Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis.

The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesiosis. The diagnosis and treatment of co-infection with babesiosis and Lyme disease will be addressed in a separate Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guideline [1]. Recommendations for the diagnosis and treatment of human granulocytic anaplasmosis can be found in the recent rickettsial disease guideline developed by the Centers for Disease Control and Prevention [2]. The target audience for the babesiosis guideline includes primary care physicians and specialists caring for this condition, such as infectious diseases specialists, emergency physicians, intensivists, internists, pediatricians, hematologists, and transfusion medicine specialists.

[1]  J. Sweeney,et al.  Adjunctive treatment of clinically severe babesiosis with red blood cell exchange: a case series of nineteen patients , 2019, Transfusion.

[2]  M. E. Cervera-Hernandez,et al.  Heavy parasitemia in babesiosis treated without adjunctive red cell exchange. , 2019, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[3]  J. O’Horo,et al.  Babesiosis: A Retrospective Review of 38 Cases in the Upper Midwest , 2019, Open forum infectious diseases.

[4]  N. Dunbar,et al.  Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue , 2019, Journal of clinical apheresis.

[5]  B. Herwaldt,et al.  Babesiosis Surveillance - United States, 2011-2015. , 2019, Morbidity and mortality weekly report. Surveillance summaries.

[6]  J. Nowakowski,et al.  Co-infections in Persons with Early Lyme Disease, New York, USA , 2019, Emerging infectious diseases.

[7]  Pardis C Sabeti,et al.  Development of a SNP barcode to genotype Babesia microti infections , 2019, PLoS neglected tropical diseases.

[8]  T. Blauwkamp,et al.  Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease , 2019, Nature Microbiology.

[9]  Choukri Ben Mamoun,et al.  Evidence for transmission of the zoonotic apicomplexan parasite Babesia duncani by the tick Dermacentor albipictus. , 2019, International journal for parasitology.

[10]  L. Mermel,et al.  Babesiosis-Associated Splenic Rupture: Case Series from a Hyperendemic Region. , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Jia-Fu Jiang,et al.  Human Babesiosis Caused by a Babesia crassa–Like Pathogen: A Case Series , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  Scott C. Williams,et al.  BmGPAC, an Antigen Capture Assay for Detection of Active Babesia microti Infection , 2018, Journal of Clinical Microbiology.

[13]  P. Krause,et al.  Superior real‐time polymerase chain reaction detection of Babesia microti parasites in whole blood utilizing high‐copy BMN antigens as amplification targets , 2018, Transfusion.

[14]  A. Rojtman,et al.  Efficient detection of symptomatic and asymptomatic patient samples for Babesia microti and Borrelia burgdorferi infection by multiplex qPCR , 2018, PloS one.

[15]  S. Madison‐Antenucci,et al.  Performance Evaluation of a Prototype Architect Antibody Assay for Babesia microti , 2018, Journal of Clinical Microbiology.

[16]  V. Lazarevic,et al.  Low-virulent Babesia venatorum infection masquerading as hemophagocytic syndrome , 2018, Annals of Hematology.

[17]  G. Wormser,et al.  Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. , 2018, Journal of the Pediatric Infectious Diseases Society.

[18]  S. Richter,et al.  Babesiosis Presenting as Acute Liver Failure , 2017, Case Reports in Gastroenterology.

[19]  L. Akoolo,et al.  Screening of patient blood samples for babesiosis using enzymatic assays. , 2017, Ticks and tick-borne diseases.

[20]  A. Schotthoefer,et al.  Risk Factors for Severe Infection, Hospitalization, and Prolonged Antimicrobial Therapy in Patients with Babesiosis. , 2017, The American journal of tropical medicine and hygiene.

[21]  L. Westblade,et al.  Clinical and Molecular Evidence of Atovaquone and Azithromycin Resistance in Relapsed Babesia microti Infection Associated With Rituximab and Chronic Lymphocytic Leukemia , 2017, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  B. Fries,et al.  Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone , 2017, Annals of Clinical Microbiology and Antimicrobials.

[23]  F. Marty,et al.  Post‐Babesiosis Warm Autoimmune Hemolytic Anemia , 2017, The New England journal of medicine.

[24]  A. Seilie,et al.  Detection of Babesia microti parasites by highly sensitive 18S rRNA reverse transcription PCR. , 2017, Diagnostic microbiology and infectious disease.

[25]  P. Bhanot,et al.  A novel quantitative PCR detects Babesia infection in patients not identified by currently available non-nucleic acid amplification tests , 2017, BMC Microbiology.

[26]  S. Stramer,et al.  Screening for Babesia microti in the U.S. Blood Supply. , 2016, The New England journal of medicine.

[27]  H. Bishop,et al.  Comparison of Babesia microti Real-Time Polymerase Chain Reaction Assays for Confirmatory Diagnosis of Babesiosis. , 2016, The American journal of tropical medicine and hygiene.

[28]  M. Oberley,et al.  Transmission of Babesia microti Parasites by Solid Organ Transplantation , 2016, Emerging infectious diseases.

