10.6084/m9.figshare.7520255.v2 Silvia Alvarez De Leon Silvia Alvarez De Leon Priyasha Srivastava Priyasha Srivastava Alberto E. Revelo Alberto E. Revelo Aparna Kadambi Aparna Kadambi Marc Y. El Khoury Marc Y. El Khoury Gary P. Wormser Gary P. Wormser Oleg Epelbaum Oleg Epelbaum Babesiosis as a cause of acute respiratory distress syndrome: a series of eight cases Taylor & Francis Group 2020 Babesiosis tick-borne infection acute respiratory distress syndrome ARDS 2020-03-10 17:48:14 Journal contribution https://tandf.figshare.com/articles/journal_contribution/Babesiosis_as_a_cause_of_acute_respiratory_distress_syndrome_a_series_of_eight_cases/7520255 <p><b>Objectives</b>: The characteristics of patients with Acute Respiratory Distress Syndrome (ARDS) as a complication of <i>Babesia microti</i> infection have not been systematically described.</p> <p><b>Methods</b>: Adult patients admitted to the medical intensive care unit (MICU) of a tertiary care hospital in the Lower Hudson Valley of New York from 1/1/2008 to 8/1/2016 were evaluated for ARDS complicating babesiosis.</p> <p><b>Results</b>: Of 22 patients with babesiosis in the MICU, eight (36.4%; 95% CI: 19.7–57.0%) had ARDS. Six patients (75%) developed ARDS following initiation of anti-babesia drug therapy; however, the mean duration of symptoms in these patients exceeded that of patients who developed ARDS prior to initiation of treatment (7.50 ± 3.83d vs. 4.50 ± 0.71d, p = 0.34). Three patients (37.5%; 95% CI: 13.7–69.4%) expired without recovery from ARDS. In comparison, the mortality rate for the 14 MICU babesiosis patients without ARDS was 14.3% (p = 0.31). There was a trend toward younger age in survivors relative to non-survivors (mean age 54.6 ± 13.8y vs. 74.0 ± 6.24y, p = 0.07). Three of the five survivors did not require mechanical ventilation. The mean sequential organ failure assessment score of non-survivors was significantly higher than that of survivors (12.3 ± 1.15 vs. 6.0 ± 1.4, p = 0.0006).</p> <p><b>Conclusion</b>: Among 22 critically ill adult patients with <i>B. microti</i> infection, ARDS developed in eight (35.4%), and three (37.5%) expired without resolution of the ARDS. ARDS often followed the initiation of anti-babesia drug therapy, raising the question of whether the death of the parasite per se contributed to its development. However, this observation was confounded by the longer duration of symptoms preceding initiation of drug therapy.</p>