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Asymptomatic Babesiosis in a Child With Hepatoblastoma Angela Rech, MD, Christina Matzenbacher Bittar, MD, Cláudio Galvão de Castro Jr., MD, MsC, Kenia Rosário Azevedo, MD, Rodrigo Pires dos Santos, MD, Adão Rogério Leal Machado, MD, MsC, Gilberto Schwartsmann, MD, PhD, Luciano Goldani, MD, PhD, and Babesiosisisatickborneillnesscausedbytheredbloodcell parasite Babesia sp.1 Recent studies have shown that Ba- besia can persist asymptomatically for long periods2 and canbe acquired from sources other than ticks, such as blood trans-fusions.3 The first report of a human case of Babesia (Babesiabovis) infection occurred in Yugoslavia in 1956.4 A case ofhuman babesiosis was described in an adult in Brazil.5 CASE REPORT
A 2-year-old boy was referred to us in September 2002 with a fetal hepatoblastoma with pulmonary metastasis. Mi-croscopic examination of blood smears revealed red blood cellinclusions consistent with Babesia microti (Fig. 1). The familyreported no previous contacts with wild animals, no priorblood transfusions, and no recent travel. The patient was FIGURE 1. Peripheral blood with red blood cells showing in-
placed on antibiotic treatment with clindamycin. Posttreat- clusions consistent with Babesia microti (ן1,000).
ment evaluation showed no evidence of babesiosis in the pe-ripheral blood. He was then started on chemotherapy using a immunocompromised patients.3 Our patient presented with an combination of cisplatin, carboplatin, and doxorubicin. The tu- asymptomatic form of babesiosis and a moderate degree of mor was completely resected in March 2003 but relapsed lo- parasitemia, which was diagnosed by incidental observation of cally 2 months after surgery. The family refused further treat- the presence of parasites. Confirmatory tests such as PCR or ment and the patient was provided with palliative therapy.
ELISA were not performed in this patient. Malaria could bemisdiagnosed as babesiosis, but the endemic region of this dis- DISCUSSION
ease starts more than 1,500 km north of our state. Physicians As babesiosis is not a common disease in Brazil, it is should be aware of babesiosis, even in a region with no previ- possible that some cases have been misdiagnosed or not re- ously reported cases. This is particularly relevant when treat- ported. In the past decade, cases of babesiosis in humans have ing immunocompromised patients, who may have severe been reported with increasing frequency, especially in the northeastern United States.6 Most cases of B. microti infectionare relatively asymptomatic in the immunocompetent host. In REFERENCES
contrast, babesiosis can be a severe and life-threatening infec- 1. Hatcher JC, Greenberg PD, Antique J, et al. Severe babesiosis in Long tion, especially in splenectomized, HIV-positive, and other Island: Review of 34 cases and their complication. Clin Infect Dis. 2001;32:1117–1127.
2. Krause P, Spielman A, Telford III Sr, et al. Persistent parasitemia after Received for publication June 2, 2003; accepted August 1, 2003.
acute babesiosis. N Engl J Med. 1998;339:160–165.
3. Dobroszycki J, Herwaldt B, Boctor F, et al. A cluster of transfusion- From the Pediatric Oncology Unit, Clinical Pathology Unit, and Medical On- associated babesiosis cases traced to a single asymptomatic donor. JAMA.
cology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
4. Steketee RW, Eckman MR, Burgess E, et al. Babesiosis in Wisconsin.
Reprints: Angela Rech, MD, Hospital de Clinicas de Porto Alegre, Pediatric Oncology Unit, Rua Ramiro Barcelos 2350,3 leste, 90035-003 Porto 5. Alecrim I, Pinto B, Avila T, et al. Registo do primeiro caso de infecção Alegre, RS, Brazil (e-mail: [email protected] or [email protected]
humana por Babesia sp no Brazil. Rev Patol Trop. 1983;12:11–29.
6. Mylonakis E. When to suspect and how to monitor babesiosis. Am Fam Copyright 2004 by Lippincott Williams & Wilkins Physician. 2001;63:1969–1974.
J Pediatr Hematol Oncol • Volume 26, Number 3, March 2004

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Fluoxetine plus cognitive behavioural therapy improves symptomsof major depressive disorder in adolescentsMarch J, Silva S, Petrycki S, et al. Fluoxetine, cognitive-behavioral therapy, and their combination foradolescents with depression: treatment for adolescents with depression study (TADS) randomizedcontrolled trial. JAMA 2004;292:807–20. . . . . . . . . . . . . . . . . . . . . . . . . .

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Doctor’s assumption bias – fact or fiction Trudie Rogers There is a theory that doctors will behave according to their bias when treating a patient. For instance, if a patient presents to emergency (who is known to be a drug addict) complaining of severe pain (such as a migraine) and requesting pain relief, the doctor will assume the patient is after Schedule 8 drugs. There is, in

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