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Medscape
17-07-2025
- Health
- Medscape
Fever, Anaemia, or Heart Failure? A Rare Tick Case
A 74-year-old woman presented with fever, chills, fatigue, and shortness of breath 2 weeks after a tick bite of unknown attachment duration. Initial testing for tick-borne illnesses, including Borrelia, Ehrlichia , Anaplasma , and Babesia , was negative. As her condition progressed, she developed haemolytic anaemia. A repeat peripheral blood smear revealed 4.5% parasitaemia, confirming severe babesiosis. Despite treatment with atovaquone and azithromycin, no clinical improvement was observed. Echocardiography alone led to a complete diagnosis. Marie Yung-Chen Wu, MD, MPH, and colleagues at MetroWest Medical Center in Framingham, Massachusetts, reported the case of a complex parasitic infection. The Patient and Her History The patient had a history of asthma and giant cell arteritis and presented to the emergency room with fever, chills, fatigue, exertional dyspnoea, and a nonproductive cough lasting 1 week. She denied experiencing chest pain, palpitations, dysuria, changes in bowel movements, or flank pain. Her family history was significant for liver failure in her father and pancreatic cancer in her mother. She was a former smoker and did not use alcohol or substances other than marijuana. Two weeks before the presentation, she had sustained a tick bite. Findings and Diagnosis On admission, she was febrile with a temperature of 39.4 °C, tachycardic with a heart rate of 124 beats/min, hypertensive with a blood pressure level of 151/67 mm Hg, tachypnoeic with a respiratory rate of 22 breaths/min, and had an oxygen saturation of 94% on room air. Initial laboratory tests showed leucocytosis (16.5 K/μL) with a left shift, normal haemoglobin, and a normal platelet count. Renal function was within normal limits, while liver transaminases were elevated (alanine transferase, 70 U/L; aspartate transaminase, 84 U/L), along with an increased total bilirubin (1.3 mg/dL). Polymerase chain reaction tests for SARS-CoV-2 and influenza A and B were negative. An elevated D-dimer level (4.85 µg/mL) prompted evaluation for thromboembolism, which was excluded by CT angiography of the chest. CT also showed no evidence of consolidation or pleural effusions. Testing for tick-borne diseases, including peripheral smears for Ehrlichia , Anaplasma , and Babesia ; Lyme antibodies; and blood cultures, was initially negative. Empiric doxycycline was initiated to treat potential tick-borne illnesses and atypical respiratory infections. Despite this, the patient's condition worsened, with persistent fever and worsening shortness of breath. Haemoglobin and platelet counts declined. Persistently elevated liver enzymes led to an abdominal ultrasound, which revealed nodularity of the liver capsule but no abnormalities in the gallbladder or biliary tract. A CT scan of the abdomen and pelvis confirmed nodular changes in the liver contour, while magnetic resonance cholangiopancreatography ruled out biliary duct dilation. Additional testing for HIV, Epstein-Barr virus, cytomegalovirus, fungi, and hepatitis viruses was negative. Doxycycline was discontinued, and empiric broad-spectrum antibiotics with piperacillin/tazobactam were initiated. Despite treatment, the patient remained febrile and developed progressive anaemia. A haemolysis panel revealed an elevated lactate dehydrogenase level of 658 U/L. A repeat set of thin and thick blood smears for parasites showed 4.5% Babesia parasitaemia. Atovaquone and azithromycin were started, and piperacillin/tazobactam was discontinued. However, her haemolytic anaemia worsened, with haemoglobin levels dropping to 8 g/dL, prompting the need for exchange transfusion. Laboratory tests showed a markedly elevated pro-B-type natriuretic peptide level of 15,716 ng/mL. Chest x-ray revealed cardiomegaly, engorged pulmonary vasculature, and bilateral pleural effusions, consistent with acutely decompensated heart failure. Echocardiography demonstrated global hypokinesis with an estimated left ventricular ejection fraction between 15% and 20%. Despite prompt diuresis, her respiratory distress progressed, necessitating intubation and mechanical ventilation. She subsequently developed refractory cardiogenic shock, requiring vasopressor support with norepinephrine and inotropic support with dobutamine. Parasitaemia responded well to atovaquone and azithromycin, achieving complete clearance after 5 days. Antimicrobial therapy was continued for an additional 14 days until the patient's symptoms improved. Discussion 'This case illustrates shortness of breath resulting from stress-induced cardiomyopathy triggered by severe babesiosis, an uncommon and diagnostically challenging presentation. Clinicians should remain alert to rare presentations like this one to enable timely recognition and appropriate management of this potentially life-threatening infection,' the authors wrote.
Yahoo
27-05-2025
- General
- Yahoo
Woman ID'd, driver charged in fatal pedestrian crash in Framingham
Officials have released the name of a 41-year-old woman who died in a pedestrian crash in Framingham over Memorial Day weekend. Julie Stewart died after she was hit by a driver in the area of 1881 Worcester Road, or Route 9, near the offramp to Route 30, at around 10:25 p.m. Saturday, May 25, the Middlesex County District Attorney's office said Tuesday. First responders performed CPR on Stewart at the scene of the crash. She was brought to MetroWest Medical Center in Framingham, where she later died, according to officials. The operator of the vehicle, later identified as 44-year-old Stewart Anderson, of Framingham, had left the scene, officials said. Anderson was later identified and has since been arraigned in Framingham District Court on one charge of leaving the scene of an accident-causing personal injury or death, according to the DA's office. Anderson's bail was set at $100,000 Tuesday with the condition of no driving. The crash is still under investigation by Framingham Police, Massachusetts State Police and the Middlesex County District Attorney's Office. Man died in Webster house fire, reports say Man killed in fire at multi-family home in Revere, fire officials say Fatal Cape Cod house fire caused by smoldering cigarettes, fire officials say Read the original article on MassLive.
Yahoo
27-05-2025
- General
- Yahoo
41-year-old woman dies in pedestrian crash in Framingham
A 41-year-old woman was killed in a pedestrian crash in Framingham over Memorial Day weekend, according to police. The crash occurred at 1881 Worcester Road, or Route 9 near the offramp to Route 30, at around 10:25 p.m. Saturday, May 25, Framingham police said. The woman involved in the incident was brought to MetroWest Medical Center in Framingham, where she later died. The woman's name has yet to be released. The person driving did not stay on scene after striking the woman, police said. They were later identified as 44-year-old Stewart Anderson of Framingham. Anderson was arrested and charged with leaving the scene of an accident-causing personal injury/death. The crash is under investigation by Framingham Police, Massachusetts State Police and the Middlesex County District Attorney's Office. Man died in Webster house fire, reports say Man killed in fire at multi-family home in Revere, fire officials say Fatal Cape Cod house fire caused by smoldering cigarettes, fire officials say Read the original article on MassLive.
