This conference discussed two vector borne cases: A subacute CNS process (West Nile Virus) that is only diagnosed after obtaining more history (dead birds) after a second LP. The second case centers on an asplenic older man with fever, hemolytic anemia, hyperbilirubinemia, thrombocytopenia, and eventually shock, renal failure, and respiratory failure. Because the patient had not traveled to an endemic area (but rather it’s the pathogen that is traveling to new areas), diagnosis was delayed until an (automatic) review of peripheral blood smear found high-grade parasitemia (severe babesiosis). It also has pictures from my trip to Alaska!
The teaching portion focuses on practical exposure-based reasoning: when to ask about farming, animals, ticks, mosquitos, asplenia, splenectomy, and “domestic travel” that may not feel like travel to the patient. It reviews babesiosis as a malaria mimic, risk factors for severe disease, diagnostic pitfalls on blood smear, and treatment decisions including atovaquone/azithromycin, severe-disease alternatives, and the role of exchange transfusion.