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TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Babesiosis is a tick-borne illness caused by B. microti and other species and transmitted by the Ixodes tick. Acute respiratory distress syndrome (ARDS) can be a manifestation of babesiosis. CASE PRESENTATION: A 69 year old female with the past medical history of HTN, HLD and hypothyroidism who presented to hospital for 1 week of intermittent fever and generalized body aches. Patient denied any tick bites. She started to have intermittent fever around 40°C, nonproductive cough and generalized body aches, associated with night sweats, nausea, diarrhea. She took 1000mg Tylenol every 4 hours for fever and body aches for 1 week without improvement.Upon admission laboratory values were significant for hemolytic anemia (Hgb 9.4 g/dL, reticulocyte count 1.2%, LDH 4896 U/L, haptoglobin < 8mg/dL, total bilirubin 2.3 mg/dL), thrombocytopenia (platelet 38× 103/mm3) and leukopenia (WBC 2.7× 103/mm3), significantly elevated acetaminophen level (22.6), transaminitis (ALT 365 IU/L, AST 579 IU/L) and elevated INR (1.4). Blood parasite smear was positive for blood parasites (Malaria/Babesia: 9.6% RBC infected). Babesia Microti DNA RT-PCR was positive, Babesia Microti Ab (IgM) ≥ 1:320, Babesia Microti Ab (IgG) was 1:512, E. Chaffeensis Ab Ig G <1:64, E. Chaffeensis Ab Ig M <1:20, Lyme Ab Scr-Q <0.90. HIV and blood culture was negative. SARS-CoV-2 RNA was negative.Patient was admitted and received Acetylcysteine for acetaminophen toxicity, atovaquone, azithromycin, doxycycline for Babesia and borreliosis coverage. On day 2 of admission, acetaminophen level decreased to less than 10, transaminitis slowly improved. But patient developed shortness of breath, cough and hypoxia. Concerning severe babesiosis induced ARDS, chest CT angiogram was ordered and showed no evidence of pulmonary embolism but mild pulmonary interstitial edema. 2D Echo showed normal left ventricular systolic function and mild diastolic dysfunction. Patient received IV Lasix, symptoms improved and the CXR on day 6 showed pulmonary edema resolved.In the following days, patient continued to receive treatment for babesiosis, blood parasitemia cleared but Hgb decreased to 6.7 g/dL, patient received transfusion and Hgb level remained 7.9 g/dL on the day of discharge. 5 days after discharge, patient's Hgb level increased to 9 g/dL. 1 month after discharge, Hgb level increased to 12g/dL and transaminase level returned to normal. DISCUSSION: ARDS is a life-threatening condition characterized by severe hypoxemia due to pulmonary gas exchange failure. Though uncommon, tick-borne diseases could present with ARDS. Moreover, acetaminophen toxicity has also been linked to acute lung injury, making the correct diagnosis challenging. Early recognition and intervention led to a favorable outcome. CONCLUSIONS: ARDS can be an early onset manifestation after initiation of treatment for babesiosis and usually resolves with supportive treatment. REFERENCE #1: Autoimmune hemolytic anemia associated with babesiosis.Roshni Narurkar, Aleksandra Mamorska-Dyga, John C. Nelson and Delong Liu.Biomarker Research (2017) 5:14. REFERENCE #2: Yousef Nassar, Seth Richter. Babesiosis Presenting as Acute Liver Failure. Case Rep Gastroenterol 2017;11:769–773. REFERENCE #3: Boustani MR, Lepore TJ, Gelfand JA, Lazarus DS. Acute respiratory failure in patients treated for babesiosis. Am J Respir Crit Care Med. 1994 Jun;149(6):1689-91. doi: 10.1164/ajrccm.149.6.8004331.PMID: 8004331 Review. DISCLOSURES: No relevant relationships by Heather Bernstein, source=Web Response No relevant relationships by ALKA FARMER, source=Web Response No relevant relationships by CUIPING LI, source=Web Response No relevant relationships by Vinay Nakhate, source=Admin input No relevant relationships by kiritkumar parmar, source=Web Response No relevant relationships by Lin Zheng, source=Web Response
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The HR has a significant role to play in crisis management. The corona virus eruption is initial and foremost a person's tragedy, moving many thousands of individuals. The COVID-19 pandemic is spreading at an unprecedented speed. “Common respiratory disease, that's worst this year then the foremost, may be a way more vital threat to the world. The crisis can impact your organization and employees resulting in a fatal impact on an organization’s business gain and even sustainability. The foremost necessary issue HR leaders can do is to stay up that perspective and guard against over-reaction. Fears concerning the corona virus are comprehensible. By providing employees with correct knowledge concerning corona virus, HR leaders can maintain sensible order and defend the organization against potential liability. Therefore on avoid the unfold of data, HR leaders need to endeavor to form certain that employees aren’t sharing false information or gossiping concerning others. Scientists still aren’t entirely positive but the virus is transmitted and, for now, there is no immunizing agent to protective cover against it. We are going to use the trends to adapt organizations and additionally the personnel to the new things, and part to assist to put together the new scenario. HR ought to take the responsibility to confirm that their organizations are aware about the impact of internal strengths & weaknesses on the human aspect to differing kinds of crises and also the crisis management set up covers all potential HR risks, concerns, and needs. After few days, people massively stepped up the use of technologies that modify remote learning, working, services and consumption. However this crisis is teaching us a vital human lesson. It’s a health and safety crisis initial and economic and business drawback second. We've to have concern about creating individuals safety first. © 2020 SERSC.