BABESIOOSI
Soile Juvonen TTT
Yleistä babesioosista:
Babesioosin voi saada punkkien välityksellä, mutta se voi tarttua myös verivalmisteista ja sen on ainakin kahdessa tutkimuksessa todettu tarttuneen raskauden aikana äidistä lapseen. Oireet alkavat yleensä 1 - 4 viikon kuluttua punkin puremasta tai 6 - 9 viikkoa infektoituneen verivalmisteen saannista.
Euroopassa babesioosia ihmisillä aiheuttaa kaksi alalajia (B. divergens ja bovis). Babesioosi on erityisen vakava sairaus sellaisilla henkilöillä, joilla on poistettu perna ja/tai heillä on jokin immuunipuutostauti. Ensimmäinen babesioositapaus ihmisessä on kirjattu vuodelta 1957. Jugoslavialainen nuori mies, jolle oli aiemmin tehty pernanpoisto, sairastui akuuttiin kuumesairauteen. Hänellä oli anemiaa ja verta virtsassa. Tauti johti lopulta kuolemaan.
Babesioosin oireet:
Oireet ilmenevät vähitellen; fatiikki, heikotus, kuumeilu, hikoilu, pahoinvointi, päänsärky, lihassärky, nivelsärky, yleinen kankeus, yskä, painonlasku, vatsakipu, ripuli, hengenahdistus, oksentelu, tumma virtsa, sivuääniä sydämestä, keltaisuus, outoja tuntemuksia päässä (Light-headedness), suurentunut maksa/perna.
Henkilöllä voi olla yhtä aikaa myös esim. borrelioosi, ehrlichioosi ja/tai bartonelloosi.
Hoito:
Hoito tulee aloittaa mahdollimman varhaisessa vaiheessa, jotta vältetään punasolujen hajoaminen ja munuaisten toiminnan heikkeneminen. Lääkitys on samantapainen kuin malarian hoidossa. Tässä artikkelissa suositellaan Kiniiniä suun kautta 650 mg 6 - 8 tunnin välein + iv klindamysiini 1200 - 2400 mg 6 - 8 tunnin välein 7 vuorokauden ajan. Vaihtoehtoisesti voidaan käyttää klindamysiiniä azithromysiinin ja doksisykliinin kanssa tai atovaquonen ja azithromysiinin kanssa.
Tapausselostus:
71-vuotiaalla miehellä todettiin yleistä heikkoutta, lämpöilyä, keltaisuutta, vilunväristyksiä. Ei ihomuutoksia.Verikokeista löytyi hepatiitti A IgG. Miehellä oli useita babesioosille tunnusomaisia oireita, mutta lääkäri ei tunnistanut niitä. Vasta laboratoriotyöntekijä huomasi näytteessä olevan jotakin outoa. Miehellä todettiin babesioosi ja borrelioosi. Mies oli sairaalassa kaksi viikkoa ja sai tänä aikana babesioosin hoitoon kiniiniä ja klindamysiiniä IV. Sairaalasta lähtiessä veriarvot olivat normalisoituneet.
Alkuperäinen teksti:
Coinfection With Babesia microti and Borrelia burgdorferi
Angela C. Kim, MD, North Shore University Hospital, Manhasset, NY; Marcia E.
Epstein, MD, North Shore University Hospital, Manhasset, NY and New York
University School of Medicine
Infect Med 18(5):271-276, 2001. © 2001 Cliggott Publishing, Division of SCP Communications
Abstract
A diagnosis of Lyme disease was made in a 71-year-old patient with fever, chills, and generalized weakness, but concurrent babesiosis was initially missed. A technician in the hematology laboratory noticed intraerythrocytic organisms initially thought to be Plasmodium, but close inspection of the blood smear and review of the patient's history pointed to infection with Babesia.
Introduction
Babesia species are intraerythrocytic protozoans that cause a spectrum of illness in humans, ranging from asymptomatic infection to cardiac, renal, pulmonary, and CNS complications to death.[1] Most manifestations are, however, subclinical.[2] Patients with babesiosis present with fever, chills, malaise, weakness, anorexia, hemolysis, and hemoglobinuria. Babesiais a zoonotic organism transmitted to humans by the arthropod vector Ixodes dammini. Other agents of tick-borne illness include Borrelia burgdorferi, Ehrlichia equi, and Ehrlichia chaffeensis. Cases of cotransmission have been described.[3-7]
Case Report
History
A previously healthy 71-year-old man was admitted to the hospital with fevers, chills, and generalized weakness. He had been in his usual state of health until 1 week before admission, at which time fatigue, anorexia, fevers, and chills developed. He visited his internist, who initiated an outpatient workup; however, the patient became more lethargic, and his family brought him to the emergency department.
The patient recalled having eaten shellfish approximately 8 to 10 days earlier without subsequent nausea, vomiting, diarrhea, or abdominal pain. He admitted to drinking 2 to 3 glasses of red wine daily. His travel history included the summer spent on the eastern end of Long Island, NY; he returned 2 weeks before admission. He had spent time gardening but was unaware of any tick bites. There was no history of recent blood transfusion, and he was a nonsmoker.
Physical and Laboratory Examination
The oral temperature was 37.3°C (99.1°F); pulse, 95 beats per minute and regular; respirations, 18 breaths per minute; and blood pressure, 103/57 mm Hg. The patient appeared noticeably jaundiced and had scleral icterus. No rashes were visible. Lungs, heart, abdomen, and extremities were normal. No hepatosplenomegaly was appreciated. Results of a guaiac test for occult blood in stool were negative. Blood chemistries and hematologic values are presented in Tables 1 and 2, respectively. Results of an ECG and chest radiographs were normal.
These initial findings were suggestive of alcoholic hepatitis, and supportive treatment was initiated.
Hospital Course
The abdominal sonogram revealed a normal liver, contracted callbladder, normal pancreas, normal kidneys, and splenomegaly (13.2 cm). Results of hepatitis serology were positive only for hepatitis A IgG. On hospital day 3, a peripheral blood smear showed greater than 50% intraerythrocytic inclusion bodies. The thin smear was consistent with babesiosis, as shown in the Figure.
Figure1. Intraerythrocytic trophozoites of Babesia microti.
Therapy was started with oral quinine and intravenous clindamycin, but the patient continued to do poorly, with persistently elevated levels on liver function tests and depressed platelet counts. Blood was sent for testing for both Lyme disease and Ehrlichia infection, and doxycycline was empirically added to the patient's regimen. On hospital day 5, the patient underwent exchange transfusion.
Lyme titers returned positive (IgG/IgM antibodies, 3.31 test units [TU]; [1.0 TU or greater is considered positive]) by traditional enzyme-linked immunosorbent assay and were confirmed by Western blot, while results of both indirect fluorescent antibody and polymerase chain reaction (PCR) tests for Ehrlichia were negative. The patient's parasitemia improved to less than 1% after exchange transfusion and was 0% on discharge on hospital day 14, at which time he had completed a 7-day course of treatment with quinine and clindamycin.
Just before discharge from the hospital, on day 13, tests revealed the following values: total bilirubin, 2.7 mg/dL; hemoglobin, 9.8 g/dL; hematocrit, 30.4%; blood urea nitrogen, 12 mg/dL; creatinine, 1 mg/dL; aspartate aminotransferase, 42 U/L; alanine aminotransferase, 67 U/L; and alkaline phosphatase, 175 U/L.
Discussion
This patient had many symptoms and signs of babesiosis, yet the admitting physician missed the diagnosis. The diagnosis of babesiosis was not considered until an astute technician in the hematology laboratory noticed intraerythrocytic organisms, thought initially to be malaria parasites. Close inspection of the smear in conjunction with the patient's clinical history suggested infection with Babesia.
Pathogen and Pathogenesis
Human babesiosis is a zoonosis caused by protozoa of the order Piroplasmida, the family Babesiidae, and the genus Babesia. There are more than 99 species of Babesia in the world that infect various hosts and are transmitted by multiple vectors. In 1957, the first reported case of babesiosis in humans was described in a splenectomized young Yugoslavian man in whom an acute febrile illness developed with hemoglobinuria, anemia, and ultimately death.[8] In humans, only a small percentage of species have been shown to cause illness. In Europe, the infectious agent is of bovine species (Babesia divergens and Babesia bovis), and in the United States, the patients are infected with the rodent species Babesia microti. In the western United States, a newly recognized species, WA-1, has been documented to cause clinical disease.[9,10] The parasites vary in length from 1 to 5 µm and may appear pear-shaped, oval, or round.
Transmission of B microti usually occurs via the tick vector I dammini. There are 3 stages of development (larva, nymph, and adult); each requires a blood meal in order to progress to the next stage. Both the larvae and nymphs are capable of infecting humans. The adult tick, which feeds primarily on the white-tailed deer, is also capable of transmitting infection to humans.[2]
On transmission from the salivary glands of the tick, merozoites will parasitize the erythrocytes, forming trophozoites. By way of synchronous, asexual budding or binary fission, each trophozoite then gives rise to 2 or 4 merozoites; the tetrad is classically referred to as the "Maltese cross."[11] There appears not to be an exoerythrocytic stage.
It has been suggested that erythrocytic invasion occurs via a complement-mediated pathway, resulting in red cell membrane abnormality with decreased deformability.[2,12,13] The change in lipid composition in the red blood cell membrane makes parasitized cells more cytoadherent to endothelial cells.[14] The ensuing hemolytic anemia is hypothesized to result from capillary sequestration.[13] Since the pathway of schizogony is asynchronous, the anemia is generally not a massive hemolysis, such as occurs in Plasmodium infection; in some cases, the anemia may be related to disseminated intravascular coagulation.[12]
Epidemiology
In the United States, the most common pathogen of babesiosis is B microti. The infection is endemic in coastal regions of the northeastern United States, such as Nantucket, Martha's Vineyard, and Cape Cod, Mass; Block Island, RI; and Shelter Island and eastern Long Island, NY.[2] Other areas include Connecticut, Wisconsin, and California.[15-17] Most cases occur during the spring and early summer. In an epidemiologic study of babesiosis in New York in 1992, 90% of 123 cases occurred during the months of June through August.[18]
Lyme disease is endemic in the same geographic locations, since the same vector transmits both diseases. As a result, much of the epidemiologic data we have for Lyme disease may potentially be applied to babesiosis. Both reservoir and vector (the white-tailed deer and the Ixodes tick, respectively) populate these locations. Patients infected with the WA-1 strain of Babesia have been from areas of Washington and northern California; however, neither the vector nor the host has yet been described.[9,10] Patients may also become infected by receiving blood products (erythrocytes, platelets) from infected donors with asymptomatic parasitemia.[19] In addition, cases of vertically transmitted Babesia have been described. In 2 cases, a history of tick bites was ascertained without ensuing smear evidence of parasitemia in the mothers, but there was serologic evidence of acute infection. Parasitemia developed in both infants.[20,21]
Clinical Features
Symptoms usually begin 1 to 4 weeks after a tick bite or 6 to 9 weeks
post-transfusion with infected blood products. The severity of signs and symptoms varies among infecting species. In Europe, both B divergens and B bovis cause fatal illness in asplenic patients. In the United States, B microti causes less severe disease in patients with an intact spleen, and the disease rarely results in death. The signs and symptoms are gradual in onset and include constitutional symptoms, anorexia, abdominal pain, and dark urine. The fever of babesiosis is not typically cyclical, as it is with malaria. Patients may or may not recall any tick bites, but most often, there is a history of outdoor activity or travel to an area where the disease is endemic.
Physical examination findings include fever, jaundice, hepatomegaly, and splenomegaly. Table 3 lists common manifesting symptoms and signs of babesiosis. Laboratory data suggest hemolytic anemia with decreased hematocrit, elevated total and direct bilirubin levels, elevated lactate dehydrogenase level, reticulocytosis, and elevated hepatic transaminase levels. Urinalysis reveals hemoglobinuria without red blood cells. The intensity of parasitemia can vary; the parasite may be undetectable, or its concentration can be greater than 85%.[22]
Prognostic Features
Risk factors for more severe outcome include male sex, alkaline phosphatase levels greater than 125 U/L, and white blood cell counts greater than 5 3 10[9]/L.[23] A history of splenec-tomy or functional asplenia and immunodeficiency (lymphoma or AIDS) are 2 other important risk factors that portend the development of clinically apparent disease or protracted illness. However, most patients with symptomatic babesiosis with a history of asplenia were infected with B divergens or the WA-1 strain. Patients infected with B microti are usually asymptomatic.
Diagnosis
The diagnosis of babesiosis may be based on Wright- or Giemsa-tained peripheral blood smears, immunofluorescent antibody tests, and/or PCR assay. Peripheral smear may reveal parasitized erythrocytes with organisms at various stages of development, consistent with the asynchronous replication of progeny. In cases of very low parasitemia, the smear may not demonstrate the intraerythrocytic parasites or the characteristic Maltese cross tetrads. Unlike in malaria, there are no schizonts or gametocytes. To avoid overlooking the correct diagnosis in the setting of a negative peripheral blood smear, suspicion should remain high and serologic studies and PCR should be pursued, especially if there is a history of travel to locations where the disease is endemic or of splenectomy with acute febrile illness and anemia. Serologically, a titer greater than 1:64 indicates a positive result or seropositivity, and a titer greater than 1:256 suggests an acute infection.[22] Quantification of the titer has not been shown to correlate with the severity of illness. PCR is a more sensitive test and may also be used to monitor progression or resolution of infection. In addition, PCR testing may detect persistent infection in patients with prolonged symptoms.[24,25]
Treatment
Treatment should be initiated early in symptomatic patients to avoid massive hemolysis with ensuing renal failure. Cases of subclinical infection need not be treated. Recommended treatment is with oral quinine, 650 mg every 6 to 8 hours, and with intravenous clindamycin, 1200 to 2400 mg every 6 to 8 hours, for 7 days. Side effects of quinine include hemolytic anemia (precaution should be taken in patients with glucose-6-phosphate dehydrogenase deficiency), thrombocytopenia, tinnitus, vertigo, hearing loss, lupus rash, gastric distress, and QT prolongation. This medication should not be administered to pregnant patients. In those who are unable to tolerate quinine, a combination of clindamycin with azithromycin and doxycycline has been used.[26] The combination of atovaquone and azithromycin has been shown to be an effective and better-tolerated alternative regimen.[27] In patients who are refractory to pharmacologic management, exchange transfusion with red blood cells has been shown to expedite recovery, probably secondary to diminishing the parasite load.[28]
Patients may remain parasitized despite adequate therapy with resolution of symptoms, with positive PCR test results raising the question of a possible exoerythrocytic stage.[25] Some patients may even require maintenance therapy to prevent recrudescence.
Cotransmission
It is important to keep in mind other tick-borne organisms that may be cotransmitted with Babesia, such as B burgdorferi (the agent of Lyme disease) and Ehrlichia species (the agent of human granulocytic ehrlichiosis).[3,5-7] Similar geographic and seasonal distribution as well as common vectors are likely responsible for this occurrence. An epidemiologic study of 136 cases of babesiosis showed that as many as 23% had concurrent Lyme disease based on clinical and serologic data.[14] In 2 separate studies, 10% of patients with Lyme disease were found to be coinfected with B microti on the basis of serologic and PCR test results.[6,7] In a study of 55 patients with confirmed Lyme infection, 2 patients had positive antibodies to Ehrlichia species.[6] Another study demonstrated cotransmission of both B microti and B burgdorferi in hamsters by disease-infected nymph forms of I dammini.[5] Taken together, these studies emphasize the need to consider coinfection with other tick-borne illnesses when the diagnosis of 1 is made.
Patients with Lyme disease present with fever, weakness, myalgias, arthralgias and, often, the characteristic rash, erythema migrans. Patients with ehrlichiosis often present with nonspecific febrile illness without rash. Laboratory data that suggest coinfection with Ehrlichia include leukopenia, thrombocytopenia, and elevation of liver enzyme levels.
