
Platelet count, x 109/L 157 154
Haptoglobin, mg/dL <8 (24, 67, 104) ND (154, 223, 202)
Lactate dehydrogenase, U/L 747 (490, 220, ND) 495 (365, 344, 331)
Creatinine, mg/dL
 1.1
 1.3
Dates of hospitalization for babesiosis Oct 20–24 None
Dates of 6-wk course of azithromycin and atovaquone Oct 20–Dec 1 Oct 23–Dec 4

*IFA, indirect fluorescent antibody; ND, not done.
†Neither patient had lived or traveled in babesiosis-endemic areas in Wisconsin (primarily, the northwestern and northcentral regions) or elsewhere.
‡Preparation of kidneys for transplantation included an in situ flush (initiated 25 min after the donor was declared brain dead and was extubated) with 2 L of University of Wisconsin solution (15), each of which was infused in <4 min; a flush with 200 mL of this solution after the kidneys were explanted; and continuous circulation with kidney perfusate solution until the kidneys were transplanted.
§Both patients had negative PCR results for followup blood specimens in February 2009.
¶Reference ranges: creatinine, 0.6–1.3 mg/dL; haptoglobin, 30–200 mg/dL; lactate dehydrogenase, 90–200 U/L.
#Hematocrit values posttransplantation were 37% (patient A) and 40% (patient B).
**Differential leukocyte counts were 73% neutrophils, 14% lymphocytes, and 13% monocytes for patient A; and 79% neutrophils, 12% lymphocytes, 8% monocytes, 1% eosinophils, and 1% basophils for patient B.

Main Article

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Page created: October 12, 2016
Page updated: October 17, 2016
Page reviewed: October 17, 2016
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