[29]  P. Krause,et al.  Apheresis for babesiosis: Therapeutic parasite reduction or removal of harmful toxins or both? , 2016, Journal of clinical apheresis.

[30]  Pardis C. Sabeti,et al.  A global map of genetic diversity in Babesia microti reveals strong population structure and identifies variants associated with clinical relapse , 2016, Nature Microbiology.

[31]  G. Wormser,et al.  Persistence of babesiosis for >2 years in a patient on rituximab for rheumatoid arthritis. , 2016, Diagnostic microbiology and infectious disease.

[32]  Rahul Gondalia,et al.  Babesiosis Occurrence among the Elderly in the United States, as Recorded in Large Medicare Databases during 2006–2013 , 2015, PloS one.

[33]  D. Jobe,et al.  The Emergence of Clinically Relevant Babesiosis in Southwestern Wisconsin. , 2015, WMJ : official publication of the State Medical Society of Wisconsin.

[34]  G. Wormser,et al.  Comparison of a quantitative PCR assay with peripheral blood smear examination for detection and quantitation of Babesia microti infection in humans. , 2015, Diagnostic microbiology and infectious disease.

[35]  C. Nylund,et al.  Azithromycin in Early Infancy and Pyloric Stenosis , 2015, Pediatrics.

[36]  Jia-Fu Jiang,et al.  Epidemiological, clinical, and laboratory characteristics of 48 cases of "Babesia venatorum" infection in China: a descriptive study. , 2015, The Lancet. Infectious diseases.

[37]  D. Kessler,et al.  Determination of Babesia microti seroprevalence in blood donor populations using an investigational enzyme immunoassay , 2014, Transfusion.

[38]  Y. Zhang,et al.  Babesia venatorum Infection in Child, China , 2014, Emerging infectious diseases.

[39]  B. Herwaldt,et al.  A longitudinal study of Babesia microti infection in seropositive blood donors , 2014, Transfusion.

[40]  Choukri Ben Mamoun,et al.  Quantitative PCR for detection of Babesia microti in Ixodes scapularis ticks and in human blood. , 2013, Vector borne and zoonotic diseases.

[41]  J. Gray,et al.  Human Babesiosis in Europe: what clinicians need to know , 2013, Infection.

[42]  S. Telford,et al.  Development of a real‐time polymerase chain reaction assay for sensitive detection and quantitation of Babesia microti infection , 2013, Transfusion.

[43]  A. Malhotra,et al.  Vertical Transmission of Babesiosis From a Pregnant, Splenectomized Mother to Her Neonate , 2012 .

[44]  P. Wilkins,et al.  The third described case of transfusion‐transmitted Babesia duncani , 2012, Transfusion.

[45]  S. Madison‐Antenucci,et al.  A New Real-Time PCR Assay for Improved Detection of the Parasite Babesia microti , 2011, Journal of Clinical Microbiology.

[46]  Susan Mallett,et al.  Circulating MicroRNAs as a Novel Class of Diagnostic Biomarkers in Gastrointestinal Tumors Detection: A Meta-Analysis Based on 42 Articles , 2014, PloS one.

[47]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[48]  R. Oberbauer,et al.  The case: hemolysis and acute renal failure. Babesiosis. , 2011, Kidney international.

[49]  D. Snydman,et al.  Persistent babesiosis in a stem cell transplant recipient. , 2011, Leukemia research.

[50]  R. Nadelman,et al.  Babesiosis in Lower Hudson Valley, New York, USA , 2011, Emerging infectious diseases.

[51]  Samit R. Joshi,et al.  Emergence of resistance to azithromycin-atovaquone in immunocompromised patients with Babesia microti infection. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[52]  G. Guyatt,et al.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations , 2008, BMJ : British Medical Journal.

[53]  M. Young,et al.  Persistent and relapsing babesiosis in immunocompromised patients. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[54]  M. Kiehntopf,et al.  First confirmed autochthonous case of human Babesia microti infection in Europe , 2007, European Journal of Clinical Microbiology & Infectious Diseases.

[55]  K. Hunfeld,et al.  First case of human babesiosis in Germany - Clinical presentation and molecular characterisation of the pathogen. , 2007, International journal of medical microbiology : IJMM.

[56]  A. Kratz,et al.  Case records of the Massachusetts General Hospital. Case 17-2007. A 25-year-old woman with relapsing fevers and recent onset of dyspnea. , 2007, The New England journal of medicine.

[57]  J. Halperin,et al.  The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[58]  R. Quick,et al.  Description of Babesia duncani n.sp. (Apicomplexa: Babesiidae) from humans and its differentiation from other piroplasms. , 2006, International journal for parasitology.

[59]  A. Arnold,et al.  Neonatal babesiosis: case report and review of the literature. , 2006, The Pediatric infectious disease journal.

[60]  A. Limaye,et al.  Babesia divergens–like Infection, Washington State , 2004, Emerging infectious diseases.

[61]  S. M. Taylor,et al.  Babesia divergens, a Bovine Blood Parasite of Veterinary and Zoonotic Importance , 2003, Clinical Microbiology Reviews.