Coinfection is thought to cause more severe illness than does disease with 1 organism alone.[4] The pathophysiologic explanation is yet to be described, although speculation suggests an immunosuppressive role of Babesia as a possibility.[6]
Drugs Mentioned in This Article
Atovaquone Mepron
Azithromycin Zithromax
Clindamycin Cleocin, Clindets
Doxycycline Vibramycin,
generic
Quinine Generic
Tables
Table 1. Blood chemistries
Value
Variable Normal range Day 1 Day 4
Alanine aminotransferase (U/L) 10 - 45 58 51
Albumin (g/dL) 3.3 - 5 2.4 2
Alkaline phosphatase (U/L) 39 - 128 198 183
Aspartate aminotransferase (U/L) 10 - 40 120 124
Creatinine (mg/dL) 0.7 - 1.3 1.6 1.2
Bilirubin, direct (mg/dL) 0 - 0.2 4.5 9.6
Bilirubin, total (mg/dL) 0.2 - 1.2 7.5 14
Lactate dehydrogenase (U/L) 50 - 242 -- 1332
Total protein (g/dL) 6.0 - 8.3 6.4 --
Urea nitrogen (mg/dL) 7 - 23 30 25
Table 2. Hematology values
Value
Variable Normal range Day 1 Day 4
White cell blood cells (3 109/L) 3.8 - 10.5 7.2
Hemoglobin (g/dL) 11.5 - 15.5 10.8
Hematocrit (%) 34.5 - 45 33.2
Platelets (3 109/L) 150 - 400 80
Differential (%)
Neutrophils 43 - 77 78 --
Bands 0 - 8 5 --
Lymphocytes 13 - 44 9 --
Reactive lymphocytes 1 --
Monocytes 2 - 14 -- --
Reticulocytes (%) 0.5 - 2.5 -- 4
Absolute reticulocytes (3 109/L) 25 - 125 -- 130
Prothrombin time (s) 10 - 14 Normal --
Partial thromboplastin time (s) 24 - 34.6 Normal --
Table 3. Common findings in babesiosis: Symptoms, signs, and history
Symptoms (%) Signs (%)
Fatigue, malaise, weakness (91.4)
Fever (90.6)
Rigors (76.7)
Diaphoresis (69.2)
Nausea/anorexia (57.3)
Headache (38.7)
Myalgia (33.6)
Cough (23.7)
Weight loss (20.5)
Arthralgias (17.1)
Abdominal pain (16.3)
Dyspnea (15.6)
Light-headedness (15.3)
Vomiting (14.1)
Dark urine (12.3)
Rash (11.7)
Diarrhea (9.6) Temperature > 38.5°C (101.3°F) (55.
Murmur (21.1)
Hepatomegaly (14.4)
Splenomegaly (10.
Jaundice (4.3)
History (%)
Chronic disease (51.
Tick bite (37.5)
Lyme disease (11.9)
Splenectomy (11.7)
Blood transfusion (2.2)
Adapted from White DJ et al. Arch Intern Med. Oct 26,
1998;158:2149-2154. Copyrighted 1998, American Medical Association.
References
1. Boustani MR, Lepore TJ, Gelfand JA, Lazarus DS. Acute respiratory
failure in patients treated for babesiosis. Am J Respir Crit Care Med.
1994;149:1689-1691.
2. Gelfand JA, Callahan MV. Babesiosis. Curr Clin Top Infect Dis.
1998;18:201-216.
3. Benach JL, Coleman JL, Habicht GS, et al. Serological evidence for
simultaneous occurrences of Lyme disease and babesiosis. J Infect Dis.
1984;152:473-477.
4. Marcus LC, Steere AC, Duray PH, et al. Fatal pancarditis in a patient
with coexistent Lyme disease and babesiosis: demonstration of spirochetes in
the myocardium. Ann Intern Med. 1985;103:374-376.
5. Piesman J, Hicks TC, Sinsky RJ, Obiri G. Simultaneous transmission of
Borrelia burgdorferi and Babesia microti by individual nymphal Ixodes
dammini ticks. J Clin Microbiol. 1987;25:2012-2013.
6. Magnarelli LA, Dumler JS, Anderson JF, et al. Coexistence of
antibodies to tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme
borreliosis in human sera. J Clin Microbiol. 1995;33:3054-3057.
7. Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and
babesiosis: evidence for increased severity and duration of illness.JAMA.
1996;275:1657-1660.
8. Skrabalo Z, Deanovic Z. Piroplasmosis in man. Documenta de Medicine
Geographica et Tropica. 1957;9:11-16.
9. Quick RE, Herwaldt BL, Thomford JW, et al. Babesiosis in Washington
State: a new species of Babesia. Ann Intern Med. 1993;119:284-290.
10. Persing DH, Herwaldt BL, Glaser C, et al. Infection with a
Babesia-like organism in northern California. N Engl J Med. 1995;5:298-303.
11. Jandl JH. Blood. 2nd ed. Boston: Little, Brown and Company Inc;
1996:488-490.
12. Gelfand JA. Babesia. In: Mandell GL, Bennett JE, Dolin R, eds.
Principles and Practice of Infectious Diseases. 4th ed. Philadelphia:
Churchill Livingstone Inc; 1995:2497-2520.
13. Krogstad DJ, Sutera SP, Boylan CW, et al. Intraerythrocytic parasites
and red cell deformability: Plasmodium berghei and Babesia microti. Blood
Cells. 1991;17:209-221.
14. Wright IG, Goodger BV, Buffington GD, et al. Immunopathophysiology of
babesial infections. Trans R Soc Trop Med Hyg. 1989;83S:11-13.
15. Krause PJ, Telford SR III, Ryan R, et al. Geographical and temporal
distribution of babesial infection in Connecticut. J Clin Microbiol.
1991;29:1-4.
16. Iacopino V, Earnhart T. Life-threatening babesiosis in a woman from
Wisconsin. Arch Intern Med. 1990;150:1527-1528.
17. Steketee RW, Eckman MR, Burgess EC, et al. Babesiosis in Wisconsin.
JAMA. 1985;253:2675-2678.
18. Meldrum SC, Birkhead GS, White DJ, et al. Human babesiosis in New York
State: an epidemiological description of 136 cases. Clin Infect Dis.
1992;15:1019-1023.
19. Dobroszycki J, Herwaldt BL, Boctor F, et al. A cluster of
transfusion-associated babesiosis cases traced to a single asymptomatic
donor. JAMA. 1999;281:927-930.
20. Esernio-Jenssen D, Scimeca PG, Benach JL, Tenenbaum MJ.
Transplacental/perinatal babesiosis. J Pediatr. 1987;110:570-572.
21. New DL, Quinn JB, Qureshi MZ, Sigler SJ. Vertically transmitted
babesiosis. J Pediatr. 1997;131:163-164.
22. Boustani MR, Gelfand JA. State-of-the-art clinical article:
babesiosis. Clin Infect Dis. 1996;22:611-615.
23. White DJ, Talarico J, Chang HG, et al. Human babesiosis in New York
State: review of 139 hospitalized cases and analysis of prognostic factors.
Arch Intern Med. 1998;158:2149-2154.
24. Pruthi RK, Marshall WF, Wiltsie JC, Persing DH. Human babesiosis. Mayo
Clin Proc. 1995;70:853-862.
25. Krause PJ, Spielman A, Telford SR, et al. Persistent parasitemia after
acute babesiosis. N Engl J Med. 1998;339:160-165.
26. Falagas ME, Klempner MS. Babesiosis in patients with AIDS: a chronic
infection presenting as fever of unknown origin. Clin Infect Dis.
1996;22:809-812.
27. Krause PJ, Lepore T, Sikand VK, et al. Atovaquone and azithromycin for
the treatment of babesiosis. N Engl J Med. 2000;343:1454-1458.
28. Cahill KM, Benach JL, Bilmes E, et al. Red cell exchange: treatment of
babesiosis in a splenectomized patient. Transfusion. 1981;21:193-198.
29. White DJ, Chang HG, Benach JL, et al. The geographic spread and
temporal increase of the Lyme disease epidemic. JAMA. 1991;9:1230-1236.
30. Centers for Disease Control and Prevention. Recommendations for the
use of Lyme disease vaccine. MMWR. 1999;48:1-25.
BABESIOOSI
Valvojat: Jatta1001, Borrelioosiyhdistys, Bb
Synnynnäinen babesioosi (2009)
Emerg Infect Dis. 2009 May;15(5):788-91. Probable congenital babesiosis in infant, new jersey, USA. Sethi S, Alcid D, Kesarwala H, Tolan RW Jr. The Children's Hospital at Monmouth Medical Center, Long Branch, New Jersey,USA. Only 2 neonates with transplacentally or perinatally acquired (congenital)babesiosis have been reported. We describe a probable third congenital case ofbabesiosis in a 26-day-old infant; transmission was determined on the basis of ablood smear from the infant (15% parasitemia) and serologic results from theinfant and mother. Publication Types:Case Reports PMID: 19402971 [PubMed - indexed for MEDLINE]
Emerg Infect Dis. 2009 May;15(5):788-91. Probable congenital babesiosis in infant, new jersey, USA. Sethi S, Alcid D, Kesarwala H, Tolan RW Jr. The Children's Hospital at Monmouth Medical Center, Long Branch, New Jersey,USA. Only 2 neonates with transplacentally or perinatally acquired (congenital)babesiosis have been reported. We describe a probable third congenital case ofbabesiosis in a 26-day-old infant; transmission was determined on the basis of ablood smear from the infant (15% parasitemia) and serologic results from theinfant and mother. Publication Types:Case Reports PMID: 19402971 [PubMed - indexed for MEDLINE]
Puolalaisista punkeista löytyi aiempia tutkimuksia enemmän babesiaa. Löydökset vaihtelivat alueittain. Suurimmillaan babesiaa löytyi 5,4 %:lla punkkeja.
Ann Agric Environ Med. 2006;13(2):319-22.
Prevalence of Babesia microti in Ixodes ricinus ticks from Lublin region (eastern Poland).
Wojcik-Fatla A, Cisak E, Chmielewska-Badora J, Zwolinski J, Buczek A, Dutkiewicz
J.
Department of Occupational Biohazards, Institute of Agricultural Medicine, Jaczewskiego 2, 20-090 Lublin, Poland. awf@galen.imw.lublin.pl
A total of 1,367 Ixodes ricinus ticks collected from 5 districts of the Lublin region (eastern Poland) were examined for the presence of Babesia microti DNA by PCR and nested-PCR. As many as 74 ticks (5.4 %) were found to be infected with Babesia microti. The infection rate varied significantly with stage/sex of ticks chi (2) =16.48543, df=2, p < 0.000264). The infection rates in females and males amounted to 6.4 % and 8.8 % respectively and were significantly higher (p=0.006 and p=0.0001 respectively) compared to minimum infection rate in nymphs that was equal to 2.8 %. The prevalence of infection showed also significant variability depending on geographic location within the Lublin region (chi(2) =18.62812, df=4, p < 0.000932). The highest rates of infection with Babesia microti were noted in ticks collected from the areas of Pulawy district situated in the northern part of region and the suburban Lublin district situated in the central part of the region (8.0 % and 7.3 % respectively). Mediocre infection rates (respectively 3.4 % and 3.3 %) were found in ticks from the Parczew and Wlodawa districts situated in eastern part of the region and covered with humid lakeland forests. The lowest infection rate (0.5 %) was noted in ticks from the Zamosc district situated in southern part of the region.
In conclusion, the infection rate of Ixodes ricinus ticks with Babesia microti found in this study is higher compared to the majority of data reported by Polish and other European authors, and indicates a potential risk of human infection during occupational or recreational exposure to tick bite.
PMID: 17196008 [PubMed - in process]
Ann Agric Environ Med. 2006;13(2):319-22.
Prevalence of Babesia microti in Ixodes ricinus ticks from Lublin region (eastern Poland).
Wojcik-Fatla A, Cisak E, Chmielewska-Badora J, Zwolinski J, Buczek A, Dutkiewicz
J.
Department of Occupational Biohazards, Institute of Agricultural Medicine, Jaczewskiego 2, 20-090 Lublin, Poland. awf@galen.imw.lublin.pl
A total of 1,367 Ixodes ricinus ticks collected from 5 districts of the Lublin region (eastern Poland) were examined for the presence of Babesia microti DNA by PCR and nested-PCR. As many as 74 ticks (5.4 %) were found to be infected with Babesia microti. The infection rate varied significantly with stage/sex of ticks chi (2) =16.48543, df=2, p < 0.000264). The infection rates in females and males amounted to 6.4 % and 8.8 % respectively and were significantly higher (p=0.006 and p=0.0001 respectively) compared to minimum infection rate in nymphs that was equal to 2.8 %. The prevalence of infection showed also significant variability depending on geographic location within the Lublin region (chi(2) =18.62812, df=4, p < 0.000932). The highest rates of infection with Babesia microti were noted in ticks collected from the areas of Pulawy district situated in the northern part of region and the suburban Lublin district situated in the central part of the region (8.0 % and 7.3 % respectively). Mediocre infection rates (respectively 3.4 % and 3.3 %) were found in ticks from the Parczew and Wlodawa districts situated in eastern part of the region and covered with humid lakeland forests. The lowest infection rate (0.5 %) was noted in ticks from the Zamosc district situated in southern part of the region.
In conclusion, the infection rate of Ixodes ricinus ticks with Babesia microti found in this study is higher compared to the majority of data reported by Polish and other European authors, and indicates a potential risk of human infection during occupational or recreational exposure to tick bite.
PMID: 17196008 [PubMed - in process]
Babesioosin aiheuttajia (Babesia EU1, B. microti, B. divergens) on löydetty hollantilaisista Ixodes ricinus -punkeista. Tutkimus suoritettiin v. 2003 - 2007.
http://www.ncbi.nlm.nih.gov/pubmed/1875 ... d_RVDocSum
Vector Borne Zoonotic Dis. 2008 Aug 30
Persistent Detection of Babesia EU1 and Babesia microti in Ixodes ricinus in The Netherlands During a 5-Year Surveillance: 2003-2007.
Wielinga PR, Fonville M, Sprong H, Gaasenbeek C, Borgsteede F, Giessen JW.
National Institute for Public Health and the Environment (RIVM), Laboratory for Zoonoses and Environmental Microbiology, Bilthoven, The Netherlands.
We report the finding of Babesia EU1 and Babesia microti in Ixodes ricinus ticks in the Netherlands. During 5 years of surveillance between 2003 and 2007, 1488 ticks were collected in a dune forest area near the North Sea and were screened for Babesia infections. In 17 ticks, DNA of the protozoan parasite genus Babesia was detected using a Babesia-specific 18S rRNA polymerase chain reaction. Further, reverse line blot analysis and DNA sequence analysis showed that 13 of these ticks carried Babesia EU1, two ticks carried B. microti, and one tick carried B. divergens. This study shows that the human pathogenic species Babesia EU1 and B. microti can complete their life cycle in the Netherlands.
PMID: 18759637 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/1875 ... d_RVDocSum
Vector Borne Zoonotic Dis. 2008 Aug 30
Persistent Detection of Babesia EU1 and Babesia microti in Ixodes ricinus in The Netherlands During a 5-Year Surveillance: 2003-2007.
Wielinga PR, Fonville M, Sprong H, Gaasenbeek C, Borgsteede F, Giessen JW.
National Institute for Public Health and the Environment (RIVM), Laboratory for Zoonoses and Environmental Microbiology, Bilthoven, The Netherlands.
We report the finding of Babesia EU1 and Babesia microti in Ixodes ricinus ticks in the Netherlands. During 5 years of surveillance between 2003 and 2007, 1488 ticks were collected in a dune forest area near the North Sea and were screened for Babesia infections. In 17 ticks, DNA of the protozoan parasite genus Babesia was detected using a Babesia-specific 18S rRNA polymerase chain reaction. Further, reverse line blot analysis and DNA sequence analysis showed that 13 of these ticks carried Babesia EU1, two ticks carried B. microti, and one tick carried B. divergens. This study shows that the human pathogenic species Babesia EU1 and B. microti can complete their life cycle in the Netherlands.
