IDSA releases recent guideline on diagnosis and management of babesiosis

Key recommendations include:

• The diagnosis of babesiosis should be based on epidemiological risk factors and clinical evidence, and confirmed by blood smear examination or PCR.
• A single positive antibody test is not sufficient to establish a diagnosis of babesiosis becauseBabesia antibodies can persist in blood for a year or more following apparent clearance of infection, with or without treatment.
• Atovaquone plus azithromycin is the preferred antimicrobial combination for patients experiencing babesiosis, while clindamycin plus quinine is the alternative choice. The duration of treatment is 7 to 10 days in immunocompetent patients but often is extended when the patient is immunocompromised.
• 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. Expert consultation with a transfusion services physician or hematologist in conjunction with an infectious diseases specialist is strongly advised.
• For immunocompetent patients, monitoring of Babesiaparasitemia is recommended during treatment of acute illness using peripheral blood smears but recommend against testing for parasitemia once symptoms have resolved.
• For immunocompromised patients, monitoring of Babesia parasitemia is suggested using peripheral blood smears even after they become asymptomatic and until blood smears are negative. PCR testing should be considered if blood smears have become negative but symptoms persist.