Neutropenia in Congenital and Adult Babesiosis.

OBJECTIVES: Anemia and thrombocytopenia are expected hematologic abnormalities in patients with acute babesiosis, whereas neutropenia (defined as an absolute neutrophil count of ≤1,800 neutrophils/µL for adults and <1,200 neutrophils/µL for infants) is not usually considered a feature of this infection. We studied the frequency with which neutropenia occurs in congenital and adult cases of babesiosis. METHODS: The frequency of neutropenia in cases of congenital babesiosis was determined based on a literature review and on the findings in an unreported case. The frequency of neutropenia in adult patients was assessed based on a review of the medical records of 51 patients who were diagnosed with babesiosis between 2010 and 2013 at two medical centers in the Northeastern United States. RESULTS: Four (80%; 95% confidence interval [CI], 36%-98%) of five infants with congenital babesiosis whose neutrophil count was reported were neutropenic. Among 51 adult cases with babesiosis, 11 (22%; 95% CI, 12%-35%) were neutropenic on clinical presentation, and seven others developed neutropenia over the next 1 to 21 days. Thus, a total of 18 (35%; 95% CI, 24%-49%) of the adult patients with babesiosis had neutropenia. CONCLUSIONS: Neutropenia appears to be a common finding in infants with congenital babesiosis and is also observed not infrequently in adults with this infection.

Comparison of a quantitative PCR assay with peripheral blood smear examination for detection and quantitation of Babesia microti infection in humans.

Using a real-time quantitative PCR (qPCR), we determined the number of DNA copies/mL of blood of a Babesia microti gene in infected patients. Thirty-six patients (whose median age was 62.5years and 75.0% were male) with at least 1 qPCR-positive blood sample were included in this analysis, including 16 with serial blood samples. Based on testing of serial blood samples, it could be demonstrated that the smear became negative while the qPCR remained positive. A moderate to strong correlation was found between the DNA copy number and the number of infected erythrocytes per milliliter of blood (Pearson's r=0.68, P<0.001). Based on limited data, the DNA copy number fell by a mean of 4.1-12.9% per day on active treatment and by 3.5-7.1% per day off therapy. qPCR methodology may permit systematic evaluations of the relative efficacy of various antiparasitic drug regimens and other therapeutic modalities, although a limitation of such testing is that DNA detection per se does not establish the presence of viable parasites.

Utilization of a real-time PCR assay for diagnosis of Babesia microti infection in clinical practice.

Babesiosis is an emerging tick-borne disease mainly caused Babesia microti, a protozoan that infects erythrocytes. Microscopic examination of blood smears is the current gold standard for detection of Babesia infection, but this diagnostic test has several limitations. We developed and assessed the clinical utilization of a multiplex real-time PCR assay targeting the 18S rRNA gene of B. microti and the human gapdh gene. The limit of detection of this PCR assay was approximately 1-3parasites/µl of blood. The assay showed a diagnostic sensitivity and probable specificity of 100% based on testing 145 retrospective and 185 prospective blood specimens from controls and patients with confirmed babesiosis. Notably, the PCR assay was more sensitive than blood smear examination in patients during and following anti-babesia drug therapy. Our study suggests that PCR testing is as good or better than a blood smear for detection of B. microti in routine clinical practice. PCR testing may confirm the presence of babesiosis in patients whose level of infection is too low for reliable microscopic detection.