PMID: 18759637 [PubMed - as supplied by publisher]
HEPARIINI BABESIOOSIN HOIDOSSA:
http://aac.asm.org/cgi/content/abstract/48/1/236
Growth-Inhibitory Effect of Heparin on Babesia Parasites
Sabine Bork,1 Naoaki Yokoyama,1 Yuzuru Ikehara,2 Sanjay Kumar,1 Chihiro Sugimoto,1 and Ikuo Igarashi1*
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555,1 Division of Oncological Pathology, Aichi Cancer Center Research Institute, Chikusa-ku, Nagoya, Aichi 464-8681, Japan2
Received 8 July 2003/ Returned for modification 8 July 2003/ Accepted 3 October 2003
We examined the inhibitory effects of three heparins on the growth of Babesia parasites. The multiplication of Babesia bovis, B. bigemina, B. equi, and B. caballi in in vitro cultures and that of B. microti in vivo were significantly inhibited in the presence of heparins, as determined by light microscopy. Treatment with various concentrations of heparin showed complete clearance of the intracellular parasites. Interestingly, a higher percentage of abnormally multidividing B. bovis parasites was observed in the presence of low concentrations of heparin. Furthermore, fluorescein isothiocyanate-labeled heparin was preferably found on the surfaces of extracellular merozoites, as detected by confocal laser scanning microscopy. These findings indicate that the heparin covers the surfaces of babesial merozoites and inhibits their subsequent invasion of erythrocytes.
http://www.healthyawareness.com/archive ... -02116.htm
Babesia are malaria-like parasites of man and animals. Babesia microti hasbeen identified as a newly emerging infection along the Eastern seaboardfrom Cape Cod to New Jersey. The major vector associated with its spreadis the deer tick (Ixodes scapularis) � the same tick associated with Lyme disease. Investigators in Japan studied the effect of various heparins on this parasite and found that, depending on the concen-tration of heparin, there may be complete clearance of intracellular parasites! The findings suggest that the heparin coats the surface of the parasite and inhibits its invasion of the red cells. Bork, S. et al. 2004. Growth-inhibitory effect of heparin on Babesia parasites. AntimicrobialAgents and Chemotherapy 48: 236-241.
http://aac.asm.org/cgi/content/abstract/48/1/236
Growth-Inhibitory Effect of Heparin on Babesia Parasites
Sabine Bork,1 Naoaki Yokoyama,1 Yuzuru Ikehara,2 Sanjay Kumar,1 Chihiro Sugimoto,1 and Ikuo Igarashi1*
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555,1 Division of Oncological Pathology, Aichi Cancer Center Research Institute, Chikusa-ku, Nagoya, Aichi 464-8681, Japan2
Received 8 July 2003/ Returned for modification 8 July 2003/ Accepted 3 October 2003
We examined the inhibitory effects of three heparins on the growth of Babesia parasites. The multiplication of Babesia bovis, B. bigemina, B. equi, and B. caballi in in vitro cultures and that of B. microti in vivo were significantly inhibited in the presence of heparins, as determined by light microscopy. Treatment with various concentrations of heparin showed complete clearance of the intracellular parasites. Interestingly, a higher percentage of abnormally multidividing B. bovis parasites was observed in the presence of low concentrations of heparin. Furthermore, fluorescein isothiocyanate-labeled heparin was preferably found on the surfaces of extracellular merozoites, as detected by confocal laser scanning microscopy. These findings indicate that the heparin covers the surfaces of babesial merozoites and inhibits their subsequent invasion of erythrocytes.
http://www.healthyawareness.com/archive ... -02116.htm
Babesia are malaria-like parasites of man and animals. Babesia microti hasbeen identified as a newly emerging infection along the Eastern seaboardfrom Cape Cod to New Jersey. The major vector associated with its spreadis the deer tick (Ixodes scapularis) � the same tick associated with Lyme disease. Investigators in Japan studied the effect of various heparins on this parasite and found that, depending on the concen-tration of heparin, there may be complete clearance of intracellular parasites! The findings suggest that the heparin coats the surface of the parasite and inhibits its invasion of the red cells. Bork, S. et al. 2004. Growth-inhibitory effect of heparin on Babesia parasites. AntimicrobialAgents and Chemotherapy 48: 236-241.
Punkeissa esiintyy EU:n alueella babesiaa - Babesia sp. EU1. Babesia tunkeutuu elimistön punasolujen sisälle.
Toisen artikkelin mukaan babesiaa löydettiin erityisesti karjatilojen punkeista.
Emerg Infect Dis. 2009 Feb;15(2):320-2.
Natural transmission of Zoonotic Babesia spp. by Ixodes ricinus ticks.
Becker CA, Bouju-Albert A, Jouglin M, Chauvin A, Malandrin L.
Institut National de la Recherche Agronomique, Nantes, France.
To determine characteristics of natural transmission of Babesia sp. EU1 and B. divergens by adult Ixodes ricinus ticks, we examined tick salivary gland contents. We found that I. ricinus is a competent vector for EU1 and that their sporozoites directly invade erythrocytes. We conclude that EU1 is naturally transmitted by I. ricinus.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19193284 [PubMed - in process]
---------------------------------------------------------------
http://www.cdc.gov:80/eid/content/15/2/320.htm
(...)
Conclusions
Our study shows that I. ricinus ticks are competent vectors for Babesia sp. EU1. Not only can these ticks carry Babesia sp. EU1 DNA, but more importantly, they enable these parasites to complete their life cycle up to the production of infectious sporozoites. ***Direct invasion of erythrocytes by Babesia sp. EU1 undoubtedly classifies this species in the genus Babesia, a feature generally not proven for most Babesia spp.
The proportions of Babesia sp. EU1-infective ticks found in our study (3/223 from cattle farm and 2/31 from wild fauna reserve, not statistically different) are comparable to published prevalence of infected ticks (1%-2%) collected either from animals or vegetation (6-8,14,15). Whatever the biotope, Babesia sp. EU1 is always present, threatening also in anthropized zones (farming areas). ****Millions of parasites inside salivary glands were observed and could be injected to the vertebrate host, from the early stage of the tick feeding**** (11.7 mg) until repletion (277 mg), which represents a massive infection. These 2 epidemiologic features, combined with the increasing number of immunocompromised persons, should lead to more awareness of the risk related to this zoonotic pathogen.
Toisen artikkelin mukaan babesiaa löydettiin erityisesti karjatilojen punkeista.
Emerg Infect Dis. 2009 Feb;15(2):320-2.
Natural transmission of Zoonotic Babesia spp. by Ixodes ricinus ticks.
Becker CA, Bouju-Albert A, Jouglin M, Chauvin A, Malandrin L.
Institut National de la Recherche Agronomique, Nantes, France.
To determine characteristics of natural transmission of Babesia sp. EU1 and B. divergens by adult Ixodes ricinus ticks, we examined tick salivary gland contents. We found that I. ricinus is a competent vector for EU1 and that their sporozoites directly invade erythrocytes. We conclude that EU1 is naturally transmitted by I. ricinus.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19193284 [PubMed - in process]
---------------------------------------------------------------
http://www.cdc.gov:80/eid/content/15/2/320.htm
(...)
Conclusions
Our study shows that I. ricinus ticks are competent vectors for Babesia sp. EU1. Not only can these ticks carry Babesia sp. EU1 DNA, but more importantly, they enable these parasites to complete their life cycle up to the production of infectious sporozoites. ***Direct invasion of erythrocytes by Babesia sp. EU1 undoubtedly classifies this species in the genus Babesia, a feature generally not proven for most Babesia spp.
The proportions of Babesia sp. EU1-infective ticks found in our study (3/223 from cattle farm and 2/31 from wild fauna reserve, not statistically different) are comparable to published prevalence of infected ticks (1%-2%) collected either from animals or vegetation (6-8,14,15). Whatever the biotope, Babesia sp. EU1 is always present, threatening also in anthropized zones (farming areas). ****Millions of parasites inside salivary glands were observed and could be injected to the vertebrate host, from the early stage of the tick feeding**** (11.7 mg) until repletion (277 mg), which represents a massive infection. These 2 epidemiologic features, combined with the increasing number of immunocompromised persons, should lead to more awareness of the risk related to this zoonotic pathogen.
Milloin tulee epäillä sairastavansa babesioosia ja miten sitä tutkitaan:
When to Suspect and How to Monitor Babesiosis
ELEFTHERIOS MYLONAKIS, M.D.,
Massachusetts General Hospital, Boston, Massachusetts
http://www.aafp.org/afp/20010515/1969.html
In the past decade, cases of babesiosis in humans have been reported with increasing frequency, especially in the northeastern United States. Babesia microti (in the United States) and bovine strains (in Europe) cause most infections in humans. Most cases are tick-borne, although cases of transfusion-associated and transplacental/perinatal transmission have also been reported. Factors associated with more severe disease include advanced age, previous splenectomy and immunodeficient states. Symptoms include high fever, chills, diaphoresis, weakness, anorexia and headache. Later in the course of the illness, the patient may develop jaundice. Congestive heart failure, renal failure and acute respiratory distress syndrome are the most common complications. Therapy using the combination of quinine sulfate and clindamycin was the most commonly used treatment; however, atovaquone suspension plus azithromycin was recently reported an equally effective and less toxic therapy. Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients. (Am Fam Physician 2001;63:1969-74,1976.)
A patient information handout on babesiosis, written by the author of this article, is provided on page 1976.
A PDF version of this document is available. Download PDF now (6 pages / 446 KB). More information on using PDF files.
Babesiosis is a worldwide tick-borne hemolytic disease that is caused by intraerythrocytic protozoan parasites of the genus Babesia. The book of Exodus refers to a plague of "murrain" (hemoglobinuria) among cattle and other domestic animals. Possibly, this biblical reference was the first historical mention of babesial infection.1-3 Intraerythrocytic piroplasms consistent with Babesia were first described by Babès in 1888 in his evaluation of the cause of febrile hemoglobinuria in cattle in Romania.1-3
In the past decade, cases of babesiosis in humans have been reported with increasing frequency, especially along the northeastern coast of the United States. The aim of this article is to summarize the current knowledge of this infection and provide guidance to clinicians.
Pathogenesis
Most cases of babesiosis are tick-borne, but cases of transfusion-associated and transplacental/perinatal transmission have also been reported.
Of the more than 100 species of Babesia, Babesia microti (in the United States) and Babesia divergens and Babesia bovis (in Europe) cause most infections in humans. B. microti also infects various small mammals and primates, while B. divergens has been found to infect rats and gerbils as well as its main bovine host. Recently, a previously unknown species of Babesia (WA-1) was isolated from an immunocompetent man in Washington state who had clinical babesiosis.4,5 Researchers also described another probable new babesial species (MO1) associated with the first reported case of babesiosis acquired in the state of Missouri. MO1 is probably distinct from B. divergens but the two share morphologic, antigenic and genetic characteristics.6
Ixodid (or hard-bodied) ticks, in particular Ixodes dammini (Ixodes scapularis) and Ixodes ricinus, are the vectors of the parasite. Ticks ingest Babesia while feeding off the host, and the parasite multiplies within the tick's gut wall. The parasites then spread to the tick's salivary glands. Inoculation into a vertebrate host occurs by a tick larva, nymph or adult.2,3 Infection in humans usually occurs from late spring to early fall.
After an infectious tick bite, the parasites invade red blood cells and a trophozoite differentiates, replicating asexually by budding with the formation of two to four merozoites. A second type of undifferentiated trophozoite is also formed that does not replicate but enlarges and differentiates into gametocyte-like forms similar to that seen in Plasmodium species. Merozoites eventually disrupt infected erythrocytes and reinvade other red blood cells.1-3
Epidemiology
Babesiosis has rarely been reported outside the United States. Sporadic cases have been reported from a number of countries including France, the former Yugoslavia, United Kingdom, Ireland, the former Soviet Union and Mexico. In the United States, infections have been reported from many states but the most endemic areas are the islands off the coast of Massachusetts (including Nantucket and Martha's Vineyard) and New York (including eastern and south central Long Island, Shelter Island and Fire Island) and in Connecticut.1-3,7,8 In these areas, asymptomatic human infection seems to be common.
Between 1968 and 1993, more than 450 Babesia infections were confirmed in the United States by blood smears or serologic testing, but the prevalence of babesiosis is difficult to estimate because of lack of surveillance, and because infections are often asymptomatic. A recent study9 evaluated the seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. In this one-year seroconversion study of patients in New York state who were at high risk for tick-borne diseases, antibodies to B. microti were seen in seven of 671 participants (1 percent), including one asymptomatic seroconversion during the year of observation.9
Transfusion-associated babesiosis has also been described.10 The risk factors for the donors have included exposure to endemic areas and being a recipient of blood transfusions. Patients receiving erythrocyte transfusions are at highest risk, while infection after transfusion of plasma has not been reported. In a survey of 779 blood donors in Cape Cod, Mass., seropositivity ranged from 3.3 to 4.9 percent, which was comparable with that in Boston, a nonendemic area.11
Overall, the risk of acquiring babesiosis from a blood transfusion is very low. In Connecticut, the risk of acquiring babesiosis from a transfused unit of packed red blood cells was estimated at about 0.17 percent (95 percent CI, 0.004 to 0.9 percent) and was even lower from a transfused unit of platelets (95 percent CI, 0.0 to 0.8 percent).12 Finally, transplacental/perinatal transmission has been reported.2,3
Clinical Features
Babesiosis in the United States has varied substantially from that described in Europe. To date, most of the patients described in Europe have been asplenic, have presented with acute febrile hemolytic disease and their clinical courses have almost always been fatal.2,3
In the United States, the clinical spectrum of the infection ranges from asymptomatic to rapidly progressive and fatal. Although babesiosis can affect persons of all ages, most patients present in their 40s or 50s. After a recognized tick bite, the incubation period of babesiosis varies from five to 33 days.1,3,7 However, most patients do not recall recent tick exposure. After an infected blood transfusion, the incubation period can be up to nine weeks.2,3,7,8
TABLE 1
Common Presenting Signs and Symptoms of Human Babesiosis
--------------------------------------------------------------------------------
Generalized weakness
Fever
Gastrointestinal symptoms (anorexia, nausea, abdominal pain, vomiting, diarrhea, etc.)
Headache
Myalgia
Weight loss
Arthralgia
Respiratory symptoms (cough, shortness of breath, etc.)
Dark urine
TABLE 2
Common Complications of Human Babesiosis
--------------------------------------------------------------------------------
Acute respiratory distress syndrome
Anemia requiring transfusion
Congestive heart failure
Disseminated intravascular coagulation
Hypotension/shock
Myocardial infarction
Renal failure
Both humoral and cell-mediated immune mechanisms influence the outcome of the infection. Factors associated with more severe disease include advanced age, previous splenectomy and immunodeficiency states including acquired immunodeficiency syndrome.7,13,14
Symptoms include high fever (up to 40°C [104°F]), chills, diaphoresis, weakness, fatigue, anorexia and headache (Table 1). Later in the course of the illness, the patient may develop jaundice and dark urine. Physical examination may reveal hepatomegaly and splenomegaly or evidence of shock. Rash is an uncommon symptom in babesiosis.1,2,3,7 Signs of central nervous system involvement include headache, photophobia, neck and back stiffness, altered sensorium and emotional lability.3,7,15
Congestive heart failure, disseminated intravascular coagulation and acute respiratory distress syndrome (that can occur even a few days after the onset of effective antimicrobial treatment) are the most common complications of human babesiosis (Table 2). Renal failure and myocardial infarction also have been associated with severe babesiosis. Researchers reviewed the clinical data and prognostic factors among 139 hospitalized cases in New York state between 1982 and 1993.16 Nine patients (6.5 percent) died, one fourth of the patients were admitted to the intensive care unit and one fourth of the patients required hospitalization for more than 14 days. The most common symptoms were fatigue/malaise/weakness (91 percent), fever (91 percent), shaking chills (77 percent) and diaphoresis (69 percent). Fifty-two percent of patients had a history of chronic disease. On average, a 12- to 14-day delay was noted between onset of symptoms and initiation of appropriate antibiotic treatment. Alkaline phosphatase levels greater than 125 U per L, white blood cell counts greater than 5 X 109 per L, history of cardiac abnormality, history of splenectomy, presence of heart murmur and parasitemia values of 4 percent or higher were associated with disease severity.16
Diagnosis
Mild to severe hemolytic anemia and a normal to slightly depressed leukocyte count are common nonspecific findings in babesiosis. Usually, the diagnosis is based on typical morphologic picture on the blood smear in conjunction with epidemiologic information. A Wright- or Giemsa-stained peripheral blood smear is most commonly used to demonstrate the presence of intraerythrocytic parasites (Figure 1). Rarely, tetrads of merozoites are visible.
