Monitoring
For patients with asymptomatic infection with positive babesial smears or positive polymerase chain reaction (PCR) for babesial DNA, smears and/or PCR should be repeated and treatment should be considered if parasitemia persists for more than 1 month.[31]
In immunocompetent patients, monitoring parasitemia during treatment of acute illness using peripheral blood smears is recommended. However, testing is not recommended once symptoms have resolved.[31]
In immunocompromised patients, close clinical and laboratory follow-up, including CBC, renal and hepatic function, and peripheral blood smear is essential to ensure clinical improvement, reduction in parasitemia, and improvement in other laboratory abnormalities, such as anemia or renal dysfunction. In immunocompromised patients who experience severe disease, peripheral blood smears should be monitored at least daily until parasitemia is <4%. After this, blood smears should be obtained at least weekly until no parasites are detected. PCR testing should be considered if blood smears have become negative but symptoms persist. There is no standardized approach to monitoring highly immunocompromised patients but close clinical and laboratory follow-up are important.[31] Patients may have persistent low levels of parasitemia for months after completing treatment.
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