Guideline sources The following summarized guidelines for the evaluation and management of babesiosis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2021). 1 Guidelines 1. Diagnostic investigations Laboratory testing: Obtain peripheral blood smear or PCR rather than antibody testing for diagnostic confirmation of acute babesiosis. A Obtain peripheral blood smear or PCR testing in patients with a positive Babesia antibody test to confirm the diagnosis of babesiosis before treatment is considered. A 2. Medical management Antimicrobial therapy: Offer one of the following combinations for the treatment of patients with babesiosis: atovaquone and azithromycin https://web.pathway.md/diseases/recoXt6OwIHzf8QuG 1/3 6/29/23, 3:16 AM Babesiosis Pathway q y clindamycin and quinine. A 3. Therapeutic procedures Red blood cell exchange transfusion: consider performing RBC exchange transfusion in selected patients with severe babesiosis. C 4. Follow-up and surveillance Follow-up: Monitor for Babesia parasitemia using peripheral blood smears in immunocompetent patients during treatment of acute illness. Do not test for parasitemia once symptoms have resolved. A Consider monitoring for Babesia parasitemia using peripheral blood smears in immunocompromised patients even after they become asymptomatic and until blood smears are negative. Consider PCR testing if blood smears have become negative but symptoms persist. C Clinical findings Symptoms Ocular exam Abdominal pain Conjunctival injection Arthralgia Integument exam Chills Cough Jaundice Dyspnea Petechiae Easy bruising Splinter hemorrhages Emotional lability Hematological findings Fatigue Fever DIC Headache Hemolytic anemia Loss of appetite blood leukocyte count Nausea blood platelet count Photophobia Sore throat Sweating Vomiting Weight loss Abdominal exam Hepatomegaly Splenomegaly https://web.pathway.md/diseases/recoXt6OwIHzf8QuG 2/3 6/29/23, 3:16 AM Babesiosis Pathway Lab findings serum ALT serum AST References 1. Peter J Krause, Paul G Auwaerter, Raveendhara R Bannuru et al. Clinical Practice Guidelines by the Infectious Diseases Society of America IDSA 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis. 2021 Jan 27;72 2):e49-e64. Open 2. Anand Padmanabhan, Laura Connelly-Smith, Nicole Aqui 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. J Clin Apher. 2019 Jun;34 3 171 354. Open https://web.pathway.md/diseases/recoXt6OwIHzf8QuG 3/3