Most often, PCR testing is used in conjunction with blood film examination and possibly serologic testing.Other laboratory findings include decreased numbers of red blood cells and platelets on complete blood count.In animals, babesiosis is suspected by observation of clinical signs (hemoglobinuria and anemia) in animals in endemic areas. Diagnosis is confirmed by observation of merozoites on thin film blood smear examined at maximum magnification under oil using Romonovski stains (methylene blue and eosin). This is a routine part of the veterinary examination of dogs and ruminants in regions where babesiosis is endemic.Babesia canis and B. bigemina are "large Babesia species" that form paired merozoites in the erythrocytes, commonly described as resembling "two pears hanging together", rather than the "Maltese cross" of the "small Babesia species". Their merozoites are around twice the size of small ones.Cerebral babesiosis is suspected in vivo when neurological signs (often severe) are seen in cattle that are positive for B. bovis on blood smear, but this has yet to be proven scientifically. Outspoken red discoloration of the grey matter post mortem further strengthens suspicion of cerebral babesiosis. Diagnosis is confirmed post mortem by observation of Babesia-infected erythrocytes sludged in the cerebral cortical capillaries in a brain smear. Treatment
Treatment of asymptomatic carriers should be considered if parasites are still detected after 3 months. In mild-to-moderate babesiosis, the treatment of choice is a combination of atovaquone and azithromycin. This regimen is preferred to clindamycin and quinine because it has fewer side effects.
Although NTM lung infections can cause lung cavities, the most common finding on imaging is bronchiectasis, which may occur with or without cavities. Mycobacterium avium complex (MAC) is the most common cause of NTM lung disease in most countries, including the United States. Classically, MAC infection results in either upper lobe cavities in male smokers with COPD or bronchiectasis in thin, older women; however, it is possible to have both cavities and bronchiectasis in the same patient. Similar to tuberculosis, the presence of cavities in MAC infection is associated with worse outcomes. Mycobacterium kansasii, Mycobacterium xenopi, and the rapidly-growing Mycobacterium abscessus have also been associated with lung cavities. Fungal
Fungal infections that can cause cavitations include histoplasmosis, coccidiomycosis, cryptococcosis, and aspergillosis. Aspergillosis, most commonly caused by Aspergillus fumigatus, can present in four different ways (listed in order of increasing severity): aspergilloma, allergic bronchopulmonary aspergillosis (ABPA), chronic necrotizing aspergillosis, and invasive aspergillosis. All of these are associated with lung cavities except for ABPA, which is a hypersensitivity response associated with bronchiectasis on imaging. An aspergilloma is an infection of a pre-existing lung cavity by Aspergillus species without tissue invasion and results in the formation of a fungal ball. Historically, tuberculosis was the most common cause of the lung cavity (and still is in areas where tuberculosis is endemic); however, the cavity can also be caused by sarcoidosis, bullae, bronchiectasis, or cystic lung disease. Chronic necrotizing aspergillosis and invasive aspergillosis are usually seen in immunocompromised people.