Babesiosis is a tick-borne, malaria-like illness caused by Babesia species that infect erythrocytes of mammals incidentally. The family Babesiidae is characterized by consisting of non-pigmented intraerythrocytic parasites that reproduce within erythrocytes by asynchronous, asexual budding into two or four daughter cells (tetrad). We experienced a case of human babesiosis presenting fever and chills. The patient was a 49-year old man, who had been in Africa (Ethiopia, Uganda). Three weeks before admission intermittent spiking fever had developed, which had been accompanied by severe chills. The peripheral blood smear (Giemsa-stain) revealed characteristic forms of an intracellular quadruplet parasite compatible with Babesia. The patient was improved significantly by the treatment with quinine and clindamycin for a week.
Africa ; Animals ; Babesia ; Babesiosis* ; Chills ; Clindamycin ; Erythrocytes ; Fever ; Humans ; Mammals ; Middle Aged ; Nuclear Family ; Parasites ; Quadruplets ; Quinine

Over the past 30 years, there has been an increase in the incidence of multifetal pregna-ncies, primarily because of the introduction of ovarian stimulants for ovulation induction and assisted reproductive technology ( ART ) in infertile patients. It is well established that multifetal pregnancies are associated with an increased frequency of the maternal complications and gre-ater perinatal morbidity and mortyality. The adverse outcome of multifetal pregnancies is dire-ctly proportional to the number of fetuses, primarily as an consequence of prterm delivery. Re-duction in the number of fetuses in multifetal pregnancies has been proposed as a way to impr-ove the perinatal outcome in this situation. Therefore, selective fetal reduction ( SFR ) is sugges-ted as a therapeutic option for continuation of pregnancy with fetuses mature enough to survi-ve. In this paper, we report our infertility clinic experiences with 6 patients who carried mult- ifetal pregnancies including 1 quintuplet, 1 quadruplet, and 4 triplets. from January, 1991 to May, 1996, transabdominal SFR was accomplished by fetal intrathoracic KCl injection at 9~10 weeks of gestation. After the prcedure, 4 patients remained as twin pregnancies, and 2 patients as single pregnancy. There have been 3 sets of twin deliveries and the 2 sets of single delivery. One case was aborted. Two patients were delivered after 37 weeks of gestation, 2 patients were at 35 weeks, and 1 patient at 24 weeks. All babies have been healthy after birth in patients after 35 weeks gestation. There was no fetal anomaly related to the procedure in the 6 cases. We concluded that transabdominal SFR is a rather safe and useful procedure that may improve the outcome of multifetal pregnancies.
Fetus ; Humans ; Incidence ; Infertility ; Ovulation Induction ; Parturition ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Twin ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted ; Triplets ; Twins

Grand multifetal pregnancies (4 or more), usually caused by ovulation induction agents and assisted reproductive technologies, challenge all members of a perinatal team and put mothers and infants increased risk. Important anesthetic considerations include greater incidence of complications that in the singleton pregnancy, risks related to the large pregnant uterus, impaired uterine contraction prior to delivery secondary to fetal oxygenation, and preparation of sufficient man-power and instruments. The importance of neonatal resuscitation cannot be overemphasized. We report a successful general anesthetic management for an emergent quadruplet cesarean section at 31 weeks 5 days weeks gestational age.
Anesthesia, General ; Cesarean Section ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Mothers ; Ovulation Induction ; Oxygen ; Pregnancy ; Quadruplets* ; Reproductive Techniques, Assisted ; Resuscitation ; Uterine Contraction ; Uterus

OBJECTIVE: The prevalence of multifetal pregnancies has increased up to 30% as a result of the introduction of ovulation inducing agents for assisted reproductive teclmology(ART). An exttemely poor pognosis could be expected for viable pregnancies in multifetal gestation. So, to decrease the consequence of multiple pregnancies and prevent complications, especially premature baby irreversibly damaged, selective fetal reduction to the smaller number of fetuses should be considered in an early gestational period. METHODS: From May 1994 to Apr 1998, transvaginal selective fetal reduction in 13 pati including 9 triplet, 3 quadruplet and 1 quintuplet. Of the 13 patients, 4 were obtained by controlled ovarian hyperstimulation with intrauterine insemination (COH with IUI), 6 were by IVF-ET, 2 wae by controlled ovarian hyperstimulation with natural contact and 1 was by natural conception. Selective fetal reduction using intracardiac KC1 injection and aspiration of amniotic fluid carried out in 8-11 weeks of gestation. RESULTS: After procedures, 8 patients were remained as twin pregnancies, 5 patients as singleton pregnancies and 1 of the remaining twin embryos vanished after procedure. There have been 7 sets of twin delivery including 1 stillbirth and 3 singleton delivery. 1 cases are ongoing state. All of the singleton delivery were completed after 37 weeks of gestation. Of the twin delivery, 2 cases were delivered after 37 weeks of gestation, 2 cases in 35-37 weeks, and 3 cases before 35 weeks of gestation. Unfortunately, 1 stillbirth occurred in 20 weeks of gestation and 2 cases of singleton were aborted. As 3 losses(2 singleton, 1 twin) occurred, the delayed fetal loss rate in this selective fetal reduction was 25.0%(3/12). There was no fetal anomaly related to the procedure. CONCLUSION: Selective fetal reduction in multifetal pregnancies is a rather safe procedure and it may improve the outcome of multiple pregnancies.
Amniotic Fluid ; Embryonic Structures ; Female ; Fertilization ; Fetus ; Humans ; Insemination ; Ovulation ; Pregnancy Reduction, Multifetal* ; Pregnancy* ; Pregnancy, Multiple ; Pregnancy, Twin ; Prevalence ; Quadruplets ; Quintuplets ; Reproductive Techniques, Assisted* ; Stillbirth ; Triplets

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.
Animals ; Atovaquone* ; Azithromycin* ; Babesia ; Babesia microti ; Babesiosis* ; Chloroquine ; Clindamycin ; Communicable Diseases ; Diagnosis ; Humans* ; Malaria ; Male ; Middle Aged ; New Jersey ; Parasites ; Plasmodium ; Polymerase Chain Reaction* ; Quadruplets ; Quinine

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.
Animals ; Atovaquone* ; Azithromycin* ; Babesia ; Babesia microti ; Babesiosis* ; Chloroquine ; Clindamycin ; Communicable Diseases ; Diagnosis ; Humans* ; Malaria ; Male ; Middle Aged ; New Jersey ; Parasites ; Plasmodium ; Polymerase Chain Reaction* ; Quadruplets ; Quinine