The organisms are intraerythrocytic ring forms closely resembling Plasmodium, the organism causing malaria. Three distinguishing features differentiate the two organisms. Babesial organisms usually form tetrads ("Maltese cross"), do not have hemozoin pigments within the affected red blood cells and have extracellular merozoites.17,18
Serologic evaluation with the indirect immunofluorescent antibody test with use of B. microti antigen is available in a few laboratories. The cutoff titer for determination of a positive result varies with the particular laboratory protocol used, but in most laboratories, titers of more than 1:64 are considered consistent with B. microti infection. Tenfold to 20-fold higher titers can be observed in the acute setting, with a gradual decline over weeks to months. The correlation between the level of the titer and the severity of symptoms is poor.1-3
FIGURE 1. Human erythrocytes showing infection with Babesia microti. Note that the ring forms with a central pale area inside the red blood cell (arrows).
Detection of B. microti by polymerase chain reaction (PCR) was first described in 1992.19 A more recent study,20 in which PCR was used prospectively for diagnosing suspected cases in the northeastern United States has shown that PCR is more sensitive and equally specific for the diagnosis of acute cases, in comparison with direct smear examination and hamster inoculation. PCR-based methods may also be indicated for monitoring of the infection.20
Treatment
Babesiosis may continue for more than two months after treatment and when left untreated, silent babesial infection may persist for months or even years. Researchers21 compared the duration of parasitemia in persons who had received specific antibabesial therapy with that in silently infected persons who had not been treated. Babesial DNA persisted for 16 days in 22 acutely ill subjects who received clindamycin and quinine therapy (P = 0.03). Among the subjects who did not receive specific therapy, symptoms of babesiosis persisted up to 114 days.21
Treatment with the combination of quinine (Quinamm; 650 mg of salt orally, three times daily) and clindamycin (Cleocin; 600 mg orally, three times daily, or 1.2 g parenterally, twice daily) for seven to 10 days is the most commonly used treatment. The pediatric dosage is 20 to 40 mg per kg per day for quinine and 25 mg per kg per day for clindamycin. The fortuitous discovery of this regimen for babesiosis in humans was made during the management of a patient with presumed transfusion-acquired malarial infection. The patient was initially treated with chloroquine (Aralen Injection); however, because of lack of response, treatment was changed to quinine and clindamycin.2,3,22,23
Several other drugs have been evaluated, including tetracycline, primaquine, sulfadiazine (Microsulfon) and pyrimethamine (Fansidar). Results have varied. Pentamidine (Pentam) has proved to be moderately effective in diminishing symptoms and decreasing parasitemia.
Atovaquone suspension (Mepron; 750 mg twice daily) plus azithromycin (Zithromax; 500 to 1,000 mg per day) is a very effective treatment. This treatment was found to be effective for the prevention and treatment of babesiosis in hamsters. Clindamycin plus quinine was also effective but less so than atovaquone. When treatment was not started until parasitemia became established, atovaquone in dosages of 300, 150 and 80 mg per kg per day was effective in the recovery of all animals compared with 50 percent of those receiving 10 mg per kg per day and 10 percent of untreated control subjects.24 Of note is that, in the same model, when atovaquone was used as monotherapy, the disease recurred. Organisms obtained from these animals, when inoculated into uninfected animals, proved to be unresponsive to atovaquone therapy, suggesting the emergence of drug resistance. Resistant organisms did not emerge in hamsters treated with the combination of atovaquone and azithromycin.25
In humans, a prospective, randomized study26 comparing the efficacy of clindamycin and quinine with that of atovaquone and azithromycin has been conducted. This study included 58 patients with nonlife-threatening babesiosis. Forty received atovaquone and azithromycin and 18 received clindamycin and quinine. The resolution of symptoms and parasitemia were similar between the two groups and both treatments were effective for all patients. However, 72 percent of the patients who received quinine and clindamycin suffered side effects from the antibiotics, compared with 15 percent of patients in the atovaquone and azithromycin group.26
Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients. This treatment is usually reserved for patients who are extremely ill--with blood parasitemia of more than 10 percent, massive hemolysis and asplenia.17
Prevention
Prevention of babesiosis involves avoiding endemic regions during the peak transmission months of May through September. This recommendation may be especially relevant for asplenic or immunocompromised persons in whom babesiosis can be a devastating illness.1,2 Using insect repellant is advised during outdoor activities, especially in wooded or grassy areas. One of the most effective tick repellents is N,N-diethyl-m-toluamide (DEET). It is commercially available in concentrations up to 100 percent. However, serious toxic and allergic reactions have been reported in persons who have used it frequently or in high concentrations. In young children, toxic encephalopathy has occurred.2,3 Products with 10 to 35 percent DEET will provide adequate protection under most conditions.
Early removal of ticks is important; the tick must remain attached for at least 24 hours before the transmission of B. microti occurs. Therefore, daily self-examination is recommended for persons who engage in outdoor activities in endemic areas. Pets also must be examined for ticks because they may carry ticks into the home.
Co-infection with Other Species of Tick-Transmitted Diseases
Co-infection with Borrelia burgdorferi and B. microti may be relatively common in endemic areas of the northeastern and upper midwestern United States. Approximately 10 percent of patients with Lyme disease in southern New England are co-infected with babesiosis in sites where both diseases are zoonotic. The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone.27,28
Co-infection with Ehrlichia species may also be seen. Three species of Ehrlichia have been described that infect humans, Ehrlichia chaffeensis, Ehrlichia phagocytophila and Ehrlichia ewingii. Typically, patients have a nonspecific febrile illness. Rash is uncommon with human granulocytic ehrlichiosis but common with human monocytic ehrlichiosis. Laboratory findings often include leukopenia, thrombocytopenia and increases in serum hepatic enzyme activities. In areas endemic for Lyme disease and ehrlichiosis, it may be advisable to add doxycycline (Vibramycin), 100 mg twice a day by mouth, in the management of patients with babesiosis until serologic confirmation has been made.
The author is the recipient of a research fellowship for physicians from the Howard Hughes Medical Institute, Chevy Chase, Md.
--------------------------------------------------------------------------------
The Author
ELEFTHERIOS MYLONAKIS, M.D.,
is a clinical and research fellow in infectious diseases at Massachusetts General Hospital, Harvard Medical School, Boston, and the recipient of a research fellowship for physicians from the Howard Hughes Medical Institute, Chevy Chase, Md. Dr. Mylonakis earned a doctorate degree in infectious diseases and internal medicine at the National University of Athens Faculty of Medicine and School of Health Sciences. He also completed a residency and chief medical residency in internal medicine at Miriam Hospital, Brown University School of Medicine, Providence, RI.
Address correspondence to Eleftherios Mylonakis, M.D., Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114 (e-mail: emylonakis@partners.org). Reprints are not available from the author.
REFERENCES
Gelfand JA. Babesia. In: Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone, 2000;2899-902.
Boustani MR, Gelfand JA. Babesiosis. Clin Infect Dis 1996;22:611-5.
Pruthi RK, Marshall WF, Wiltsie JC, Persing DH. Human babesiosis. Mayo Clin Proc 1995;70:853-62.
Persing DH, Herwaldt BL, Glaser C, Lane RS, Thomford JW, Mathiesen D, et al. Infection with a babesia-like organism in northern California. N Engl J Med 1995;332:298-303.
Quick RE, Herwaldt BL, Thomford JW, Garnett ME, Eberhard ML, Wilson M, et al. Babesiosis in Washington State: a new species of Babesia? Ann Intern Med 1993;119:284-90.
Herwaldt B, Persing DH, Precigout EA, Goff WL, Mathiesen DA, Taylor PW, et al. A fatal case of babesiosis in Missouri: identification of another piroplasm that infects humans. Ann Intern Med 1996;124:643-50.
Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE, Fritsche TR. Tick-borne diseases in the United States. N Engl J Med 1993;329:936-47.
Spielman A, Wilson ML, Levine JF, Piesman J. Ecology of Ixodes dammini-borne human babesiosis and Lyme disease. Annu Rev Entomol 1985;30: 439-60.
Hilton E, DeVoti J, Benach JL, Halluska ML, White DJ, Paxton H, et al. Seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. Am J Med 1999;106:404-9.
Dobroszycki J, Herwaldt BL, Boctor F, Miller JR, Linden J, Eberhard ML, et al. A cluster of transfusion-associated babesiosis cases traced to a single asymptomatic donor. JAMA 1999;281:927-30.
Popovsky MA, Lindberg LE, Syrek AL, Page PL. Prevalence of Babesia antibody in a selected blood donor population. Transfusion 1988;28:59-61.
Gerber MA, Shapiro ED, Krause PJ, Cable RG, Badon SJ, Ryan RW. The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 1994;170:231-4.
Benezra D, Brown AE, Polsky B, Gold JW, Armstrong D. Babesiosis and infection with human immunodeficiency virus (HIV) [Letter]. Ann Intern Med 1987;107:944.
Rosner F, Zarrabi MH, Benach JL, Habicht GS. Babesiosis in splenectomized adults. Review of 22 reported cases. Am J Med 1984;76:696-701.
Ruebush TK 2d, Cassaday PB, Marsh HJ, Lisker SA, Voorhees DB, Mahoney EB, et al. Human babesiosis on Nantucket Island. Clinical features. Ann Intern Med l977;86:6-9.
White DJ, Talarico J, Chang HG, Birkhead GS, Heimberger T, Morse DL. Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors. Arch Intern Med 1998;158:2149-54.
Bonoan JT, Johnson DH, Cunha BA. Life-threatening babesiosis in an asplenic patient treated with exchange transfusion, azithromycin, and atovaquone. Heart Lung 1998;27:424-8.
Loutan L, Rossier J, Zufferey G, Cuenod D, Hatz C, Marti HP, Gern L. Imported babesiosis diagnosed as malaria [Letter]. Lancet 1993;342:749.
Persing DH, Mathiesen D, Marshall WF, Telford SR, Spielman A, Thomford JW, et al. Detection of Babesia microti by polymerase chain reaction. J Clin Microbiol 1992;30:2097-103.
Eskow ES, Krause PJ, Spielman A, Freeman K, Aslanzadeh J. Southern extension of the range of human babesiosis in the eastern United States. J Clin Microbiol 1999;37:2051-2.
Krause PJ, Spielman A, Telford SR 3rd, Sikand VK, McKay K, Christianson D, et al. Persistent parasitemia after acute babesiosis. N Engl J Med 1998; 339:160-5.
Rowin KS, Tanowitz HB, Wittner M. Therapy of experimental babesiosis. Ann Intern Med 1982;97: 556-8.
Wittner M, Rowin KS, Tanowitz HB, Hobbs JF, Saltzman S, Wenz B, et al. Successful chemotherapy of transfusion babesiosis. Ann Intern Med 1982;96:601-4.
Weiss LM, Wittner M, Wasserman S, Oz HS, Retsema J, Tanowitz HB. Efficacy of azithromycin for treating Babesia microti infection in the hamster model. J Infect Dis 1993;168:1289-92.
Wittner M, Lederman J, Tanowitz HB, Rosenbaum GS, Weiss LM. Atovaquone in the treatment of Babesia microti infections in hamsters. Am J Trop Med Hyg 1996;55:219-22.
Krause PJ, Lepore T, Sikand VK, Gadbaw JJ, Burke G, Telford SR, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 2000;343:1454-8.
Krause PJ, Telford SR 3rd, Spielman A, Sikand V, Ryan R, Christianson D, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
2Sweeney CJ, Ghassemi M, Agger WA, Persing DH. Coinfection with Babesia microti and Borrelia burgdorferi in a western Wisconsin resident. Mayo Clin Proc 1998;73:338-41.
Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
When to Suspect and How to Monitor Babesiosis
ELEFTHERIOS MYLONAKIS, M.D.,
Massachusetts General Hospital, Boston, Massachusetts
http://www.aafp.org/afp/20010515/1969.html
In the past decade, cases of babesiosis in humans have been reported with increasing frequency, especially in the northeastern United States. Babesia microti (in the United States) and bovine strains (in Europe) cause most infections in humans. Most cases are tick-borne, although cases of transfusion-associated and transplacental/perinatal transmission have also been reported. Factors associated with more severe disease include advanced age, previous splenectomy and immunodeficient states. Symptoms include high fever, chills, diaphoresis, weakness, anorexia and headache. Later in the course of the illness, the patient may develop jaundice. Congestive heart failure, renal failure and acute respiratory distress syndrome are the most common complications. Therapy using the combination of quinine sulfate and clindamycin was the most commonly used treatment; however, atovaquone suspension plus azithromycin was recently reported an equally effective and less toxic therapy. Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients. (Am Fam Physician 2001;63:1969-74,1976.)
A patient information handout on babesiosis, written by the author of this article, is provided on page 1976.
A PDF version of this document is available. Download PDF now (6 pages / 446 KB). More information on using PDF files.
Babesiosis is a worldwide tick-borne hemolytic disease that is caused by intraerythrocytic protozoan parasites of the genus Babesia. The book of Exodus refers to a plague of "murrain" (hemoglobinuria) among cattle and other domestic animals. Possibly, this biblical reference was the first historical mention of babesial infection.1-3 Intraerythrocytic piroplasms consistent with Babesia were first described by Babès in 1888 in his evaluation of the cause of febrile hemoglobinuria in cattle in Romania.1-3
In the past decade, cases of babesiosis in humans have been reported with increasing frequency, especially along the northeastern coast of the United States. The aim of this article is to summarize the current knowledge of this infection and provide guidance to clinicians.
Pathogenesis
Most cases of babesiosis are tick-borne, but cases of transfusion-associated and transplacental/perinatal transmission have also been reported.
Of the more than 100 species of Babesia, Babesia microti (in the United States) and Babesia divergens and Babesia bovis (in Europe) cause most infections in humans. B. microti also infects various small mammals and primates, while B. divergens has been found to infect rats and gerbils as well as its main bovine host. Recently, a previously unknown species of Babesia (WA-1) was isolated from an immunocompetent man in Washington state who had clinical babesiosis.4,5 Researchers also described another probable new babesial species (MO1) associated with the first reported case of babesiosis acquired in the state of Missouri. MO1 is probably distinct from B. divergens but the two share morphologic, antigenic and genetic characteristics.6
Ixodid (or hard-bodied) ticks, in particular Ixodes dammini (Ixodes scapularis) and Ixodes ricinus, are the vectors of the parasite. Ticks ingest Babesia while feeding off the host, and the parasite multiplies within the tick's gut wall. The parasites then spread to the tick's salivary glands. Inoculation into a vertebrate host occurs by a tick larva, nymph or adult.2,3 Infection in humans usually occurs from late spring to early fall.
