What Is Babesiosis? by BRIDGET PARSH, Edd, MSN, RN, CNS, and KAITLYN WHITNEY

Infection Prevention

What is babesiosis? BY BRIDGET PARSH, EdD, MSN, RN, CNS, AND KAITLYN WHITNEY

RIMARILY CAUSED BY experience nausea, emesis, night history, such as a recent tick bite, the protozoan parasite sweats, headache, dry cough, weight blood transfusion, or trip to an Babesia microti in the US, loss, anemia, and hematuria.2,9-11 endemic area.1,5 Babesia can be P babesiosis is an infec- Although most asymptomatic detected inside RBCs via blood tion that destroys red blood cells patients do not require treatment, smear in the first 2 weeks of (RBCs).1 In the US, it is endemic symptomatic patients usually infection.10,11 Antibody testing can to the Northeast and upper Mid- require antimicrobial treatment confirm the diagnosis.5 The poly- west and typically transmitted by for 7 to 10 days with combination merase chain reaction assay, the deer tick, Ixodes scapularis.1-5 atovaquone and azithromycin or immunofluorescence antibody test, However, the transmitting species clindamycin and quinine.2 and fluorescent in situ hybridization of babesiosis can vary globally. This Babesiosis can be a severe and assay can each detect antibodies bloodborne infection can also be life-threatening infection for older related to the infection.2,13,14 transmitted by an infected donor adults and immunocompromised It may be necessary to run several via blood transfusion and, rarely, patients, such as those being treated tests, and negative results should not through organ transplantation or for cancer or HIV infection and be used to rule out treatment.3 maternal-fetal transmission.6,7 This those who are asplenic.12 Patients Currently available testing detects article discusses the clinical presen- may experience relapses for more only two Babesia species, but there tation, diagnosis, and transmission than a year.8 Signs and symptoms are over 100 species of Babesia throughout the world.3,14,15 The differential diagnosis may help to Babesiosis is best prevented by avoiding contact with rule out similar, comorbid infec- deer ticks, especially by those at increased risk such as tions, such as Lyme disease, 5 immunocompromised individuals. toxoplasmosis, and anaplasmosis. Although donors may be asked about existing infections during prescreening, blood blanks do of babesiosis and offers prevention may include fever and hemolytic not typically test donated blood strategies for individuals spending anemia, leading to multiorgan for Babesia due to the unreliable time in deer tick habitats. failure, severe pancytopenia, testing.3,7 Blood products from disseminated intravascular coagula- asymptomatic donors may result Signs and symptoms tion, or splenic rupture.2,7,10,11 in transmission and potentially After a tick bite, the incubation However, acute respiratory distress fatal clinical illness in transfusion period for babesiosis ranges between syndrome is the most common recipients.7 Approximately 11% 1 and 4 weeks. Transmissions via complication of the infection.1 of transfusion-related deaths are transfusion typically incubate over a In addition to antimicrobial due to microbial infection, with period of 3 to 7 weeks, but this may medications, patients with severe up to 38% of these resulting from range from 1 week to 6 months.1 For babesiosis may require antipyretics, Babesia.3,13 immunocompetent patients, the vasopressors, blood transfusions, infection can last months to years exchange transfusions, mechanical Prevention and may remain undiagnosed.8 ventilation, or dialysis to treat There is no vaccine or prophylaxis Most immunocompetent patients complications.2 for babesiosis. Infection is best are asymptomatic or experience only prevented by avoiding contact with mild, nonspecific signs and symp- Diagnosis and transmission deer ticks, especially by those at toms such as fever, malaise, chills, Babesiosis is diagnosed based on increased risk such as immunocom- myalgia, and fatigue. Some patients clinical presentation and patient promised individuals. Deer ticks are www.Nursing2020.com May l Nursing2020 l 13

