Treatment of Refractory Babesia microti Infection with Atovaquone-Proguanil in an HIV-Infected Patient: Case Report

A patient with acquired immune deficiency syndrome presented with babesiosis 6 months after presumed tick exposure. Despite initial treatment with azithromycin and atovaquone, followed by quinine and clindamycin, he experienced an increasing parasite load. Finally, red blood cell exchange transfusio...

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Bibliographic Details
Published in:Clinical infectious diseases 2007-12, Vol.45 (12), p.1588-1560
Main Authors: Vyas, Jatin M., Telford, Sam R., Robbins, Gregory K.
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Acquired Immunodeficiency Syndrome - complications
Acquired Immunodeficiency Syndrome - immunology
AIDS
Animals
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiparasitic agents
Antiretrovirals
Atovaquone - administration & dosage
Atovaquone - therapeutic use
Babesia microti
Babesiosis
Babesiosis - complications
Babesiosis - diagnosis
Babesiosis - drug therapy
Biological and medical sciences
Blood
Blood transfusion
Brief Reports
Case studies
Drug Combinations
Drug therapy
Fever
Human immunodeficiency virus
Human viral diseases
Humans
Immunocompromised Host
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infections
Infectious diseases
Ixodidae
Male
Medical sciences
Middle Aged
Parasitemia
Parasites
Parasitism
Pharmacology. Drug treatments
Proguanil - administration & dosage
Proguanil - therapeutic use
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Description
Summary:A patient with acquired immune deficiency syndrome presented with babesiosis 6 months after presumed tick exposure. Despite initial treatment with azithromycin and atovaquone, followed by quinine and clindamycin, he experienced an increasing parasite load. Finally, red blood cell exchange transfusion, anti-Babesia therapy, and the addition of atovaquone-proguanil to the treatment regimen led to symptomatic improvement and elimination of parasitemia. Low-level parasitemia recurred 20 weeks later and was eradicated by administration of atovaquone-proguanil monotherapy. Atovaquone-proguanil appears to have activity against babesiosis and should be studied as a potential therapy for patients with refractory babesiosis.
ISSN:1058-4838
1537-6591
DOI:10.1086/523731