After an infectious tick bite, the parasites invade red blood cells and a trophozoite differentiates, replicating asexually by budding with the formation of two to four merozoites. A second type of undifferentiated trophozoite is also formed that does not replicate but enlarges and differentiates into gametocyte-like forms similar to that seen in Plasmodium species. Merozoites eventually disrupt infected erythrocytes and reinvade other red blood cells.1-3
Epidemiology
Babesiosis has rarely been reported outside the United States. Sporadic cases have been reported from a number of countries including France, the former Yugoslavia, United Kingdom, Ireland, the former Soviet Union and Mexico. In the United States, infections have been reported from many states but the most endemic areas are the islands off the coast of Massachusetts (including Nantucket and Martha's Vineyard) and New York (including eastern and south central Long Island, Shelter Island and Fire Island) and in Connecticut.1-3,7,8 In these areas, asymptomatic human infection seems to be common.
Between 1968 and 1993, more than 450 Babesia infections were confirmed in the United States by blood smears or serologic testing, but the prevalence of babesiosis is difficult to estimate because of lack of surveillance, and because infections are often asymptomatic. A recent study9 evaluated the seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. In this one-year seroconversion study of patients in New York state who were at high risk for tick-borne diseases, antibodies to B. microti were seen in seven of 671 participants (1 percent), including one asymptomatic seroconversion during the year of observation.9
Transfusion-associated babesiosis has also been described.10 The risk factors for the donors have included exposure to endemic areas and being a recipient of blood transfusions. Patients receiving erythrocyte transfusions are at highest risk, while infection after transfusion of plasma has not been reported. In a survey of 779 blood donors in Cape Cod, Mass., seropositivity ranged from 3.3 to 4.9 percent, which was comparable with that in Boston, a nonendemic area.11
Overall, the risk of acquiring babesiosis from a blood transfusion is very low. In Connecticut, the risk of acquiring babesiosis from a transfused unit of packed red blood cells was estimated at about 0.17 percent (95 percent CI, 0.004 to 0.9 percent) and was even lower from a transfused unit of platelets (95 percent CI, 0.0 to 0.8 percent).12 Finally, transplacental/perinatal transmission has been reported.2,3
Clinical Features
Babesiosis in the United States has varied substantially from that described in Europe. To date, most of the patients described in Europe have been asplenic, have presented with acute febrile hemolytic disease and their clinical courses have almost always been fatal.2,3
In the United States, the clinical spectrum of the infection ranges from asymptomatic to rapidly progressive and fatal. Although babesiosis can affect persons of all ages, most patients present in their 40s or 50s. After a recognized tick bite, the incubation period of babesiosis varies from five to 33 days.1,3,7 However, most patients do not recall recent tick exposure. After an infected blood transfusion, the incubation period can be up to nine weeks.2,3,7,8
TABLE 1
Common Presenting Signs and Symptoms of Human Babesiosis
--------------------------------------------------------------------------------
Generalized weakness
Fever
Gastrointestinal symptoms (anorexia, nausea, abdominal pain, vomiting, diarrhea, etc.)
Headache
Myalgia
Weight loss
Arthralgia
Respiratory symptoms (cough, shortness of breath, etc.)
Dark urine
TABLE 2
Common Complications of Human Babesiosis
--------------------------------------------------------------------------------
Acute respiratory distress syndrome
Anemia requiring transfusion
Congestive heart failure
Disseminated intravascular coagulation
Hypotension/shock
Myocardial infarction
Renal failure
Both humoral and cell-mediated immune mechanisms influence the outcome of the infection. Factors associated with more severe disease include advanced age, previous splenectomy and immunodeficiency states including acquired immunodeficiency syndrome.7,13,14
Symptoms include high fever (up to 40°C [104°F]), chills, diaphoresis, weakness, fatigue, anorexia and headache (Table 1). Later in the course of the illness, the patient may develop jaundice and dark urine. Physical examination may reveal hepatomegaly and splenomegaly or evidence of shock. Rash is an uncommon symptom in babesiosis.1,2,3,7 Signs of central nervous system involvement include headache, photophobia, neck and back stiffness, altered sensorium and emotional lability.3,7,15
Congestive heart failure, disseminated intravascular coagulation and acute respiratory distress syndrome (that can occur even a few days after the onset of effective antimicrobial treatment) are the most common complications of human babesiosis (Table 2). Renal failure and myocardial infarction also have been associated with severe babesiosis. Researchers reviewed the clinical data and prognostic factors among 139 hospitalized cases in New York state between 1982 and 1993.16 Nine patients (6.5 percent) died, one fourth of the patients were admitted to the intensive care unit and one fourth of the patients required hospitalization for more than 14 days. The most common symptoms were fatigue/malaise/weakness (91 percent), fever (91 percent), shaking chills (77 percent) and diaphoresis (69 percent). Fifty-two percent of patients had a history of chronic disease. On average, a 12- to 14-day delay was noted between onset of symptoms and initiation of appropriate antibiotic treatment. Alkaline phosphatase levels greater than 125 U per L, white blood cell counts greater than 5 X 109 per L, history of cardiac abnormality, history of splenectomy, presence of heart murmur and parasitemia values of 4 percent or higher were associated with disease severity.16
Diagnosis
Mild to severe hemolytic anemia and a normal to slightly depressed leukocyte count are common nonspecific findings in babesiosis. Usually, the diagnosis is based on typical morphologic picture on the blood smear in conjunction with epidemiologic information. A Wright- or Giemsa-stained peripheral blood smear is most commonly used to demonstrate the presence of intraerythrocytic parasites (Figure 1). Rarely, tetrads of merozoites are visible.
The organisms are intraerythrocytic ring forms closely resembling Plasmodium, the organism causing malaria. Three distinguishing features differentiate the two organisms. Babesial organisms usually form tetrads ("Maltese cross"), do not have hemozoin pigments within the affected red blood cells and have extracellular merozoites.17,18
Serologic evaluation with the indirect immunofluorescent antibody test with use of B. microti antigen is available in a few laboratories. The cutoff titer for determination of a positive result varies with the particular laboratory protocol used, but in most laboratories, titers of more than 1:64 are considered consistent with B. microti infection. Tenfold to 20-fold higher titers can be observed in the acute setting, with a gradual decline over weeks to months. The correlation between the level of the titer and the severity of symptoms is poor.1-3
FIGURE 1. Human erythrocytes showing infection with Babesia microti. Note that the ring forms with a central pale area inside the red blood cell (arrows).
Detection of B. microti by polymerase chain reaction (PCR) was first described in 1992.19 A more recent study,20 in which PCR was used prospectively for diagnosing suspected cases in the northeastern United States has shown that PCR is more sensitive and equally specific for the diagnosis of acute cases, in comparison with direct smear examination and hamster inoculation. PCR-based methods may also be indicated for monitoring of the infection.20
Treatment
Babesiosis may continue for more than two months after treatment and when left untreated, silent babesial infection may persist for months or even years. Researchers21 compared the duration of parasitemia in persons who had received specific antibabesial therapy with that in silently infected persons who had not been treated. Babesial DNA persisted for 16 days in 22 acutely ill subjects who received clindamycin and quinine therapy (P = 0.03). Among the subjects who did not receive specific therapy, symptoms of babesiosis persisted up to 114 days.21
Treatment with the combination of quinine (Quinamm; 650 mg of salt orally, three times daily) and clindamycin (Cleocin; 600 mg orally, three times daily, or 1.2 g parenterally, twice daily) for seven to 10 days is the most commonly used treatment. The pediatric dosage is 20 to 40 mg per kg per day for quinine and 25 mg per kg per day for clindamycin. The fortuitous discovery of this regimen for babesiosis in humans was made during the management of a patient with presumed transfusion-acquired malarial infection. The patient was initially treated with chloroquine (Aralen Injection); however, because of lack of response, treatment was changed to quinine and clindamycin.2,3,22,23
Several other drugs have been evaluated, including tetracycline, primaquine, sulfadiazine (Microsulfon) and pyrimethamine (Fansidar). Results have varied. Pentamidine (Pentam) has proved to be moderately effective in diminishing symptoms and decreasing parasitemia.
Atovaquone suspension (Mepron; 750 mg twice daily) plus azithromycin (Zithromax; 500 to 1,000 mg per day) is a very effective treatment. This treatment was found to be effective for the prevention and treatment of babesiosis in hamsters. Clindamycin plus quinine was also effective but less so than atovaquone. When treatment was not started until parasitemia became established, atovaquone in dosages of 300, 150 and 80 mg per kg per day was effective in the recovery of all animals compared with 50 percent of those receiving 10 mg per kg per day and 10 percent of untreated control subjects.24 Of note is that, in the same model, when atovaquone was used as monotherapy, the disease recurred. Organisms obtained from these animals, when inoculated into uninfected animals, proved to be unresponsive to atovaquone therapy, suggesting the emergence of drug resistance. Resistant organisms did not emerge in hamsters treated with the combination of atovaquone and azithromycin.25
In humans, a prospective, randomized study26 comparing the efficacy of clindamycin and quinine with that of atovaquone and azithromycin has been conducted. This study included 58 patients with nonlife-threatening babesiosis. Forty received atovaquone and azithromycin and 18 received clindamycin and quinine. The resolution of symptoms and parasitemia were similar between the two groups and both treatments were effective for all patients. However, 72 percent of the patients who received quinine and clindamycin suffered side effects from the antibiotics, compared with 15 percent of patients in the atovaquone and azithromycin group.26
Exchange transfusion, together with antibabesial chemotherapy, may be necessary in critically ill patients. This treatment is usually reserved for patients who are extremely ill--with blood parasitemia of more than 10 percent, massive hemolysis and asplenia.17
Prevention
Prevention of babesiosis involves avoiding endemic regions during the peak transmission months of May through September. This recommendation may be especially relevant for asplenic or immunocompromised persons in whom babesiosis can be a devastating illness.1,2 Using insect repellant is advised during outdoor activities, especially in wooded or grassy areas. One of the most effective tick repellents is N,N-diethyl-m-toluamide (DEET). It is commercially available in concentrations up to 100 percent. However, serious toxic and allergic reactions have been reported in persons who have used it frequently or in high concentrations. In young children, toxic encephalopathy has occurred.2,3 Products with 10 to 35 percent DEET will provide adequate protection under most conditions.
Early removal of ticks is important; the tick must remain attached for at least 24 hours before the transmission of B. microti occurs. Therefore, daily self-examination is recommended for persons who engage in outdoor activities in endemic areas. Pets also must be examined for ticks because they may carry ticks into the home.
Co-infection with Other Species of Tick-Transmitted Diseases
Co-infection with Borrelia burgdorferi and B. microti may be relatively common in endemic areas of the northeastern and upper midwestern United States. Approximately 10 percent of patients with Lyme disease in southern New England are co-infected with babesiosis in sites where both diseases are zoonotic. The number of symptoms and duration of illness in patients with concurrent Lyme disease and babesiosis are greater than in patients with either infection alone.27,28
Co-infection with Ehrlichia species may also be seen. Three species of Ehrlichia have been described that infect humans, Ehrlichia chaffeensis, Ehrlichia phagocytophila and Ehrlichia ewingii. Typically, patients have a nonspecific febrile illness. Rash is uncommon with human granulocytic ehrlichiosis but common with human monocytic ehrlichiosis. Laboratory findings often include leukopenia, thrombocytopenia and increases in serum hepatic enzyme activities. In areas endemic for Lyme disease and ehrlichiosis, it may be advisable to add doxycycline (Vibramycin), 100 mg twice a day by mouth, in the management of patients with babesiosis until serologic confirmation has been made.
The author is the recipient of a research fellowship for physicians from the Howard Hughes Medical Institute, Chevy Chase, Md.
--------------------------------------------------------------------------------
The Author
ELEFTHERIOS MYLONAKIS, M.D.,
is a clinical and research fellow in infectious diseases at Massachusetts General Hospital, Harvard Medical School, Boston, and the recipient of a research fellowship for physicians from the Howard Hughes Medical Institute, Chevy Chase, Md. Dr. Mylonakis earned a doctorate degree in infectious diseases and internal medicine at the National University of Athens Faculty of Medicine and School of Health Sciences. He also completed a residency and chief medical residency in internal medicine at Miriam Hospital, Brown University School of Medicine, Providence, RI.
Address correspondence to Eleftherios Mylonakis, M.D., Infectious Diseases Division, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114 (e-mail: emylonakis@partners.org). Reprints are not available from the author.
REFERENCES
Gelfand JA. Babesia. In: Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone, 2000;2899-902.
Boustani MR, Gelfand JA. Babesiosis. Clin Infect Dis 1996;22:611-5.
Pruthi RK, Marshall WF, Wiltsie JC, Persing DH. Human babesiosis. Mayo Clin Proc 1995;70:853-62.
Persing DH, Herwaldt BL, Glaser C, Lane RS, Thomford JW, Mathiesen D, et al. Infection with a babesia-like organism in northern California. N Engl J Med 1995;332:298-303.
Quick RE, Herwaldt BL, Thomford JW, Garnett ME, Eberhard ML, Wilson M, et al. Babesiosis in Washington State: a new species of Babesia? Ann Intern Med 1993;119:284-90.
Herwaldt B, Persing DH, Precigout EA, Goff WL, Mathiesen DA, Taylor PW, et al. A fatal case of babesiosis in Missouri: identification of another piroplasm that infects humans. Ann Intern Med 1996;124:643-50.
Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE, Fritsche TR. Tick-borne diseases in the United States. N Engl J Med 1993;329:936-47.
Spielman A, Wilson ML, Levine JF, Piesman J. Ecology of Ixodes dammini-borne human babesiosis and Lyme disease. Annu Rev Entomol 1985;30: 439-60.
Hilton E, DeVoti J, Benach JL, Halluska ML, White DJ, Paxton H, et al. Seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. Am J Med 1999;106:404-9.
Dobroszycki J, Herwaldt BL, Boctor F, Miller JR, Linden J, Eberhard ML, et al. A cluster of transfusion-associated babesiosis cases traced to a single asymptomatic donor. JAMA 1999;281:927-30.
Popovsky MA, Lindberg LE, Syrek AL, Page PL. Prevalence of Babesia antibody in a selected blood donor population. Transfusion 1988;28:59-61.
Gerber MA, Shapiro ED, Krause PJ, Cable RG, Badon SJ, Ryan RW. The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 1994;170:231-4.
Benezra D, Brown AE, Polsky B, Gold JW, Armstrong D. Babesiosis and infection with human immunodeficiency virus (HIV) [Letter]. Ann Intern Med 1987;107:944.
Rosner F, Zarrabi MH, Benach JL, Habicht GS. Babesiosis in splenectomized adults. Review of 22 reported cases. Am J Med 1984;76:696-701.
Ruebush TK 2d, Cassaday PB, Marsh HJ, Lisker SA, Voorhees DB, Mahoney EB, et al. Human babesiosis on Nantucket Island. Clinical features. Ann Intern Med l977;86:6-9.
White DJ, Talarico J, Chang HG, Birkhead GS, Heimberger T, Morse DL. Human babesiosis in New York State: Review of 139 hospitalized cases and analysis of prognostic factors. Arch Intern Med 1998;158:2149-54.
Bonoan JT, Johnson DH, Cunha BA. Life-threatening babesiosis in an asplenic patient treated with exchange transfusion, azithromycin, and atovaquone. Heart Lung 1998;27:424-8.
Loutan L, Rossier J, Zufferey G, Cuenod D, Hatz C, Marti HP, Gern L. Imported babesiosis diagnosed as malaria [Letter]. Lancet 1993;342:749.
Persing DH, Mathiesen D, Marshall WF, Telford SR, Spielman A, Thomford JW, et al. Detection of Babesia microti by polymerase chain reaction. J Clin Microbiol 1992;30:2097-103.
Eskow ES, Krause PJ, Spielman A, Freeman K, Aslanzadeh J. Southern extension of the range of human babesiosis in the eastern United States. J Clin Microbiol 1999;37:2051-2.
Krause PJ, Spielman A, Telford SR 3rd, Sikand VK, McKay K, Christianson D, et al. Persistent parasitemia after acute babesiosis. N Engl J Med 1998; 339:160-5.
