Am. J. Respir. Crit. Care Med., Vol 149, No. 6, 06 1994, 1689-1691.
Acute respiratory failure in patients treated for babesiosis
MR Boustani, TJ Lepore, JA Gelfand and DS Lazarus
New England Medical Center, Pulmonary and Critical Care Division, Boston, MA 02111.
Babesiosis is a tick-borne protozoal disease with infrequent clinical
complications. We report three cases of noncardiogenic pulmonary edema in
patients from Nantucket Island, MA, with a history of Lyme disease and
review the clinical presentation of babesiosis and its treatment.
Respiratory complications in our patients, as well as in the four
previously reported cases in the literature, occurred a few days after
initiation of medical therapy. We hypothesize that the pathophysiology of
the pulmonary edema is multifactorial, due to decreased deformability of
the infected erythrocytes, increased cytoadherence of red blood cells in
capillaries and venules, and a possible role of excessive production of
certain cytokines, such as tumor necrosis factor and interleukin-1.
