Extended-Spectrum β-Lactamases in Escherichia coli and Klebsiella pneumoniae in Gulls, Alaska, USA

Previously reported babesiosis cases in children have been mostly acquired by blood transfusion (10). The patient had no history of transfusions with blood products and had never traveled outside his home town before disease onset. Although he and his parents did not recall any tick bites, he was at high risk for exposure to ticks because he often played with his dog, which frequently went outdoors in a tick-infested forested area. The dog may have transmitted a Babesia sp.–infected tick to the patient. However, ticks from the dog were not available for identification and testing. The patient in our study was presumed to be healthy and immunocompetent, which indicates that Babesia species can cause infections even in healthy persons. Babesiosis should be considered in the differential diagnosis of patients with a history of tick exposure and prolonged and irregular fever. Blood smear evaluation for intraerythrocytic parasites should be considered. The patient was treated with azithromycin and atovaquone and the parasites were cleared within 1 month. This combined treatment was well tolerated and effective, and it can be recommended as an alternative treatment to the commonly used therapy of quinine and clindamycin (1).