Rowin KS, Tanowitz HB, Wittner M. Therapy of experimental babesiosis. Ann Intern Med 1982;97: 556-8.
Wittner M, Rowin KS, Tanowitz HB, Hobbs JF, Saltzman S, Wenz B, et al. Successful chemotherapy of transfusion babesiosis. Ann Intern Med 1982;96:601-4.
Weiss LM, Wittner M, Wasserman S, Oz HS, Retsema J, Tanowitz HB. Efficacy of azithromycin for treating Babesia microti infection in the hamster model. J Infect Dis 1993;168:1289-92.
Wittner M, Lederman J, Tanowitz HB, Rosenbaum GS, Weiss LM. Atovaquone in the treatment of Babesia microti infections in hamsters. Am J Trop Med Hyg 1996;55:219-22.
Krause PJ, Lepore T, Sikand VK, Gadbaw JJ, Burke G, Telford SR, et al. Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 2000;343:1454-8.
Krause PJ, Telford SR 3rd, Spielman A, Sikand V, Ryan R, Christianson D, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
2Sweeney CJ, Ghassemi M, Agger WA, Persing DH. Coinfection with Babesia microti and Borrelia burgdorferi in a western Wisconsin resident. Mayo Clin Proc 1998;73:338-41.
Copyright © 2001 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
Verenluovuttajien verestä on löydetty yhä useammin babesiaa. Tiedossa on 70 verenluovutuksen kautta tullutta sairastumistapausta. Näistä 12 on johtanut kuolemaan. (USA 2009)
Transfusion. 2009 Oct 10; [Epub ahead of print] Seroprevalence of Babesia microti in blood donors from Babesia-endemic areas ofthe northeastern United States: 2000 through 2007. Johnson ST, Cable RG, Tonnetti L, Spencer B, Rios J, Leiby DA. From the Transmissible Diseases Department, Jerome H. Holland Laboratory, andBiomedical Services, American Red Cross, Farmington, Connecticut; theTransmissible Diseases Department, Jerome H. Holland Laboratory, American RedCross, Rockville, Maryland; and Biomedical Services, American Red Cross, Dedham,Massachusetts.
BACKGROUND: Current estimates of 70 cases of transfusion-transmitted Babesiamicroti, with 12 associated deaths, suggest that Babesia is a growing bloodsafety concern. The extent of Babesia infections among blood donors has not beenwell defined. To determine how common exposure to B. microti is among blooddonors, a seroprevalence study was undertaken in the American Red CrossNortheast Division. STUDY DESIGN AND METHODS: Blood donations at selected blooddrives in Connecticut and Massachusetts (2000 through 2007) were tested for thepresence of immunoglobulin (Ig)G antibodies to B. microti usingimmunofluorescence assay. Geographic and temporal trends of B. microtiseroprevalence were estimated for donor's zip code of residence. RESULTS:Overall, a 1.1% seroprevalence was identified in Connecticut, with the highestlevels found in two Southeastern counties (Middlesex and New London). Observedseroprevalence for offshore islands of Massachusetts was 1.4%. Seropositivedonations were identified from donors residing in all eight counties inConnecticut and three counties in Massachusetts. Although a seasonal peak wasfound between July and September, seropositive donations were identified inevery month of the year. CONCLUSIONS: Foci of statistically higher B. microtiseroprevalence among blood donors were observed; however, B. microti transfusiontransmission risk exists for blood collected throughout Connecticut and portionsof Massachusetts. Similarly, a seasonal peak was identified; nevertheless,seropositive donations were found year-round. Thus, geographic and/or seasonalexclusion methods are insufficient to fully safeguard the blood supply fromBabesia transmission. Steps should be taken to reduce risk oftransfusion-transmitted B. microti, perhaps through implementation ofyear-round, regional testing. http://eutils.ncbi.nlm.nih.gov/entrez/e ... rlinksPMID: 19821951 [PubMed - as supplied by publisher]
Transfusion. 2009 Oct 10; [Epub ahead of print] Seroprevalence of Babesia microti in blood donors from Babesia-endemic areas ofthe northeastern United States: 2000 through 2007. Johnson ST, Cable RG, Tonnetti L, Spencer B, Rios J, Leiby DA. From the Transmissible Diseases Department, Jerome H. Holland Laboratory, andBiomedical Services, American Red Cross, Farmington, Connecticut; theTransmissible Diseases Department, Jerome H. Holland Laboratory, American RedCross, Rockville, Maryland; and Biomedical Services, American Red Cross, Dedham,Massachusetts.
BACKGROUND: Current estimates of 70 cases of transfusion-transmitted Babesiamicroti, with 12 associated deaths, suggest that Babesia is a growing bloodsafety concern. The extent of Babesia infections among blood donors has not beenwell defined. To determine how common exposure to B. microti is among blooddonors, a seroprevalence study was undertaken in the American Red CrossNortheast Division. STUDY DESIGN AND METHODS: Blood donations at selected blooddrives in Connecticut and Massachusetts (2000 through 2007) were tested for thepresence of immunoglobulin (Ig)G antibodies to B. microti usingimmunofluorescence assay. Geographic and temporal trends of B. microtiseroprevalence were estimated for donor's zip code of residence. RESULTS:Overall, a 1.1% seroprevalence was identified in Connecticut, with the highestlevels found in two Southeastern counties (Middlesex and New London). Observedseroprevalence for offshore islands of Massachusetts was 1.4%. Seropositivedonations were identified from donors residing in all eight counties inConnecticut and three counties in Massachusetts. Although a seasonal peak wasfound between July and September, seropositive donations were identified inevery month of the year. CONCLUSIONS: Foci of statistically higher B. microtiseroprevalence among blood donors were observed; however, B. microti transfusiontransmission risk exists for blood collected throughout Connecticut and portionsof Massachusetts. Similarly, a seasonal peak was identified; nevertheless,seropositive donations were found year-round. Thus, geographic and/or seasonalexclusion methods are insufficient to fully safeguard the blood supply fromBabesia transmission. Steps should be taken to reduce risk oftransfusion-transmitted B. microti, perhaps through implementation ofyear-round, regional testing. http://eutils.ncbi.nlm.nih.gov/entrez/e ... rlinksPMID: 19821951 [PubMed - as supplied by publisher]
Tri James Schaller on antanut juuri päivittämänsä kirjan babesioosista "Babesia update 2009. Routine and advanced testing often fail. Standard treatments don´t cure.", vapaasti sähköisesti luettavaksi.
Kirja käsittelee ensisijassa babesioosin diagnostiikkaa.
http://ebooks.hopeacademic.com/BabesiaU ... -Ebook.pdf
"Babesioosi: Babesioositestit eivät ole riittävän luotettavia - rutiinihoidot eivät paranna tautia."
"Babesia EU1 on vain yksi ihmisille tautia aiheuttavista babesian alalajeista. Todennäköisesti myös monet muut Euroopassa tavattavat alalajit aiheuttavat infektion ihmisissä.
Yleisesti tiedossa on että Babesia bovis voi aiheuttaa infektion myös ihmisessä, mutta yksikään laboratorio ei testaa tätä alalajia.
Euroopassa babesioositapauksia ihmisissä ei yleensä testata. Jos sitä joskus testataan niin taudinaiheuttajan väitetään olevan Babesia divergens vaikka lukuisilta potilailta on löydetty Babesian alalajeja jotka ovat geneettisesti yhdistyneet Babesia odocoilein kanssa (valkohäntäpeuroissa elävä parasiitti)."
Kirjassa mainitaan mm migreenin, kroonisen väsymyksen, yöhikoilun, vilutuksen, ylipainon jne voivan johtua babesioosista. Hän painottaa myös sitä, että bartonella, borrelioosi ja babesioosi esiintyvät usein yhdessä. Mielenkiintoinen oli maininta siitä että esm. bartonellabakteerin voi saada eläimen syljen välityksellä.
Kirja käsittelee ensisijassa babesioosin diagnostiikkaa.
http://ebooks.hopeacademic.com/BabesiaU ... -Ebook.pdf
"Babesioosi: Babesioositestit eivät ole riittävän luotettavia - rutiinihoidot eivät paranna tautia."
"Babesia EU1 on vain yksi ihmisille tautia aiheuttavista babesian alalajeista. Todennäköisesti myös monet muut Euroopassa tavattavat alalajit aiheuttavat infektion ihmisissä.
Yleisesti tiedossa on että Babesia bovis voi aiheuttaa infektion myös ihmisessä, mutta yksikään laboratorio ei testaa tätä alalajia.
Euroopassa babesioositapauksia ihmisissä ei yleensä testata. Jos sitä joskus testataan niin taudinaiheuttajan väitetään olevan Babesia divergens vaikka lukuisilta potilailta on löydetty Babesian alalajeja jotka ovat geneettisesti yhdistyneet Babesia odocoilein kanssa (valkohäntäpeuroissa elävä parasiitti)."
Kirjassa mainitaan mm migreenin, kroonisen väsymyksen, yöhikoilun, vilutuksen, ylipainon jne voivan johtua babesioosista. Hän painottaa myös sitä, että bartonella, borrelioosi ja babesioosi esiintyvät usein yhdessä. Mielenkiintoinen oli maininta siitä että esm. bartonellabakteerin voi saada eläimen syljen välityksellä.
USA:ssa luultua useammat punkit kantavat borreliabakteerin lisäksi babesioosia. Tavanomaiset antibiootit eivät tehoa siihen. Babesioosi aiheuttaa mm. kuumeilua, hikoilua ja fatiikkia, mutta ei yleensä nivelvaivoja.
http://www.newstimes.com/news/article/A ... 268052.php
Area ticks laden with disease, study shows
By Robert Miller, Staff Writer
Published: 10:35 p.m., Friday, November 27, 2009
The percentage of black-legged ticks in the area infected with at least two disease-causing microbes -- the bacteria that cause Lyme disease and the parasite that causes babesiosis -- may be much higher than previously thought.
A new study, performed by Dr. Eva Sapi of the University of New Haven, collected ticks in four towns in northern Fairfield County -- Bethel, Newtown, Redding, and Ridgefield.
It found that in 2009, about 90 percent of the ticks tested had the Lyme disease bacteria. The same study showed about 30 percent of ticks tested had babesia, the parasite that causes the malaria-like illness babesiosis.
"To be honest, it doesn't surprise me at all,'' said Maggie Shaw, of the Newtown Tick-borne Disease Committee, Friday. "I've had babesiosis," she said. "My daughter has had babesiosis.''
Dr. Gary Schleiter, chief of infectious diseases at Danbury Hospital, said that the hospital has also seen an increase in cases of people with babesiosis recently.
"It's been around here for years but in the past two or three years, it seems to be increasing,'' he said. "This study confirms what we've been seeing.''
The study, done in coordination with the Fairfield County Municipal Deer Management Alliance, is in the second year of a three-year project.
For the data, Sapi collected nearly 900 black-legged ticks -- also known as deer ticks -- in the four towns in the study in 2008 and 2009.
They showed high rates of infection in all the ticks collected -- as high as 98 percent infection for Lyme bacteria and 36 percent for babesia in the 41 ticks collected near the Head O' Meadows School in Newtown.
These rates are much higher than those done by other researchers studying Lyme disease in the area.
For example, Kirby Stafford of the Connecticut Agricultural Experiment Station in New Haven has tested the blood of engorged ticks sent to the station and found much lower rates of Lyme infection in the state -- as low as 13.6 percent in Newtown and 23 percent statewide in 2008.
Stafford was unavailable for comment Friday.
At the same time, the number of Lyme disease cases in the state is rising, according to the state Department of Public Health. The state reported 3,896 confirmed cases of Lyme disease reported in Connecticut in 2008, compared to 3,058 in 2007.
By most accounts, that number under-counts the actual number of Lyme cases by a factor of 10.
Shaw and Karen Gaudian of the Ridgefield Lyme Disease Task Force said the high numbers for both diseases show the difficulties most patients face if they become co-infected with both Lyme -- caused by the Borrelia burgdorferi bacteria -- and babesiosis -- caused by the Babesia microti parasite.
Lyme causes fever, headache and aching joints, while babesia can cause fevers, sweats and fatigue.
"Babesiosis usually doesn't come with joint pain,'' Schleiter said. "Unfortunately, it doesn't always have distinctive symptoms. A lot of things can look like babesiosis.''
Which, Shaw and Gaudian said, make it important for doctors to know about babesiosis and its symptoms and to treat it with drugs that will kill the parasites.
"Doctors treat Lyme disease with antibiotics,'' Gaudian said. "Antibiotics don't touch babesiosis.''
Contact Robert Miller
at bmiller@newstimes.com
or at 203-731-3345.
http://www.newstimes.com/news/article/A ... 268052.php
Area ticks laden with disease, study shows
By Robert Miller, Staff Writer
Published: 10:35 p.m., Friday, November 27, 2009
The percentage of black-legged ticks in the area infected with at least two disease-causing microbes -- the bacteria that cause Lyme disease and the parasite that causes babesiosis -- may be much higher than previously thought.
A new study, performed by Dr. Eva Sapi of the University of New Haven, collected ticks in four towns in northern Fairfield County -- Bethel, Newtown, Redding, and Ridgefield.
It found that in 2009, about 90 percent of the ticks tested had the Lyme disease bacteria. The same study showed about 30 percent of ticks tested had babesia, the parasite that causes the malaria-like illness babesiosis.
"To be honest, it doesn't surprise me at all,'' said Maggie Shaw, of the Newtown Tick-borne Disease Committee, Friday. "I've had babesiosis," she said. "My daughter has had babesiosis.''
Dr. Gary Schleiter, chief of infectious diseases at Danbury Hospital, said that the hospital has also seen an increase in cases of people with babesiosis recently.
"It's been around here for years but in the past two or three years, it seems to be increasing,'' he said. "This study confirms what we've been seeing.''
The study, done in coordination with the Fairfield County Municipal Deer Management Alliance, is in the second year of a three-year project.
For the data, Sapi collected nearly 900 black-legged ticks -- also known as deer ticks -- in the four towns in the study in 2008 and 2009.
They showed high rates of infection in all the ticks collected -- as high as 98 percent infection for Lyme bacteria and 36 percent for babesia in the 41 ticks collected near the Head O' Meadows School in Newtown.
These rates are much higher than those done by other researchers studying Lyme disease in the area.
For example, Kirby Stafford of the Connecticut Agricultural Experiment Station in New Haven has tested the blood of engorged ticks sent to the station and found much lower rates of Lyme infection in the state -- as low as 13.6 percent in Newtown and 23 percent statewide in 2008.
Stafford was unavailable for comment Friday.
At the same time, the number of Lyme disease cases in the state is rising, according to the state Department of Public Health. The state reported 3,896 confirmed cases of Lyme disease reported in Connecticut in 2008, compared to 3,058 in 2007.
By most accounts, that number under-counts the actual number of Lyme cases by a factor of 10.
Shaw and Karen Gaudian of the Ridgefield Lyme Disease Task Force said the high numbers for both diseases show the difficulties most patients face if they become co-infected with both Lyme -- caused by the Borrelia burgdorferi bacteria -- and babesiosis -- caused by the Babesia microti parasite.
Lyme causes fever, headache and aching joints, while babesia can cause fevers, sweats and fatigue.
"Babesiosis usually doesn't come with joint pain,'' Schleiter said. "Unfortunately, it doesn't always have distinctive symptoms. A lot of things can look like babesiosis.''
Which, Shaw and Gaudian said, make it important for doctors to know about babesiosis and its symptoms and to treat it with drugs that will kill the parasites.
"Doctors treat Lyme disease with antibiotics,'' Gaudian said. "Antibiotics don't touch babesiosis.''
Contact Robert Miller
at bmiller@newstimes.com
or at 203-731-3345.
Antibioottihoito Atsitromysiini + Atovaquone ei välttämättä tehoa babesioosiin. Yksi tutkimuksen kolmesta sairastuneesta kuoli babesioosin aiheuttamiin komplikaatioihin.
