{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:07:59Z","timestamp":1788984479405,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Llura A. Gund Laboratory for Vector borne Disease Research"},{"DOI":"10.13039\/100020167","name":"Gordon and Llura Gund Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020167","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R03AI176091-02"],"award-info":[{"award-number":["1R03AI176091-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30CA008748"],"award-info":[{"award-number":["P30CA008748"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Dammin and Windsor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Relapsing babesiosis often occurs in highly immunocompromised patients and has been attributed to the acquisition of resistance against drugs commonly used for treatment such as atovaquone, azithromycin, and clindamycin. Tafenoquine, which is approved for malaria prophylaxis and presumptive antirelapse treatment of Plasmodium vivax malaria, has shown activity against Babesia microti in several animal models of acute infection and in a single human case of relapsing babesiosis. Here, we report 5 cases of relapsing babesiosis treated with tafenoquine, including the previous case, and begin to define the conditions for optimal use of tafenoquine in relapsing babesiosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A definitive diagnosis of babesiosis was made by microscopic examination of Giemsa-stained thin blood smears or a real-time polymerase chain reaction (PCR) that targets the parasite 18S rRNA gene. Clearance of B. microti infection was ascertained by use of blood smear and real-time PCR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Tafenoquine was initiated with a loading dose of 600\u2005mg. A weekly maintenance dose consisted of 200 mg or 300\u2005mg; the lower dose was associated with a delayed clearance of B. microti. In 2 cases, all antimicrobial agents but tafenoquine were discontinued prior to clearance of infection. In 2 other cases, clearance was achieved while tafenoquine was administered along with other antimicrobial agents. In 3 of these 4 cases, tafenoquine was used in combination with atovaquone-proguanil. Other agents included atovaquone, azithromycin, and\/or clindamycin. In 1 case, tafenoquine was administered alone and failed to prevent relapse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Tafenoquine can be a useful adjunct for the treatment of highly immunocompromised patients experiencing relapsing babesiosis caused by B. microti.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae238","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T20:41:13Z","timestamp":1717101673000},"page":"130-137","source":"Crossref","is-referenced-by-count":22,"title":["Tafenoquine for Relapsing Babesiosis: A Case Series"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3498-9454","authenticated-orcid":false,"given":"Peter J","family":"Krause","sequence":"first","affiliation":[{"name":"Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine , New Haven, Connecticut , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Rogers","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Warrant Alpert Medical School of Brown University , Providence, Rhode Island , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika K","family":"Shah","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York , USA"},{"name":"Department of Medicine, Weill Cornell Medical College, Cornell University , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HeeEun","family":"Kang","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center , Lebanon, New Hampshire , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Parsonnet","sequence":"additional","affiliation":[{"name":"Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Medical Center , Lebanon, New Hampshire , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich","family":"Kodama","sequence":"additional","affiliation":[{"name":"Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Vannier","sequence":"additional","affiliation":[{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"2024071918113504400_ciae238-B1","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1093\/cid\/ciaa1216","article-title":"Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis","volume":"72","author":"Krause","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2024071918113504400_ciae238-B2","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1056\/NEJM200011163432004","article-title":"Atovaquone and azithromycin for the treatment of babesiosis","volume":"343","author":"Krause","year":"2000","journal-title":"N Engl J Med"},{"key":"2024071918113504400_ciae238-B3","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1086\/525852","article-title":"Persistent and relapsing babesiosis in immunocompromised patients","volume":"46","author":"Krause","year":"2008","journal-title":"Clin Infect Dis"},{"key":"2024071918113504400_ciae238-B4","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1093\/clinids\/22.5.809","article-title":"Babesiosis in patients with AIDS: a chronic infection presenting as fever of unknown origin","volume":"22","author":"Falagas","year":"1996","journal-title":"Clin Infect Dis"},{"key":"2024071918113504400_ciae238-B5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ijmm.2007.01.002","article-title":"First case of human babesiosis in Germany\u2014clinical presentation and molecular characterisation of the pathogen","volume":"297","author":"Haselbarth","year":"2007","journal-title":"Int J Med Microbiol"},{"key":"2024071918113504400_ciae238-B6","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1056\/NEJMcpc079011","article-title":"Case records of the Massachusetts General Hospital. 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