PCR testing should be considered if blood smears have become negative but symptoms persist (weak recommendation, moderate-quality evidence).īabesiosis is a disease caused by intraerythrocytic protozoa of the genus Babesia that are transmitted throughout the world by hard-bodied ticks. How Should Immunocompetent and Immunocompromised Patients Be Monitored After Babesiosis Therapy Is Initiated? How Frequently and for How Long? Recommendations:įor immunocompetent patients, we recommend monitoring Babesia parasitemia during treatment of acute illness using peripheral blood smears but recommend against testing for parasitemia once symptoms have resolved (strong recommendation, moderate-quality evidence).įor immunocompromised patients, we suggest monitoring Babesia parasitemia using peripheral blood smears even after they become asymptomatic and until blood smears are negative. Expert consultation with a transfusion services physician or hematologist in conjunction with an infectious diseases specialist is strongly advised. Comment: Exchange transfusion may be considered for patients with high-grade parasitemia (>10%) or who have any one or more of the following: severe hemolytic anemia and/or severe pulmonary, renal, or hepatic compromise. In selected patients with severe babesiosis, we suggest exchange transfusion using red blood cells (weak recommendation, low-quality evidence). Is Exchange Transfusion Indicated for Severe Babesiosis? Recommendation: The duration of treatment is 7 to 10 days in immunocompetent patients but often is extended when the patient is immunocompromised ( Tables 1 and 2). Comment: Atovaquone plus azithromycin is the preferred antimicrobial combination for patients experiencing babesiosis, while clindamycin plus quinine is the alternative choice. We recommend treating babesiosis with the combination of atovaquone plus azithromycin or the combination of clindamycin plus quinine (strong recommendation, moderate-quality evidence). What Are the Preferred Treatment Regimens for Babesiosis? Recommendation: Comment: A single positive antibody test is not sufficient to establish a diagnosis of babesiosis because Babesia antibodies can persist in blood for a year or more following apparent clearance of infection, with or without treatment. Can an Active Case of Babesiosis Be Diagnosed Based on a Single Positive Antibody Test or Is a Blood Smear, PCR, or a Four-fold Rise in Antibody Necessary for Confirmation? Recommendation:įor patients with a positive Babesia antibody test, we recommend confirmation with blood smear or PCR before treatment is considered (strong recommendation, moderate-quality evidence). Comment: The diagnosis of babesiosis should be based on epidemiological risk factors and clinical evidence, and confirmed by blood smear examination or PCR. How Should the Diagnosis of Babesiosis Be Confirmed? Recommendation:įor diagnostic confirmation of acute babesiosis, we recommend peripheral blood smear examination or polymerase chain reaction (PCR) rather than antibody testing (strong recommendation, moderate-quality evidence). A detailed description of background, methods, evidence summary, and rationale that support each recommendation, and knowledge gaps can be found online in the full text. The panel followed a systematic process used in the development of other IDSA clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation) ( Figure 1). Summarized below are the 2020 recommendations for the diagnosis and management of babesiosis. The target audience for the babesiosis guideline includes primary care physicians and specialists caring for this condition, such as infectious diseases specialists, emergency physicians, intensivists, internists, pediatricians, hematologists, and transfusion medicine specialists. Recommendations for the diagnosis and treatment of human granulocytic anaplasmosis can be found in the recent rickettsial disease guideline developed by the Centers for Disease Control and Prevention. The diagnosis and treatment of co-infection with babesiosis and Lyme disease will be addressed in a separate Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guideline. The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesiosis. Medical Education Community of Practice.Fellows-In-Training Career & Education Center.myIDSA Practice Managers Community Opt-in Form.
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