Prognosis
The majority of cases that are diagnosed and treated resolve without complication. In such cases, prognosis is excellent. However, patients with confirmed infection should refrain from donating blood until documentation of parasite clearance.
Additionally, many cases of babesiosis are asymptomatic or subclinical and go undiagnosed. These cases resolve without specific antimicrobial treatment, although parasitaemia may persist for months.
Age <50 years and immunocompetent
In these patients the vast majority of infections are mild and respond quickly to antimicrobial therapy. Complications are rare. A few cases of severe disease in young, healthy patients have been reported.
Age >50 years and/or immunosuppressed
Severe disease with complications such as persistent or relapsing parasitaemia, disseminated intravascular coagulation, or renal failure is more common in this patient group. Three of 9 (33%) patients who died after transfusion-related babesiosis and 11 of 34 (32%) patients admitted to hospital with severe babesiosis had previous splenectomy.[5][18] Another study found that 10 of 14 case patients (71%) with relapsing or persistent disease were asplenic.[29] Immunosuppressed patients often require prolonged courses of antimicrobial therapy and may require multiple courses for recurrent parasitaemia. In immunocompromised patients, higher doses of azithromycin may be used.[31] Close follow-up after hospital discharge is recommended.
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