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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 201 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.
              Article 0 comments Cited 109 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Igor Dumic:
                ORCID: https://orcid.org/0000-0002-5312-8812
                Journal
                Journal ID (nlm-ta): Can J Infect Dis Med Microbiol
                Journal ID (iso-abbrev): Can J Infect Dis Med Microbiol
                Journal ID (publisher-id): CJIDMM
                Title: The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien des Maladies Infectieuses et de la Microbiologie Médicale
                Publisher: Hindawi
                ISSN (Print): 1712-9532
                ISSN (Electronic): 1918-1493
                Publication date Collection: 2020
                Publication date (Electronic): 27 May 2020
                Volume: 2020
                Electronic Location Identifier: 6934149
                Affiliations
                1Mayo Clinic Alix College of Medicine and Science, Rochester, MN, USA
                2Division of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
                3Icahn School of Medicine at Mount Sinai, New York City, NY, USA
                4Division of Infectious Disease, University of Colorado, Denver, CO, USA
                Author notes

                Academic Editor: Vidula Vachharajani

                Author information
                https://orcid.org/0000-0002-5312-8812
                Article
                DOI: 10.1155/2020/6934149
                PMC ID: 7275217
                PubMed ID: 32566058
                SO-VID: 9127e947-0edc-4113-9c33-dc8cae87fe87
                Copyright © Copyright © 2020 Igor Dumic et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 January 2020
                Date accepted : 25 April 2020
                Categories
                Subject: Review Article

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