Tick borne diseases for the nephrologist – Babesiosis

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The following few posts are a
summary of tick borne illnesses that can cause renal failure and/or electrolyte
problems. 
Babesiosis
First identified
on Nantucket Island in 1969 and was initially know as Nantucket fever.

Endemic areas.
CDC map. Reported
cases in 2012
Cases have been
reported in Europe (Croatia, France, Great Britain, Ireland, Portugal, Spain,
Sweden, Switzerland)(Babesia divergens).

The tick.

Ixodes
scapularis. The Blacklegged tick.
The pathogen.
Babesia microti and
B. duncani (USA). B divergens
(Europe). Protozoan parasites
infecting red blood cells
Humans are not a
natural host. Infection by blood transfusion has been reported.
Incubation period 1 –
9 weeks
Clinical features.
Fever, chills,
sweats, Malaise, fatigue, Myalgia, arthralgia, headache, Gastrointestinal
symptoms, such as anorexia and nausea (less common: abdominal pain, vomiting)
Dark urine
Less common:
cough, sore throat, emotional lability, depression, photophobia, conjunctival
injection
Mild splenomegaly,
mild hepatomegaly, or jaundice may occur in some patients
Lab features
Haemolytic
anemia, thrombocytopenia, renal failure, transaminitis.
Diagnosis – Light
microscopy of blood cells, serology and PCR for B. microti or B. duncani
Treatment – Atovaquone
plus azithromycin or quinine plus clindamycin orally for 7 to 10 days.

Atovaquone plus azithromycin is preferred as
this combination is better tolerated.

The source for this review is mainly from the CDC website as well as
various references cited in the posts. The tick
pictures provided may differ from what might be found on a bitten human. Ticks
become larger and engorged after feeding and will look different.

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