Cases of babesiosis, a potentially lethal, tick-borne parasitic infection that destroys erythrocytes, have grown faster in the Lower Hudson Valley than in the rest of New York. While the reason for the increase remains unknown, nurses should stay alert for this seasonally occurring disease.
It can lead to life-threatening situations, says Saungi McCalla, RN, MSN, MPH, CIC, director of infection prevention and control at White Plains (N.Y.) Hospital Center, which has had 16 babesiosis cases since 2009. The main thing is to avoid it because there is no vaccine. And if you have symptoms, go in to the doctor or hospital to be diagnosed and treated.
The number of Lower Hudson Valley residents diagnosed with babesiosis has increased from six cases in 2001 to 119 cases in 2008, while cases have risen about 1.6-fold in the rest of the state during the same period, from 89 cases in 2001 to 142 cases in 2008, according to a report published in the Centers for Disease Control and Preventions article Emerging Infectious Diseases.
We are seeing an increase in this area, 20-fold in the Lower Hudson Valley, says Brenda Martin, RN, infection control coordinator at Northern Dutchess Hospital in Rhinebeck, N.Y., which had one case of babesiosis in 2010.
Babesiosis occurs primarily in the spring, summer and fall. Cases have been reported on Long Island and in Massachusetts, Wisconsin, California, Georgia, Missouri and some European countries, according to the New York State Department of Health.
Although the disease is on the increase, it still pales in comparison to Lyme disease, another tick-borne illness endemic to the area. The CDC reported 4,609 Lyme disease cases in the Lower Hudson Valley in 2008. People can become infected with both babesiosis and Lyme disease simultaneously.
Etiology and TransmissionNorine Della Rocco, RN
In New York, Ixodes scapularis ticks, commonly referred to as deer ticks, transmit the causative parasite Babesia microti. The white-footed mouse serves as the principal animal reservoir for B. microti, but voles and shrews also can harbor the parasite. None of these animals travel long distances, so it remains unclear how babesiosis became an emerging infectious disease in the Lower Hudson Valley.
Babesiosis is not contagious by casual exposure to an infected person. However, it can be transmitted through blood transfusions. The Food and Drug Administration has not approved any tests to screen for Babesia in donated blood.
SymptomsSaungi McCalla, RN
Many infected people feel fine, while other individuals may develop fever, headache, malaise, fatigue, chills or nausea within one week to months after exposure to the parasite. Hemolytic anemia, splenomegaly, hepatomegaly or jaundice may occur.
One of the key things is the anemia in addition to these [flu-like] symptoms, McCalla says.
If a patient presents with fever and chills and a history of gardening or other outdoor activity, then the ED or clinic nurse would do a visual screen to check for ticks and ask whether the patient remembers a tick bite, says Norine Della Rocco, RN, ICP, CIC, infectious disease specialist at South Shore Medical Center in New Rochelle, N.Y., which had only one patient last year with babesiosis. Babesiosis-infected tick bites do not leave characteristic marks on the skin.
Diagnosis requires a blood smear to check for Babesia parasites in the red cells. People with low levels of parasites may need multiple smears. McCalla adds that her hospital will send a positive specimen to the state health department laboratory to confirm the diagnosis.
Patient CareBrenda Martin, RN
A lot of these patients are totally asymptomatic, and they do not require any treatment, says Della Rocco. When needed, treatment includes azithromycin and atovaquone or quinine and clindamycin taken orally for at least seven to 10 days.
The CDC says the second combination is the standard of care for severely ill patients, Martin says. It can be fatal. Particularly in immunocompromised [patients], it can lead to a life-threatening illness, either thrombocytopenia or DIC (disseminated intravascular coagulation), a bleeding disorder. It can affect your vital organs.
In addition, people who have had their spleen removed or suffer from other serious health conditions and the elderly are at a greater risk for more severe disease.
Some patients may need supportive care, such as antipyretics, vasopressors, blood transfusions, exchange transfusions, mechanical ventilation or dialysis.
Avoiding tick bites remains the best defense against babesiosis. High-risk people should stay away from tick-infested areas. Prevention is key, says Martin, who encourages controlling for rodents, keeping grass mowed and wearing light clothing so ticks are more visible.
In grassy or woody areas, people should tuck pants into socks and shirt into pants, and every two to three hours when outdoors, check for ticks and brush them off clothing before they attach to the skin. Young Ixodes scapularis ticks, called nymphs, are about the size of a poppy seed and hard to see. Always check yourself when you come inside to see if you have any ticks on you and check pets, too, Della Rocco advises.
Use of repellents, such as products with DEET (N, N-diethyl-m-toluamide), can decrease the risk of tick bites. Users should follow product instructions and use the repellents only in small amounts. Once indoors, people should wash the repellent off.
Remove ticks with tweezers as close as possible to the skin, without squeezing, crushing or puncturing the ticks body. The tick can be sent to the New York State Department of Health Tick Identification Service to determine, at no charge, the species, whether it is engorged with blood and if parts of the mouth are present.
We need to educate our patients and our families, specifically in the spring through fall, how to take precautions and be aware of the increase in this parasite and treatment for it, Martin says.