Review Article

Splenic Complications of Babesia microti Infection in Humans: A Systematic Review

Table 1

Demographic data, clinical features, management, and outcome of patients who developed splenic complications during acute Babesia microti infection.

Case (ref)Year (author)AgeSexUS state, countryComorbid conditionsSymptoms duration PTP (days)Dx missed initiallyRemembers tick biteSIRS/HD unstable on admissionHgb (md/dl)Platelet (×109/L)CoinfectionParasitemia level (%)SplenomegalyType of splenic involvement PTA or AATransfusion (units)ICSAntibiotic treatmentSplenectomy

1 [19]2001 (Javed)85MNJ, USAHTNFever, chills, malaise (7–14)YesNoNo1223Yes E.ch.8NoIYes (2)NoTCV + CLIN + QINo, expired
2 [20]2008 (Kuwaya ma)61MNJ, USANoneFever, chills, malaise, AP (180) intermittentYesNo (golfing)No1133No5YesR (AA)Yes (4)NoAZ + ATQ (7)Yes
3 [21]2008 (Froberg)56MMN, USAHTNNight sweats, malaise (NR)YesNRYes9.337Yes (LD)NRYesR (AA)NRNoNRYes
4 [22]2008 (Florescu)58MNJ, USANoneFever, AP, malaise, syncope (5)YesNoNo13.6209APG0.5YesINoAZ + ATQ (NR)No
5 [22]2008 (Florescu)75FNY, USAHTNNight sweats, malaise (NR)YesNoYes8.755NoNRYes (massive)INRNoAZ + ATQ QI + CLINNo, expired
6 [23]2008 (Sidertis)50MNJ, USANoneFever, AP, malaise, syncope (5)YesNo (golfing)Yes9.3458NR3YesR (PTA)Yes (2)NoAZ + ATQ (NR)Yes
7 [23]2008 (Sidertis)71MNJ, USANRSyncope (NR)NoNRYes9.272NRNRYesR (PTA)Yes (2)NoCLIN + QI (10)Yes
8 [24]2011 (Tobler)54MMA, USANoneNausea, chills, malaise, fever, AP (2)NoNoNo10.226No3YesR (PTA)Yes (platelet)NoAZ + ATQ (10)No
9 [25]2011 (Abbas)23MCT, USANoneFever, chills, weight loss, malaise LDN (0.5)YesYesNo6.878No30YesR (PTA)Yes (4)NoCLIN + QI (10)No
10 [26]2011 (Reis)70MNY, USANRFever, nausea, vomiting (3)NoNoNo8.590NoNRYesR (PTA)Yes (2)NoAZ + ATQ (14)No, SA embolization
11 [27]2011 (El Khouri)70MNY, USANoneFever, chills, malaise (4)NoNRNo10.177No8YesR (PTA)Yes (3)NoCLIN + QI AZ + ATQ (16)No, SA embolization
12 [27]2011 (El Khouri)36MNY, USANoneFever, headache, chills, cough (14)NoNRNo8.5133No3.5YesR (AA)NoNoAZ + ATQ (21)No
13 [28]2011 (Wormser)55MRI, USADiverticulosisFever, rash, AP (10)YesNRYes13.499NR0.1NRR (PTA)NRNoAZ + ATQ (42) relapse after 10-day courseYes
14 [29]2013 (Seible)83MMA, USANRFever, nausea, AP (2)NoNRNRNR66No14NRR (PTA)Yes exchangeNoCLIN + QI (30)No
15 [30]2013 (Leinwan d)48MCT, USANoneHeadache, AP, malaise (7)NoNo (camping)No10.5137No10YesR (PTA)NRNoAZ + ATQ (NS)No observation
16 [31]2014 (Usatti)54MCT, USANoneFever, headache, AP (2)YesNRYes10.6123NoNRYesR (PTA)Yes (2)NoAZ + ATQ (10)No
17 [32]2015 (Farber)59FCT, USAHLP depressionFever, chills, syncope, fatigue, AP (14)NoNo (gardening)Yes8.2127No1YesR (PTA)Yes (2)NoCLIN + AZ + ATQ (14)Yes
