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      Splenic Complications of Babesia microti Infection in Humans: A Systematic Review

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          Abstract

          Splenic complications of acute Babesia microti infection include splenomegaly, splenic infarct, and splenic rupture. These complications are relatively rarely reported, and the aim of this research was to synthetize data on this topic according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the PubMed database. In this review, we find that unlike other severe complications of babesiosis, splenic infarct and rupture occur in younger and immunocompetent patients, and they do not correlate with parasitemia level. Furthermore, admission hemoglobin of 10 mg/dl or less, platelet count of 50 × 10⁹/L or less, presence of hemodynamic instability, and splenic rupture were associated independently with an increased risk of requiring splenectomy. As babesiosis is an emerging tick-borne zoonosis, we hope that this review will help to raise awareness among clinicians regarding this rare but potentially life-threatening complication.

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          Human babesiosis.

          Edouard Vannier, Peter Krause (2012)
          Article 0 comments Cited 202 times – based on 0 reviews     Review now
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            Clinical review: Severe malaria

            Andrej Trampuz, Matjaz Jereb, Igor Muzlovic … (2003)
            Malaria represents a medical emergency because it may rapidly progress to complications and death without prompt and appropriate treatment. Severe malaria is almost exclusively caused by Plasmodium falciparum. The incidence of imported malaria is increasing and the case fatality rate remains high despite progress in intensive care and antimalarial treatment. Clinical deterioration usually appears 3–7 days after onset of fever. Complications involve the nervous, respiratory, renal, and/or hematopoietic systems. Metabolic acidosis and hypoglycemia are common systemic complications. Intravenous quinine and quinidine are the most widely used drugs in the initial treatment of severe falciparum malaria, whereas artemisinin derivatives are currently recommended for quinine-resistant cases. As soon as the patient is clinically stable and able to swallow, oral treatment should be given. The intravascular volume should be maintained at the lowest level sufficient for adequate systemic perfusion to prevent development of acute respiratory distress syndrome. Renal replacement therapy should be initiated early. Exchange blood transfusion has been suggested for the treatment of patients with severe malaria and high parasitemia. For early diagnosis, it is paramount to consider malaria in every febrile patient with a history of travel in an area endemic for malaria.
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              Systematic review of atraumatic splenic rupture.

              P Renzulli, A Hostettler, D. Candinas … (2009)
              Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity. The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed. Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis. The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.
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                Author and article information

                Journal
                Title: Canadian Journal of Infectious Diseases and Medical Microbiology
                Abbreviated Title: Canadian Journal of Infectious Diseases and Medical Microbiology
                Publisher: Hindawi Limited
                ISSN (Print): 1712-9532
                ISSN (Electronic): 1918-1493
                Publication date Created: May 28 2020
                Publication date (Print): May 28 2020
                Volume: 2020
                Pages: 1-8
                Affiliations
                [1 ]Mayo Clinic Alix College of Medicine and Science, Rochester, MN, USA
                [2 ]Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
                [3 ]Icahn School of Medicine at Mount Sinai, New York City, NY, USA
                [4 ]Division of Infectious Disease, University of Colorado, Denver, CO, USA
                Article
                DOI: 10.1155/2020/6934149
                SO-VID: 9127e947-0edc-4113-9c33-dc8cae87fe87
                Copyright © © 2020
                License:

                http://creativecommons.org/licenses/by/4.0/

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