Atypical challenging and first case report of babesiosis in Ecuador.

Babesia is known to be prevalent in the Eastern United States and other temperate countries but the prevalence of babesia is not well known in the tropical malaria-endemic countries because of the higher prevalence of malaria. A 72-year-old Hispanic male from Ecuador presenting with increasing left lower quadrant abdominal pain and distention for one year. He experienced nausea, vomiting, diarrhea, fever, chill, and myalgias. He reported 9 kg weight loss over the last two months. Patient moved to Chicago recently from Ecuador where he worked at a banana plantation and had frequent exposure to many insects and animals. Vital signs were normal but patient appeared chronically ill. Mild tenderness to palpation over the left side of the abdomen with marked splenomegaly, measuring 16 cm below the costal margin. Laboratory results with no leukocytosis hemoglobin 7.8 × 109/L; and platelet count, 55 × 109/L. Sodium was 128 mmol/L. Labs showed elevated LDH, ESR and ferritin values. The haptoglobin was low with a positive Combs test. CT abdomen showed moderate splenomegaly with large patchy, wedge-shaped hypodense area in posterior mid and upper spleen suggesting splenic infarction. Rapid malaria screening was negative, but a peripheral smear identified plasmodium species in more than 0.5% of red blood cells. Treatment with atovaquone and proguanil started. Two weeks later, molecular testing revealed Babesia DNA. This report details a case of babesiosis in a patient coming from a malaria-endemic region. The initial workup and blood work highly suggested a plasmodium infection. However the polymerase chain reaction confirmed the diagnosis of a Babesia microti. Learning objectives: We report the first case of human Babesiosis in previously healthy individual from Ecuador.