To further investigate the patient’s anemia and thrombocytopenia, we ordered a peripheral blood smear to rule out microangiopathic hemolytic anemia, which showed intraerythrocytic forms suggestive of malaria.
We did not test for anaplasmosis at the time. Blood culture, urine culture and serology tests for hepatitis A, B and C HIV cytomegalovirus Epstein–Barr virus West Nile virus and Borrelia burgdorferi were negative.
Laboratory investigations presented in Table 1 showed evidence of hemolysis and acute kidney injury. Investigations showed that the patient’s pancytopenia had progressed since his last emergency department visit, and his liver enzyme levels were elevated. Given his recent negative CT scan and nonspecific symptoms, the likely cause was infectious, and our differential diagnosis focused on viral and atypical infections. His physical examination was unremarkable, with no insect bites, rashes, lymphadenopathy, hepatosplenomegaly, or jaundice. On admission to hospital, the patient was febrile (38.6☌) and tachycardic (105 beats/min). The patient later presented to our emergency department with persistent symptoms, and we admitted him for further investigations.Ĭourse of events and clinical course of a 75-year-old man with babesiosis. After this, an urgent outpatient computed tomography (CT) scan of his chest, abdomen and pelvis was unremarkable. When the symptoms persisted despite antibiotic treatment, he went to a community emergency department, where the physician identified anemia and thrombocytopenia ( Table 1). After 3 weeks of symptoms, he had visited his family physician, who prescribed a 1-week course of amoxicillin–clavulanic acid. In August 2019, a 75-year-old man presented to the emergency department in Winnipeg with a 6-week history of fever, myalgia, lethargy and 7-kg weight loss. Tick-borne diseases, including babesiosis, should be included in the differential diagnosis in Canada, and empiric treatment should be considered. Thin blood smears and polymerase chain reaction testing are diagnostic. Babesia microti, transmitted by Ixodes scapularis, is the primary cause of babesiosis in North America.īabeosis usually presents with intermittent fever, malaise, anemia and thrombocytopenia, and can coexist with other tickborne infections.īabesiosis can mimic malaria on blood smear.
0 kommentar(er)
