228.4 📌 章末速蚘

  • Babesia: tick-borne intra-erythrocytic protozoan
  • B. microti USA NE/Midwest (Ixodes scapularis, same as Lyme)
  • B. divergens Europe (asplenic severe)
  • B. duncani USA W Coast
  • Risk for severe: asplenic, immunocompromise, elderly, pregnant
  • Clinical: fever + chills + sweats + thrombocytopenia + hemolytic anemia (↑ LDH, ↓ haptoglobin); severe = AKI + DIC + multi-organ
  • Diagnosis: thick + thin Giemsa smears (Maltese cross tetrads pathognomonic), PCR (most sensitive), serology
  • Treatment:
    • Mild-Moderate: atovaquone + azithromycin × 7-10 d
    • Severe: clindamycin + quinine × 7-10 d
    • Refractory / Asplenic / Parasitemia > 10%: + exchange transfusion
    • Immunocompromise: longer course (6+ wk)
  • Co-infection (Ixodes): Lyme + Anaplasma + B. miyamotoi
  • Transfusion-transmitted babesiosis USA NE concern; 2024 FDA expanded donor screening
  • 盧醫垫 hint: NE USA travel + asplenic / immunocompromise + febrile illness → 必 Babesia smear + PCR; exchange transfusion if severe