3. Lymedisease.org. Lyme disease co-infection: 19 Proper tick removal and disposal babesiosis. 2018. www.lymedisease.org/lyme-basics/ co-infections/Babesia. • As soon as possible, remove the tick using a pair of clean, fine-tipped 4. Vector Base. Ixodes scapularis. 2019. www.vector tweezers. base.org/organisms/ixodes-scapularis. • Grasp the tick as close to the skin’s surface as possible and pull 5. National Organization for Rare Disorders. Rare disease database: babesiosis. 2019. https://rare upward with steady, even pressure. Do not twist or make a jerking diseases.org/rare-diseases/babesiosis. movement, as this can cause the mouthparts to break off and remain 6. Smith RP Jr, Elias SP, Borelli TJ, et al. Human in the skin. These may also be removed with tweezers, but if you are babesiosis, Maine, USA, 1995–2011. Emerg Infect unable to do so, leave it alone and let the skin heal. Dis. 2014;20(10):1727-1730. • 7. American Association of Blood Banks. Babesiosis. After removal, clean the bite area thoroughly with isopropyl alcohol 2019. www.aabb.org/advocacy/regulatorygovernment/ and perform hand hygiene. donoreligibility/babesiosis/Pages/default.aspx. • Dispose of a live tick by putting it in alcohol, placing it in a sealed bag 8. Parija SC, Kp D, Venugopal H, et al. Diagnosis and management of human babesiosis. Trop Parasitol. or container, wrapping it tightly in tape, or flushing it down the toilet. 2015;5(2):88-93. Never crush it with your fingers. 9. Peniche-Lara G, Balmaceda L, Perez-Osorio C, • Avoid folklore remedies such as using nail polish, petroleum jelly, Munoz-Zanzi C. Human babesiosis, Yucatán state, or heat to make the tick detach from the skin. The goal is to Mexico, 2015. Emerg Infect Dis. 2018;24(11):2061-2062. remove the tick as quickly as possible rather than waiting for it 10. Akel T, Mobarakai N. Hematologic manifestations of babesiosis. Ann Clin Microbiol Antimicrob. to detach. 2017;16:6. 11. Leland DK. Touched by Lyme: a close look at six Lyme-related infections. Lymedisease.org. 2017. mainly found in wooded, brushy, or After time spent outdoors, www.lymedisease.org/touchedbylyme-wayne- grassy areas in the northern, conduct a full-body exam and anderson. eastern, and midwestern US. promptly remove any ticks that 12. Columbia University Irving Medical Center: Lyme and Tick-Borne Diseases Research Center. Babesiosis. Simple protective steps may be are found. Remember to check 2020. www.columbia-lyme.org/babesiosis. taken to reduce the risk of exposure children and pets. Remove any 13. Marcum L. Lyme sci: Babesia and the blood in tick-infested areas. Keep lawns ticks found on clothing before supply. Lymedisease.org. 2017. www.lymedisease. org/lyme-sci-Babesia-and-the-blood-supply. mowed to avoid tick infestations. going indoors, and remove those 14. Scott JD. First record of locally acquired human When hiking, walk toward the attached to the skin as soon as babesiosis in Canada caused by Babesia duncani: a center of cleared trails and mini- possible.2 (See Proper tick removal case report. SAGE Open Med Case Rep. 2017;5: 2050313X17725645. mize contact with leaves, brush, and disposal.) 15. Healthline. Everything you should know and overgrown grass where ticks are about Babesia. 2019. www.healthline.com/health/ likely to be found. Precautions dur- Nursing care babesia. ing outdoor activities in known tick Remind patients about the risks of 16. Centers for Disease Control and Prevention. Ticks: preventing tick bites. 2019. www.cdc.gov/ habitats, such as wearing a long- tick exposure and assess them for ticks/avoid/on_people.html. sleeved shirt and long pants with previous bites. With the exception 17. Centers for Disease Control and Prevention. the legs tucked into socks, may keep of transfusions, organ transplants, Parasites—babesiosis: prevention & control. 2019. www.cdc.gov/parasites/babesiosis/prevent.html. ticks off of the skin. Light-colored or maternal-fetal transmissions, 18. Centers for Disease Control and Prevention. clothing can make it easier to see babesiosis is not transmitted Type and duration of precautions recommended for and remove ticks before they are person-to-person.6,7,18 In the cases selected infections and conditions. 2018. exposed to skin.16 of infection, teach patients and 19. Centers for Disease Control and Prevention. Lyme disease. Tick removal and testing. 2019. Insect repellents may further families to complete any prescribed www.cdc.gov/lyme/removal. reduce the risk of exposure. Follow antibiotic regimens as directed and the instructions on the product educate them about potential risks label, including details on how and and adverse reactions.2 ■ At Sacramento State University School of Nursing in Sacramento, Calif., Bridget Parsh is a professor and where to apply it, how often to Kaitlyn Whitney is a nursing student.

reapply it, and how to use it safely REFERENCES on children. Permethrin products 1. Krause PJ, Vannier EG. Babesiosis: clinical manifestations and diagnosis. UpToDate. 2019. The authors have disclosed no ﬁ nancial relationships may kill ticks that come into contact related to this article. with treated clothing or footwear, www.uptodate.com. 2. Centers for Disease Control and Prevention. but it should not be applied directly Parasites—babesiosis. 2019. www.cdc.gov/ to the skin.16,17 parasites/babesiosis/index.html. DOI-10.1097/01.NURSE.0000657024.91124.91

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