Risk factors for relapsing and persistent babesiosis:
(1) B cell lymphoma or CLL
(2) asplenia
(3) therapy with rituximab
(4) cancer, with or without chemotherapy
(5) congenital hemolytic anemia (hereditary spherocytosis, etc) with splenomegaly
(6) AIDS
(7) primary immunodeficiency
(8) other forms of immunosuppression (transplant, etc)
Cure is defined as the absence of signs and symptoms for at 4 months after discontinuing antibabesial therapy.
Recommendations:
(1) Patients with one or more risk factors should avoid areas where babesiosis is endemic. If in these areas they should take precautions to avoid ticks.
(2) If infected then immunosuppressive therapy should be discontinued if possible.
(3) These patients should be closely monitored for complications.
(4) Therapy needs to be administered for a longer period than normal. It should be given for at least 6 weeks and for at least 2 weeks after the parasite is no longer seen in the peripheral blood.
(5) A patient with one or more risk factors for relapse should be monitored during and for at least 3 months after therapy. Blood smears should be examined for parasites if the patient shows any symptoms suggestive of babesia.