Emergence of Resistance to Azithromycin-Atovaquone in Immuno-compromised Patients with Babesia microti Infection
Clinical Infectious Diseases, 01/19/10
Gary P. Wormser,1 Aakanksha Prasad,1 Ellen Neuhaus,4 Samit Joshi,5 John Nowakowski,1 John Nelson,2 Abraham Mittleman,2 Maria Aguero‐Rosenfeld,3 Jeffrey Topal,5 and Peter J. Krause6
Divisions of 1Infectious Diseases and 2Hematology/Oncology, Departments of Medicine and 3Pathology, New York Medical College, Valhalla; 4Division of Infectious Diseases, Rockville General Hospital, Rockville, and 5Division of Infectious Diseases, 6Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
Background.Babesiosis is an emerging tickborne malaria‐like infection principally caused by Babesia microti. This infection typically resolves either spontaneously or after administration of a 7?10‐day course of azithromycin plus atovaquone or clindamycin plus quinine. Although certain highly immunocompromised patients may respond suboptimally to these drug regimens, unlike the situation with malaria there has been no reported evidence that the cause of treatment failure is infection with drug‐resistant strains of B. microti.
Methods.Emergence of drug resistance in B. microti was defined as the development of a microbiologic relapse (recurrent parasitemia or a marked increase in parasitemia) in association with both clinical and laboratory abnormalities indicative of active babesiosis in a patient after 28 days of uninterrupted antibabesia drug therapy and while still receiving treatment.
Results.The clinical case histories of 3 highly immunocompromised patients who received a subcurative course of azithromycin‐atovaquone associated with the eventual development of resistance to this drug regimen are described. One of the 3 patients died of complications related to babesiosis.
Conclusions.B. microti may become resistant to azithromycin‐atovaquone during the treatment of babesiosis with this combined drug regimen in highly immunocompromised patients. Although research is needed to determine the optimal therapy for highly immunocompromised patients with babesiosis, reducing the level of immunosuppression when possible would appear to be a desirable strategy.
Received 28 May 2009; accepted 31 August 2009; electronically published 4 January 2010.
Emergence of Resistance to Azithromycin-Atovaquone in Immuno-compromised Patients with Babesia microti Infection
Clinical Infectious Diseases, 01/19/10
Gary P. Wormser,1 Aakanksha Prasad,1 Ellen Neuhaus,4 Samit Joshi,5 John Nowakowski,1 John Nelson,2 Abraham Mittleman,2 Maria Aguero‐Rosenfeld,3 Jeffrey Topal,5 and Peter J. Krause6
Divisions of 1Infectious Diseases and 2Hematology/Oncology, Departments of Medicine and 3Pathology, New York Medical College, Valhalla; 4Division of Infectious Diseases, Rockville General Hospital, Rockville, and 5Division of Infectious Diseases, 6Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
Background.Babesiosis is an emerging tickborne malaria‐like infection principally caused by Babesia microti. This infection typically resolves either spontaneously or after administration of a 7?10‐day course of azithromycin plus atovaquone or clindamycin plus quinine. Although certain highly immunocompromised patients may respond suboptimally to these drug regimens, unlike the situation with malaria there has been no reported evidence that the cause of treatment failure is infection with drug‐resistant strains of B. microti.
Methods.Emergence of drug resistance in B. microti was defined as the development of a microbiologic relapse (recurrent parasitemia or a marked increase in parasitemia) in association with both clinical and laboratory abnormalities indicative of active babesiosis in a patient after 28 days of uninterrupted antibabesia drug therapy and while still receiving treatment.
Results.The clinical case histories of 3 highly immunocompromised patients who received a subcurative course of azithromycin‐atovaquone associated with the eventual development of resistance to this drug regimen are described. One of the 3 patients died of complications related to babesiosis.
Conclusions.B. microti may become resistant to azithromycin‐atovaquone during the treatment of babesiosis with this combined drug regimen in highly immunocompromised patients. Although research is needed to determine the optimal therapy for highly immunocompromised patients with babesiosis, reducing the level of immunosuppression when possible would appear to be a desirable strategy.
Received 28 May 2009; accepted 31 August 2009; electronically published 4 January 2010.
Päivitys Babesioosi-kirjaan:
SECOND FREE BABESIA TEXTBOOK
THE ONLY EXTENSIVE BABESIA IMAGE BOOK
LIKE THE PREVIOUS FREE BABESIA 2009 UPDATE THIS POST AND LINK
CANNOT BE EDITED. THE WORDS OUTSIDE THE LINKS HAVE REASONS.
Some physicians, patients and laboratories are using microscopy to find
Babesia. The problem with this approach includes that there is no
benchmarkbook on the vast forms of Babesia found inside and outside blood
cells. No Babesia Hematology book exists for physicians, microscope enthusiasts
or aggressive patients interested in basic staining and blood examination.
1) While the CDC and various state departments of health (DOH)
provided a large number of core images for this book, their useful slides
show massively infected Red Blood Cells. While they are useful to show
profoundly infected people , such images in hematology are rare. Indeed,
some microscopy lovers report many markedly infected patients are ?negative?
on manual smears 100% of the time by most labs. In reality, sometimes one
needs to look 2-3 hours to see a single Babesia form. The CDC suggests
looking for 2-3 minutes for these types of protozoa infections. Massive
infections can possibly kill, cause clear RBC destruction, create massive
sickness and immense fevers, and this can lead to the discovery of new
species or sub-species. However, using catastrophic cases or any one lab
test to diagnose Babesia found in at least 30% of deer ticks is a concern.
Further, it is rare for patients to receive aggressive direct types of
testing from multiple laborat!
ories. In addition, some health workers are starting to believe indirect
testing is actually more sensitive.
2) Some images in the book use Babesia images from Fry Labs before
April/2007. PLEASE NOTE : We have not had a positive Babesia from Fry since
March/2007. Dr. Fry and I have different views at times, but are good
friends, and we feel the reason for negative Babesia slides is clear. For
various reasons Fry Labs VERY strongly avoids possible Babesia artifacts. No
one in the world can be 100% sure that some presentation of ?Babesia? is not
an artifact. My position is to accept any very highly suspicious image. Yet
his position is to avoid any false positives. Honorable people have
different priorities and goals. Fry laboratory is also spending massive time
and income to become involved in DNA lab innovation as their priority. Other
reasons for this direction are proprietary. In conclusion, the use of the
Fry smear for Babesia alone seems unwise.
3) I wrote this book some years ago. Any TBD book is likely slightly
outdated in months , although some things are true for thirty years. This
is common for anyone reading and passionate about credible new ideas. I have
no time to offer an updated edition. O utdated comments and errors may
exist. We have radically changed much of what we do even in the last six
months.
YOU MAY POST THIS FREE ON ANY SITE WITH THE WORDS LISTED IN THIS
EMAIL WITH NO DELETIONS .
SECOND FREE BABESIA TEXTBOOK
THE ONLY EXTENSIVE BABESIA IMAGE BOOK
LIKE THE PREVIOUS FREE BABESIA 2009 UPDATE THIS POST AND LINK
CANNOT BE EDITED. THE WORDS OUTSIDE THE LINKS HAVE REASONS.
Some physicians, patients and laboratories are using microscopy to find
Babesia. The problem with this approach includes that there is no
benchmarkbook on the vast forms of Babesia found inside and outside blood
cells. No Babesia Hematology book exists for physicians, microscope enthusiasts
or aggressive patients interested in basic staining and blood examination.
1) While the CDC and various state departments of health (DOH)
provided a large number of core images for this book, their useful slides
show massively infected Red Blood Cells. While they are useful to show
profoundly infected people , such images in hematology are rare. Indeed,
some microscopy lovers report many markedly infected patients are ?negative?
on manual smears 100% of the time by most labs. In reality, sometimes one
needs to look 2-3 hours to see a single Babesia form. The CDC suggests
looking for 2-3 minutes for these types of protozoa infections. Massive
infections can possibly kill, cause clear RBC destruction, create massive
sickness and immense fevers, and this can lead to the discovery of new
species or sub-species. However, using catastrophic cases or any one lab
test to diagnose Babesia found in at least 30% of deer ticks is a concern.
Further, it is rare for patients to receive aggressive direct types of
testing from multiple laborat!
ories. In addition, some health workers are starting to believe indirect
testing is actually more sensitive.
2) Some images in the book use Babesia images from Fry Labs before
April/2007. PLEASE NOTE : We have not had a positive Babesia from Fry since
March/2007. Dr. Fry and I have different views at times, but are good
friends, and we feel the reason for negative Babesia slides is clear. For
various reasons Fry Labs VERY strongly avoids possible Babesia artifacts. No
one in the world can be 100% sure that some presentation of ?Babesia? is not
an artifact. My position is to accept any very highly suspicious image. Yet
his position is to avoid any false positives. Honorable people have
different priorities and goals. Fry laboratory is also spending massive time
and income to become involved in DNA lab innovation as their priority. Other
reasons for this direction are proprietary. In conclusion, the use of the
Fry smear for Babesia alone seems unwise.
3) I wrote this book some years ago. Any TBD book is likely slightly
outdated in months , although some things are true for thirty years. This
is common for anyone reading and passionate about credible new ideas. I have
no time to offer an updated edition. O utdated comments and errors may
exist. We have radically changed much of what we do even in the last six
months.
YOU MAY POST THIS FREE ON ANY SITE WITH THE WORDS LISTED IN THIS
EMAIL WITH NO DELETIONS .
Babesioosiin sairastuneet kärsivät useimmiten errilaisista epämääräisistä oireista, kuten väsymyksestä, viikkoja/kuukausia ennen kuin oikeaan diagnoosiin päästään.
http://www.barnstablepatriot.com/home2/ ... &Itemid=30
Feb 05 2010
Babesiosis: a quiet yet deadly concern PDF E-mail
Written by Joyce Johnson
Tick-borne disease doesn?t share the ?Lyme-light?
It?s an apparent medical dilemma - a disease whose victims may suffer vague symptoms for weeks or months as physicians ponder the cause, sometimes coming to the right diagnosis just hours too late to save the patient.
The affliction is babesiosis, yet another disease passed on to humans by a deer tick and recognized for decades without attaining the notoriety of two other life-threatening diseases carried by the same tick, Lyme and anaplasmosis (also known as ehrlichiosis.)
If you haven?t heard of babesiosis, you have lots of company. The majority of those who were asked by this reporter if they were familiar with the disease indicated they had never heard of it. A few others said they knew someone who had had it but little else.
However, those interviewed who had had close contact with the disease were surprisingly eager to talk about their experiences, some of which were harrowing tales. That included two people whose close relatives had suffered and died just hours after a diagnosis of babesiosis was reached in a hospital emergency room, too late to save them.
Several others counted themselves among the ?lucky? because either they were examined by a doctor who admitted to not know the cause of the symptoms which often resemble those of the flu, and referred them to someone who did. Or they were examined at a facility that sometimes orders simultaneous tests for three of the known tick-borne diseases. That procedure may have saved lives this past summer when at least four cases of babesiosis were diagnosed promptly on the Lower Cape.
For background to the uninitiated, babesiosis is a disease of the red blood cells where parasites, similar to cases of malaria, attempt to destroy those cells. Victims most at risk when they contract babesiosis are the elderly and those at any age with chronic diseases or physical impairments that could compromise recovery. Also at risk are those who ignore chronic symptoms when the first or second physician they consult fails to diagnose their condition. Fortunately, the spleen, one of whose duties is to filter red blood cells, can assist in recovery despite a failed diagnosis, especially in younger victims who do not have compromising health conditions.
A 77-year-old who had retired to Brewster and had no potentially compromising physical issues sought out a heart specialist when he was having breathing problems, weakness and loss of weight, three of the many possible symptoms for babesiosis. He passed a set of tests for heart disease and was told he had no problems in that area. When the symptoms continued, he consulted his regular physician who thought he might have pneumonia. Once again no health problems were identified. These efforts to understand what was wrong continued over a period of five or six weeks, his wife said. Neither doctor had ordered a blood test.
His condition continued to deteriorate until finally his wife took him to the emergency room at Cape Cod Hospital. The doctor ordered a blood test and it showed he had an unusually high count of white blood cells caused by babesia parasites. The diagnosis, even after he was given multiple transfusions, was too late and he passed away.
Another sad example is a relatively young person from Orleans who died from babesiosis. He was 53 and suffering from Crohn?s Disease when he was bitten by an infected tick. His mother said he misconstrued his symptoms as an attack of Crohn?s so he did not call a physician. When his mother checked on him she became very concerned and had him transported to a hospital. A blood test confirmed he had babesiosis, but the parasites had done their job well and he died hours later.
Survivors Tell Their Stories
Happily, other Cape Cod residents diagnosed with babesiosis have more encouraging tales to tell. Several victims of the disease in the Wellfleet/Provincetown area last summer were diagnosed promptly because their physicians ordered the composite test for tick-borne diseases and babesiosis was identified. All have expressed concern and impatience at their slow but steady recovery after taking medication developed to replace quinine (which at one time was the only known treatment but could have harmful side effects.) One victim, who was diagnosed with Lyme at the same time as babesiosis, continues to have persistent breathing problems and other symptoms which she attributes to tick-related disease and is seeking other types of treatment.
For another Wellfleet victim, diagnosis was elusive. She said in the summer of 2008 she had been feeling vaguely ill for months, which can be typical of babesiosis, whose symptoms may be so mild it is not recognized. When her situation finally became acute she was sent by ambulance to Beth Israel Hospital in Boston, where babesiosis was diagnosed. She spent at least eight days in the hospital while transfusions were administered to counteract anemia caused by the red blood cell parasites. She could be termed one of the ?lucky? ones as she is in her 80s and recovery is expected to be more difficult, or, at worst, questionable, for the elderly.
Babesiosis for an Orleans resident came on slyly, catching her unawares as she drove to the Hyannis office of the non-profit organization where she volunteers. Dozing off as she drove on Route 6, she was awakened by driving over the rough edge of the highway surface just as she was about to run off the road.
Thinking only that it was a case of overtiredness from not feeling well recently, she continued on to the office, where a fellow volunteer, startled by her appearance, asked her what was the matter. She found she had a temperature of 104 degrees. A visit to her doctor?s office resulted in being given a prescription for an antibiotic and the admonition to go to the emergency room at Cape Cod Hospital the next morning if she did not feel better.
She took his advice. A blood test revealed she had babesiosis. She received at least three transfusions over a week?s time.
?They gave me another one just as I was dismissed,? she said, with the advice it might take at least six months for her blood to regain its balance and she would start feeling ?normal.? She said the timing was right on.
But a South Chatham woman who was in her 50s when she contracted babesiosis said it took her over 10 months to fully recover. Her symptoms had included fever and an incredible headache, enough for her physician to insist that she go to the hospital for blood tests, fearing meningitis. The diagnosis was babesiosis.
The frustration of victims of tick-borne diseases - from a creature that is so small in the ?nymph? stage it can hardly be seen, and sometimes can be scratched off without any awareness that the victim has been bitten ? is paramount, as those interviewed were eager to impart. They are dismayed they have had to make real life changes to avoid exposure to ticks. For instance, gardening and casual walks in the woods and dunes which have been so important to their lives must now be done with concern for their health, and conscious steps for self protection.
A Growing Threat
In the spring, like any newborn, the nymphs are voraciously hungry, laying in wait on the tips of leaves, moist grasses (they require a moist habitat), in wood piles and bushes, for a warm-blooded animal or person to pass by close enough to transfer themselves to it, the victim unaware and seemingly powerless to protect itself.
As the nymph stage progresses in June from the size of a poppy seed to eventually the size of an immature wood tick, its characteristic reddish brown body is more identifiable, but it is still so small that it is possible to be unaware of its presence, usually in the more protected and moist parts of the body -- behind the knees, ears, base of neck and the like.