18 [33]2016 (Al Zoubi)72MEcuadorHTNFever, chills, weight loss, AP (NR)YesNRNo7.855No0.5YesINRNoATQ + PRG (NR)No
19 [34]2016 (Wong)56MNY, USADiabetesFever, malaise, night sweats (6)YesNo (landscaping)No10.7163Yes (LD)1.5NoINoNOAZ + ATQ (10)No SA embolization
20 [35]2017 (Permpalu ng)59MMA USAMVPHeadache, fever, AP (14)YesNRNR10.4156NoNRYesINoNoAZ + ATQ (10)No SA embolization
21 [36]2018 (Dumic)79FWI, USAHTN atrial fibrillation CADChest pain, dizziness (1)YesYesYes6.56.5Yes (LD)1.3NoR (PTA)Yes (4)NoAZ + ATQ (10) Doxy (21)Yes
22 [37]2018 (Blackwo od)51MRI, USAHTN atrial fibrillationFever, chills, malaise, AP (5)NoYesYes9.325NR0.25YesR (PTA)Yes (4)NoAZ + ATQ (14)Yes
23 [37]2018 (Blackwo od)61MRI, USAHTN, HLPFever, chills, malaise, AP (3)YesNo (gardening)Yes12.489NR0.44YesINoNoAZ + ATQ (NR)No
24 [38]2018 (Li)48MRI, USAAsthmaFever, chills, night sweats, AP (7)NRNRNo8.868NR0.22YESR (NR)NRNoNRNo SA embolization
25 [13]2018 (Patel)48MRI, USAAsthmaFever, chills, night sweats, AP (7)NRNRNo8.868NR0.22YesR (NR)NRNoNRNo SA embolization
26 [13]2018 (Patel)83MRI, USACKD COPDAP (1)NRNRYes11.394NR0.30NRR (NR)NRNoNRNo
27 [13]2018 (Patel)40MRI USADiabetesFever, malaise, night sweats (5)NRNRNo7.874NR0.07NRR (NR)NRNoNRNo
28 [13]2018 (Patel)51MRI, USAHTN atrial fibrillationNight sweats, headache, malaise, AP (3)NRNRYes8.725NR0.2518.2R (NR)NRNoNRYes
29 [13]2018 (Patel)48MRI, USANoneFatigue, AP (5)NRNRYes7.959NR0.2616R (NR)NRNoNRYes
30 [13]2018 (Patel)36MRI, USANoneFever, AP (4)NRNRNo10.680NR0.35NRR (NR)NRNoNRNo
31 [13]2018 (Patel)68MRI, USAHTNMalaise, AP (NR)NRNRNo6.6NRNR5NRR (NR)NRNoNRNo
32 [39]2018 (Kwon)50FSouth Korea (imported from NJ, USA)NoneHeadache, fever, AP, chills (NR)YesNR (gardening)No11.253NRNRNRINRNoATQ/+AZ (NR)No
33 [40]2019 (Alvi)60MCT, USAHTN, diabetes, HLPFever, chills, rigors, AP (7–10)YesNoYes10.236No11YesIYesNoNS AZ + ATQ (14)No observation
34 [41]2019 (Gupta)53MNY, USANoneFever, chills, weakness (7)NoNo (hiking)NR11.290NR1.5NRINoNoAZ + ATQ (NS)No observation

A: azithromycin; AA: after admission; AP: abdominal pain; APG: Anaplasma phagocytophilum; ATQ: atovaquone; CKD: chronic kidney disease; CLIN: clindamycin; CT: Connecticut; Dx: diagnosis; E. ch: Ehrlichia chaffeensis; F: female; HA: headache; HD: hemodynamic; Hgb: hemoglobin, HLP: hyperlipidemia; HTN: hypertension; I: infarction; ICS immunocompromised state; LD: Lyme disease; LDN: lymphadenopathy; M: male; MA: Massachusetts; MN: Minnesota; MVP mitral valve prolapse; NJ: New Jersey; NR: not reported; NS: not specified; NY: New York; PRG: proguanil; PTA: prior to admission; PTP: prior to presentation; QI: quinine; R: rupture; Ref: reference; SA: splenic artery; TCV: ticarcillin-clavulanic acid “SIRS: systemic inflammatory response syndrome”.