[62]  F. Gherlinzoni,et al.  Molecular Characterization of a Non–Babesia divergens Organism Causing Zoonotic Babesiosis in Europe , 2003, Emerging infectious diseases.

[63]  A. Steere,et al.  Prospective study of coinfection in patients with erythema migrans. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[64]  S. Telford,et al.  Increasing health burden of human babesiosis in endemic sites. , 2003, The American journal of tropical medicine and hygiene.

[65]  C. L. Fritz,et al.  Investigation of transfusion transmission of a WA1‐type babesial parasite to a premature infant in California , 2002, Transfusion.

[66]  M. L. Michelson,et al.  Acute babesiosis caused by Babesia divergens in a resident of Kentucky. , 2002, The New England journal of medicine.

[67]  S. Telford,et al.  Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[68]  A. Spielman,et al.  Diagnosis of Babesiosis Using an Immunoblot Serologic Test , 2001, Clinical Diagnostic Laboratory Immunology.

[69]  P. Greenberg,et al.  Severe babesiosis in Long Island: review of 34 cases and their complications. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[70]  L. Weiss,et al.  The treatment of babesiosis. , 2001, The New England journal of medicine.

[71]  S. Telford,et al.  Atovaquone and azithromycin for the treatment of babesiosis. , 2000, The New England journal of medicine.

[72]  M. Liang,et al.  Coexposure to Borrelia burgdorferi and Babesia microti does not worsen the long-term outcome of lyme disease. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[73]  G. Birkhead,et al.  Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors. , 1998, Archives of internal medicine.

[74]  R. Pollack,et al.  Persistent parasitemia after acute babesiosis. , 1998, The New England journal of medicine.

[75]  S. Ong,et al.  Human babesiosis in Taiwan: asymptomatic infection with a Babesia microti-like organism in a Taiwanese woman , 1997, Journal of clinical microbiology.

[76]  S. Telford,et al.  Comparison of PCR with blood smear and inoculation of small animals for diagnosis of Babesia microti parasitemia , 1996, Journal of clinical microbiology.

[77]  S. Telford,et al.  Efficacy of immunoglobulin M serodiagnostic test for rapid diagnosis of acute babesiosis , 1996, Journal of clinical microbiology.

[78]  R. Pollack,et al.  Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. , 1996, JAMA.

[79]  P. Krause,et al.  Infection with a babesia-like organism in northern California. , 1995, The New England journal of medicine.

[80]  S. Telford,et al.  Diagnosis of babesiosis: evaluation of a serologic test for the detection of Babesia microti antibody. , 1994, The Journal of infectious diseases.

[81]  J. Benach,et al.  Human babesiosis in New York State: an epidemiological description of 136 cases. , 1992, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[82]  F. Rosner,et al.  Babesiosis in splenectomized adults. Review of 22 reported cases. , 1984, The American journal of medicine.

[83]  H. Masur,et al.  Babesiosis transmitted by a transfusion of frozen-thawed blood. , 1982, Annals of internal medicine.

[84]  A. Spielman,et al.  Treatment of transfusion-transmitted babesiosis by exchange transfusion. , 1980, The New England journal of medicine.

[85]  G. Healy,et al.  Babesiosis in a Massachusetts resident. , 1970, The New England journal of medicine.

[86]  A. Klainer.  Manual of Clinical Microbiology , 1970 .

[87]  G. Healy,et al.  A case of babesiosis in man in the United States. , 1968, The American journal of tropical medicine and hygiene.

[88]  Ž. Deanović,et al.  Piroplasmosis in man; report of a case. , 1957, Documenta de medicina geographica et tropica.

[89]  C. Hanhart,et al.  Investigation of a , 2008 .

[90]  B. Pritt,et al.  Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States. , 2016, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[91]  P. Krause,et al.  Coinfection by Ixodes Tick-Borne Pathogens: Ecological, Epidemiological, and Clinical Consequences. , 2016, Trends in parasitology.

[92]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[93]  Gerald Gartlehner,et al.  [GRADE guidelines 15: going from evidence to recommendation - determinants of a recommendation's direction and strength]. , 2014, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[94]  J. Stockman,et al.  Transfusion-Associated Babesiosis in the United States: A Description of Cases , 2013 .

[95]  Peter J. Krause,et al.  Human babesiosis. , 2012, The New England journal of medicine.

[96]  S. Greenfield,et al.  Clinical practice guidelines we can trust , 2011 .

[97]  W. Rogers.  Plasmodium and Babesia. , 2011 .

[98]  C. Bias.  The Cochrane Collaboration's tool for assessing risk of bias in randomised trials , 2011 .

[99]  J. Rich,et al.  Red cell exchange transfusion for babesiosis in Rhode Island , 2009, Journal of clinical apheresis.

[100]  G. Healy,et al.  Development and persistence of antibody in persons infected with Babesia microti. , 1981, The American journal of tropical medicine and hygiene.

[101]  G. Healy,et al.  Morphology of Babesia microti in human blood smears. , 1980, American journal of clinical pathology.

[102]  G. Healy,et al.  Human babesiosis on Nantucket Island. Clinical features. , 1977, Annals of internal medicine.