The diagnostic alternatives for newborns’ thrombocytopenia (low platelet count) are broad, ranging from infection to fetal and neonatal alloimmune thrombocytopenia (FNAIT), as illustrated by a recently published case report in Index of Suspicion.
The case involved a 30-month-old girl with no relevant medical history before developing high-grade fever preceded by 3 days of flu-like symptoms. The patient’s obstetric history was unremarkable, and she had normal laboratory results after birth.
“Thrombocytopenia in febrile neonates should prompt a broad differential diagnosis beyond typical bacterial and viral pathogens; a peripheral blood smear can be an important diagnostic test in these cases,” the authors wrote.
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Upon emergency room admission, the patient’s physical examination revealed an enlarged liver, as well as elevated heart rate and respiratory frequency. Initial laboratory tests showed significant thrombocytopenia, elevated inflammatory markers, and mildly elevated white blood cells (WBC). Cerebrospinal fluid, urine and respiratory panel tests turned out normal. The patient was started on empiric antibiotic therapy, underscoring the severity of her condition and the need for an early and accurate diagnosis.
The authors mentioned the wide diagnostic possibilities including viral infection, bacterial infection, autoimmune disease and FNAIT. In this case FNAIT was ruled out early, as patients typically present symptoms during the first two weeks of life, underscoring the importance of early diagnosis in such cases.
In search of further diagnostic clues, her physicians performed a peripheral blood analysis, a meticulous process that involves observing the structure of blood cells under a microscope. The results showed that her red blood cells (RBC) contained Babesia parasites, the babeosis diagnosis was later confirmed through molecular testing, demonstrating the thoroughness of the diagnostic process.
Babesia, typically transmitted through tick bites, was the cause of the patient’s condition. The patient lived in a wooded area of New Jersey, where tick bites are common, and the mother reported tick bites during pregnancy. Common symptoms of Babesia infection include fever, fatigue, thrombocytopenia, enlarged liver, and anemia. Maternal transmission during pregnancy is rare, and this case is only the 13th reported instance in medical literature, underscoring its significance.
“While babesiosis can be a self-limited illness in children and adults, the illness course appears more severe in infants,” the authors wrote.
After diagnosis, the patient continued guideline-guided antibiotic therapy, received platelet and blood transfusions, and experienced complete recovery 14 days after treatment initiation.
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