Table 1.

Babesia divergens infections in Europe.

Year	Country	Age, Gender, (Outcome)	Course of Disease *	Co-Morbidities Compl./Unusual Features	Misdiagnosis, Time from Symptoms until Diagnosis: Prior ad./Post ad.	Parasitemia	Antibabesial Therapy	References
1957–1998 22 cases	10× in France (8 cured, 2 died) 6× British Isles (2 cured, 4 died) 1× Russia (died) 2× Spain (1 cured, 1 died) 1× Sweden (cured) 1× Switzerland (cured) ** 1× Ex-Yugoslavia (died)		mild to lethal	Co-morbidities: Hodgkin’s disease, splenectomy, hypertension, diabetes; Compl: ARF, ARDS, shock, HLH, cardio-respiratory arrest, cardiac effusion	malaria, 3 days/10 days or diagnosis post mortem	2–80%	Drugs used: QN + CLI, QN +CHQ PNT + CTM QN + CLI + PNT QN + DOX CH + CLI CH + DOX + MEF ET	[64]
1999–2021 Asplenic and Hyposplenic Patients
1999	France	44, M, splenecto-mized (cured)	mild to moderate	NI	3 days/1 day	1%	QN + CLI	[69]
2003	Portugal	66, M, splenecto-mized (died)	severe to lethal	Co-morbidities: MI 1984, subtotal gastrectomy; Compl: ARDS, ARF	malaria, 1 week/4 days	30%	QN + CLI + VI	[14]
2004	Finland	53, M, rudimentary spleen (died)	severe to lethal	Co-morbidities: severe alcohol-induced pancraetitis, diabetes type 1; Compl: Septic shock, multiple organ failure, pulmonary aspergillosis, UF: ECM	1 week/2 days	10%	QN + CLI + CFX, ET	[44]
2005	France	51, M, splenecto-mized (cured)	moderate to severe	Compl: ARF, ARDS	2 days/1 day	60%	QN + CLI	[70]
2015	Norway	58, M, splenecto-mized (cured)	severe	Compl: ARF, ARDS, atrial fibrillation	FUO, 4 days/2 days	30%	QN + CLI, ET	[73]
2015	Spain	37, M, splenecto-mized (cured)	moderate to severe	Co-morbidity: newly diagnosed HIV; Compl: HLH, ARDS	Mycobacterium spp., 3 days post ad.	low	QN + CLI, AZM + ATQ	[74]
2015	Turkey	28, F, splenecto-mized (cured)	moderate to severe	NI	malaria, 1 month/2 days	50%	ET, QN + CLI	[77]
2017	Ireland	79, M, hypo-splenism (cured)	moderate to severe	Co-morbidities: adult celiac disease, pulmonary TB; Compl: ARF, HAP	7 days/2 days	20%	ATQ + AZM, CLI + QN	[78]
1999–2021 Normosplenic Patients
2011	France	37, F (cured)	mild	NI	TBD, 3 weeks post ad.	0.29%	DOX	[71]
2011	Spain	46, M (cured)	moderate to severe	Compl: ARF, relapse	3 days/1 day	10%	QN + CLI; relapse: AZM + AP	[75]
2018	Spain	87, F (died)	severe to lethal	Co-morbidities: ovarian tumor, malignant hypertension, transient ischemic attacks, osteoporosis; Compl: ARF, bleeding disorders, cardio-respiratory arrest	3 months/4 days	2.9%	AZM + AP	[76]
2020	France	6 patients, no information about sex and age (cured)	mild to moderate	UF/Compl: 1× unusual cutaneous symptom, 1× K. pneumonia septicemia and hepatic abscesses, 1× acute pneumonia, 1× febrile eosinophilic panniculitis	retrospective analysis	In 2/6 pos.	2 patients: DOX 2 patients: AZM + ATQ 1 patient: CTX + SPI 1 patient: COX + AMC + OFX	[72]
2021	UK	72, F (NI)	moderate to severe	NI	3 days/1 day	20%	NI	[79]

M—male, F—female, ND—not done, NI—no information, pos.—positive, ad.—admission, UF—unusual feature, Compl.—complications, FUO—fever of unknown origin, MI—myocardial infarction, TB—tuberculosis, TBD—bacterial tick-borne disease, ARF—acute renal failure, ARDS—acute respiratory distress syndrome, HAP—hospital-acquired pneumonia, HLH—hemophagocytic lymphohistiocytosis. * Classification of disease severity followed criteria suggested by Vannier and Krause (2009) [80]. ** infection probably acquired in Wales. AZM—azithromycin, ATQ—atovaquone, AP—atovaquone/proguanil, QN—quinine, CLI—clindamycin, VI—vibramycin, CTX—ceftriaxone, COX—cefotaxime, AMC—amikacin, OFX—olfloxacin, CHQ—chloroquine, PNT—pentamidine, CTM—cotrimoxazole, CH—chinin, MEF—mefloquine, ET—exchange transfusio