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      Babesiosis, Significance of Spleen Function Illustrated by Postsplenectomy Course in 3 Cases


      Abstract We present 3 cases of babesiosis: (a) in a patient (50-year-old man) who, immediately after splenectomy for spleen rupture, developed fulminant Babesia infection and subsequently was treated successfully; (b) babesiosis in a patient (71-year-old man) whose spleen ruptured and his postsplenectomy course was uneventful due to the fact that Babesia infection was recognized timely and treated in the perioperative period; and (c) babesiosis in a patient (66-year-old woman) who underwent splenectomy in the past and years later developed Babesia infection with fulminant course. Three major conclusions: (1) babesiosis may cause or contribute to spleen rupture, as the first 2 cases showed; (2) babesiosis may be a severe disease in a postsplenectomy patient, independent if recent or remote, as first and third cases showed; and (3) clinical and morphological warning: babesiosis may not be readily identified after splenectomy because of overwhelming reactive thrombocythemia (first case) or may not be recognized because of overwhelming infestation not corresponding to textbook pictures or personal experience with typical cases (third case). A patient undergoing splenectomy should be carefully checked for preexisting babesiosis to ensure an uncomplicated postsplenectomy course.

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