Broad Antimicrobial Resistance in a Case of Relapsing Babesiosis Successfully Treated With Tafenoquine

Ralph Rogers; Peter J Krause; Ashlyn M Norris; Michelle H Ting; Ellen H Nagami; Brian Cilley; Edouard Vannier

doi:10.1093/cid/ciac473

Broad Antimicrobial Resistance in a Case of Relapsing Babesiosis Successfully Treated With Tafenoquine

Clin Infect Dis. 2023 Feb 18;76(4):741-744. doi: 10.1093/cid/ciac473.

Authors

Ralph Rogers¹, Peter J Krause², Ashlyn M Norris³, Michelle H Ting³, Ellen H Nagami⁴, Brian Cilley⁵, Edouard Vannier⁶

Affiliations

¹ Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
² Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA.
³ Department of Pharmacy, Rhode Island Hospital, Providence, Rhode Island, USA.
⁴ Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ South County Primary Care, South County Health, Narragansett, Rhode Island, USA.
⁶ Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA.

PMID: 35684960
DOI: 10.1093/cid/ciac473

Abstract

We describe a case of relapsing babesiosis in an immunocompromised patient. A point mutation in the Babesia microti 23S rRNA gene predicted resistance to azithromycin and clindamycin, whereas an amino acid change in the parasite cytochrome b predicted resistance to atovaquone. Following initiation of tafenoquine, symptoms and parasitemia resolved.

Keywords: antimicrobial resistance; babesiosis; relapse; ribosome; tafenoquine.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Aminoquinolines* / therapeutic use
Atovaquone
Babesiosis* / drug therapy
Drug Resistance / genetics
Humans
RNA, Ribosomal, 23S / genetics
Recurrence

Substances

Atovaquone
tafenoquine
Aminoquinolines
RNA, Ribosomal, 23S