Two other deer tick-borne diseases are more familiar to the general public than babesiosis - anaplasmosis, which involves parasites of the white blood cells (also known as ehrlichiosis), and Lyme disease, named after the town in Connecticut where it was first recognized in the 1970s. The strange symptoms of Lyme which many doctors early on were finding difficult to pinpoint, raised the concern of parents and friends as they saw their loved ones and associates in pain and signs of progressive loss of health. Their concerns slowly triggered the long process of raising consciousness about tick-related diseases and their troubling, potentially long lasting and threatening elements.
The deer tick is not alone in its transgressions against humans. The wood tick (larger than the deer tick but with white graphitic-like marks on its back) carries yet another serious disease, Rocky Mountain Spotted Fever, also life threatening if not recognized and treated promptly. Ironically, one could hardly call the wood tick preferable to a deer tick, but at least because of its size - about twice that of a deer tick - it can usually be felt crawling on your skin and removed before it imbeds itself. (An imbedded tick will not transfer its diseases if it is removed up to 24 hours after it became imbedded, according to some reports.)
The Cape Cod Cooperative Extension in Barnstable has taken a stand against ticks on Cape Cod and the Islands and is attempting to rid the area of them, using knowledge of the deer tick?s life cycle - from deer to field mice to humans. If the cycle can be broken the threat will be lessened. The question is how to find the funds to accomplish such a task.
One such attempt that was state funded included setting up feeders for deer in the woods where a deer is lured to a feeder placed so that it rubs against four posts on which pesticides had been deposited. If successful, the pesticides kill the ticks. But the failing economy caused the funds for the program to be cut. David Simser of the Extension Service said he has no idea when and if such programs will be refunded, although he hopes some will be coming forth from the Environmental Protection Agency.
?I?ve got my fingers crossed,? Simser said.
So protection from ticks, at least for the time being, apparently mostly falls to the residents of the area to assist by appropriate management of their properties, as well as more intensive education of the public by local organizations.
County Leads Education, Prevention Campaign
The Cape and Islands Tick Disease Task Force, founded over 10 years ago by Truro biologist Brenda Boleyn, provides information and seminars to keep doctors and other professionals updated on tick issues, as well as initiatives in alerting the public.
The extension service has put out a booklet, which is available by contacting it at www.capecodextension.org. It contains advice for reducing the number of deer ticks, for instance, by clearing property borders of low lying limbs, leaves and grass. It lists the safe uses of pesticides and tips for disposal of clothing when working outside or walking in the country. There are suggestions for plantings and other ways to make gardens less attractive to deer, mice and other animals that might carry babesia parasites.
The extension service in 2007 compiled data from a survey of deer ticks on the Cape (Sandwich to Yarmouth as well as the Islands) and the diseases they carry. In that report, an average of 47 percent of the ticks tested carried Lyme disease. More alarming, an average of 5 percent of the ticks in three of the towns where testing took place - Harwich, Yarmouth and on Martha?s Vineyard - carried all three of the diseases, Lyme, babesiosis and anaplasmosis. Funding for testing of the Lower Cape has not been secured.
Simser said more recent figures indicate there were 25 confirmed cases of babesiosis in Barnstable County in 2008 and a total of 51 cases for the combined counties of Barnstable, Dukes and Nantucket, or an increase of 34 percent of cases in 2008 over those in 2007. He said the current state budget does not include tick testing.
Education, be it through the extension service or other means, includes understanding of tick habitats so they can be avoided, such as wet, swampy areas, wood piles that may contain damp rot, as well as early morning dew- laden grasses, along the shore or in woods and open fields. Also pertinent is that the deer tick, unlike the wood tick, is present year round, with the potential for transmitting diseases when temperatures are above 30 degree. Clothing can also help protect an individual. White socks drawn up over light-colored trousers will make ticks more visible. Throwing clothing into a dryer for 20 to 30 minutes could help get rid of ticks missed visually. Unfortunately, a hot shower or bath may annoy but not kill ticks so full body checks at night are critical after potential exposure, including double examination of key areas such as the hair lines and behind ears.
Joyce Johnson is a free lance reporter who has had personal experience with tick-borne disease. She was a staff reporter for The Cape Codder newspaper for 16 years where she wrote extensively about Lyme Disease on Cape Cod. She may be reached by e-mail at www.joysculpt1@comcast.net.
http://www.barnstablepatriot.com/home2/ ... &Itemid=30
Feb 05 2010
Babesiosis: a quiet yet deadly concern PDF E-mail
Written by Joyce Johnson
Tick-borne disease doesn?t share the ?Lyme-light?
It?s an apparent medical dilemma - a disease whose victims may suffer vague symptoms for weeks or months as physicians ponder the cause, sometimes coming to the right diagnosis just hours too late to save the patient.
The affliction is babesiosis, yet another disease passed on to humans by a deer tick and recognized for decades without attaining the notoriety of two other life-threatening diseases carried by the same tick, Lyme and anaplasmosis (also known as ehrlichiosis.)
If you haven?t heard of babesiosis, you have lots of company. The majority of those who were asked by this reporter if they were familiar with the disease indicated they had never heard of it. A few others said they knew someone who had had it but little else.
However, those interviewed who had had close contact with the disease were surprisingly eager to talk about their experiences, some of which were harrowing tales. That included two people whose close relatives had suffered and died just hours after a diagnosis of babesiosis was reached in a hospital emergency room, too late to save them.
Several others counted themselves among the ?lucky? because either they were examined by a doctor who admitted to not know the cause of the symptoms which often resemble those of the flu, and referred them to someone who did. Or they were examined at a facility that sometimes orders simultaneous tests for three of the known tick-borne diseases. That procedure may have saved lives this past summer when at least four cases of babesiosis were diagnosed promptly on the Lower Cape.
For background to the uninitiated, babesiosis is a disease of the red blood cells where parasites, similar to cases of malaria, attempt to destroy those cells. Victims most at risk when they contract babesiosis are the elderly and those at any age with chronic diseases or physical impairments that could compromise recovery. Also at risk are those who ignore chronic symptoms when the first or second physician they consult fails to diagnose their condition. Fortunately, the spleen, one of whose duties is to filter red blood cells, can assist in recovery despite a failed diagnosis, especially in younger victims who do not have compromising health conditions.
A 77-year-old who had retired to Brewster and had no potentially compromising physical issues sought out a heart specialist when he was having breathing problems, weakness and loss of weight, three of the many possible symptoms for babesiosis. He passed a set of tests for heart disease and was told he had no problems in that area. When the symptoms continued, he consulted his regular physician who thought he might have pneumonia. Once again no health problems were identified. These efforts to understand what was wrong continued over a period of five or six weeks, his wife said. Neither doctor had ordered a blood test.
His condition continued to deteriorate until finally his wife took him to the emergency room at Cape Cod Hospital. The doctor ordered a blood test and it showed he had an unusually high count of white blood cells caused by babesia parasites. The diagnosis, even after he was given multiple transfusions, was too late and he passed away.
Another sad example is a relatively young person from Orleans who died from babesiosis. He was 53 and suffering from Crohn?s Disease when he was bitten by an infected tick. His mother said he misconstrued his symptoms as an attack of Crohn?s so he did not call a physician. When his mother checked on him she became very concerned and had him transported to a hospital. A blood test confirmed he had babesiosis, but the parasites had done their job well and he died hours later.
Survivors Tell Their Stories
Happily, other Cape Cod residents diagnosed with babesiosis have more encouraging tales to tell. Several victims of the disease in the Wellfleet/Provincetown area last summer were diagnosed promptly because their physicians ordered the composite test for tick-borne diseases and babesiosis was identified. All have expressed concern and impatience at their slow but steady recovery after taking medication developed to replace quinine (which at one time was the only known treatment but could have harmful side effects.) One victim, who was diagnosed with Lyme at the same time as babesiosis, continues to have persistent breathing problems and other symptoms which she attributes to tick-related disease and is seeking other types of treatment.
For another Wellfleet victim, diagnosis was elusive. She said in the summer of 2008 she had been feeling vaguely ill for months, which can be typical of babesiosis, whose symptoms may be so mild it is not recognized. When her situation finally became acute she was sent by ambulance to Beth Israel Hospital in Boston, where babesiosis was diagnosed. She spent at least eight days in the hospital while transfusions were administered to counteract anemia caused by the red blood cell parasites. She could be termed one of the ?lucky? ones as she is in her 80s and recovery is expected to be more difficult, or, at worst, questionable, for the elderly.
Babesiosis for an Orleans resident came on slyly, catching her unawares as she drove to the Hyannis office of the non-profit organization where she volunteers. Dozing off as she drove on Route 6, she was awakened by driving over the rough edge of the highway surface just as she was about to run off the road.
Thinking only that it was a case of overtiredness from not feeling well recently, she continued on to the office, where a fellow volunteer, startled by her appearance, asked her what was the matter. She found she had a temperature of 104 degrees. A visit to her doctor?s office resulted in being given a prescription for an antibiotic and the admonition to go to the emergency room at Cape Cod Hospital the next morning if she did not feel better.
She took his advice. A blood test revealed she had babesiosis. She received at least three transfusions over a week?s time.
?They gave me another one just as I was dismissed,? she said, with the advice it might take at least six months for her blood to regain its balance and she would start feeling ?normal.? She said the timing was right on.
But a South Chatham woman who was in her 50s when she contracted babesiosis said it took her over 10 months to fully recover. Her symptoms had included fever and an incredible headache, enough for her physician to insist that she go to the hospital for blood tests, fearing meningitis. The diagnosis was babesiosis.
The frustration of victims of tick-borne diseases - from a creature that is so small in the ?nymph? stage it can hardly be seen, and sometimes can be scratched off without any awareness that the victim has been bitten ? is paramount, as those interviewed were eager to impart. They are dismayed they have had to make real life changes to avoid exposure to ticks. For instance, gardening and casual walks in the woods and dunes which have been so important to their lives must now be done with concern for their health, and conscious steps for self protection.
A Growing Threat
In the spring, like any newborn, the nymphs are voraciously hungry, laying in wait on the tips of leaves, moist grasses (they require a moist habitat), in wood piles and bushes, for a warm-blooded animal or person to pass by close enough to transfer themselves to it, the victim unaware and seemingly powerless to protect itself.
As the nymph stage progresses in June from the size of a poppy seed to eventually the size of an immature wood tick, its characteristic reddish brown body is more identifiable, but it is still so small that it is possible to be unaware of its presence, usually in the more protected and moist parts of the body -- behind the knees, ears, base of neck and the like.
Two other deer tick-borne diseases are more familiar to the general public than babesiosis - anaplasmosis, which involves parasites of the white blood cells (also known as ehrlichiosis), and Lyme disease, named after the town in Connecticut where it was first recognized in the 1970s. The strange symptoms of Lyme which many doctors early on were finding difficult to pinpoint, raised the concern of parents and friends as they saw their loved ones and associates in pain and signs of progressive loss of health. Their concerns slowly triggered the long process of raising consciousness about tick-related diseases and their troubling, potentially long lasting and threatening elements.
The deer tick is not alone in its transgressions against humans. The wood tick (larger than the deer tick but with white graphitic-like marks on its back) carries yet another serious disease, Rocky Mountain Spotted Fever, also life threatening if not recognized and treated promptly. Ironically, one could hardly call the wood tick preferable to a deer tick, but at least because of its size - about twice that of a deer tick - it can usually be felt crawling on your skin and removed before it imbeds itself. (An imbedded tick will not transfer its diseases if it is removed up to 24 hours after it became imbedded, according to some reports.)
The Cape Cod Cooperative Extension in Barnstable has taken a stand against ticks on Cape Cod and the Islands and is attempting to rid the area of them, using knowledge of the deer tick?s life cycle - from deer to field mice to humans. If the cycle can be broken the threat will be lessened. The question is how to find the funds to accomplish such a task.
One such attempt that was state funded included setting up feeders for deer in the woods where a deer is lured to a feeder placed so that it rubs against four posts on which pesticides had been deposited. If successful, the pesticides kill the ticks. But the failing economy caused the funds for the program to be cut. David Simser of the Extension Service said he has no idea when and if such programs will be refunded, although he hopes some will be coming forth from the Environmental Protection Agency.
?I?ve got my fingers crossed,? Simser said.
So protection from ticks, at least for the time being, apparently mostly falls to the residents of the area to assist by appropriate management of their properties, as well as more intensive education of the public by local organizations.
County Leads Education, Prevention Campaign
The Cape and Islands Tick Disease Task Force, founded over 10 years ago by Truro biologist Brenda Boleyn, provides information and seminars to keep doctors and other professionals updated on tick issues, as well as initiatives in alerting the public.
The extension service has put out a booklet, which is available by contacting it at www.capecodextension.org. It contains advice for reducing the number of deer ticks, for instance, by clearing property borders of low lying limbs, leaves and grass. It lists the safe uses of pesticides and tips for disposal of clothing when working outside or walking in the country. There are suggestions for plantings and other ways to make gardens less attractive to deer, mice and other animals that might carry babesia parasites.
The extension service in 2007 compiled data from a survey of deer ticks on the Cape (Sandwich to Yarmouth as well as the Islands) and the diseases they carry. In that report, an average of 47 percent of the ticks tested carried Lyme disease. More alarming, an average of 5 percent of the ticks in three of the towns where testing took place - Harwich, Yarmouth and on Martha?s Vineyard - carried all three of the diseases, Lyme, babesiosis and anaplasmosis. Funding for testing of the Lower Cape has not been secured.
Simser said more recent figures indicate there were 25 confirmed cases of babesiosis in Barnstable County in 2008 and a total of 51 cases for the combined counties of Barnstable, Dukes and Nantucket, or an increase of 34 percent of cases in 2008 over those in 2007. He said the current state budget does not include tick testing.
Education, be it through the extension service or other means, includes understanding of tick habitats so they can be avoided, such as wet, swampy areas, wood piles that may contain damp rot, as well as early morning dew- laden grasses, along the shore or in woods and open fields. Also pertinent is that the deer tick, unlike the wood tick, is present year round, with the potential for transmitting diseases when temperatures are above 30 degree. Clothing can also help protect an individual. White socks drawn up over light-colored trousers will make ticks more visible. Throwing clothing into a dryer for 20 to 30 minutes could help get rid of ticks missed visually. Unfortunately, a hot shower or bath may annoy but not kill ticks so full body checks at night are critical after potential exposure, including double examination of key areas such as the hair lines and behind ears.
Joyce Johnson is a free lance reporter who has had personal experience with tick-borne disease. She was a staff reporter for The Cape Codder newspaper for 16 years where she wrote extensively about Lyme Disease on Cape Cod. She may be reached by e-mail at www.joysculpt1@comcast.net.
Amerikkalaisen lääkärin kokemus omasta babesioosista ja sen hoidosta. Hän käyttää nykyään omaa hoitoprotokollaansa omille potilailleen. Hän käytti eri antibioottien yhdistelmähoitoa sekä suun kautta että suonensisäisesti. Hänen mukaansa kaikkien borrelioosia sairastavien tulisi hoitaa myös lisäinfektiot vaikka testit olisivat negatiiviset koska nykyiset testit eivät ole riittävän herkkiä toteamaan infektiota.
Hän aloitti hoitonsa lääkeyrteillä: artemisiini ja enula useiden kuukausien ajan. Oireet palasivat 6 kk kuluttua (hikoilu, päänsärky, mielialan vaihtelut jne.). Sen jälkeen hän aloitti yhdistelmäantibioottien käytön.
"I have personally conquered Babesia Duncani I want to share my experience with you. I have since used similar treatments in patients.
I began therapies using high doses of Artemesinin (Allergy Research) with Zhang herbal Artemesiae. Dr Zhang has isolated the active ingredient of Artemesinin (the active portion of Artemesia), and I do believe his Artemesiae is very effective. I used this combination with the Cowden herb, Enula for the first several months of my treatments. Many symptoms cleared but I relapsed after 6 months developing sweats, horrific headaches, and mood swings.
I was the then treated with Doxycycline, Mepron and Zithromycin. I believe that these drugs should be given the full length of the RBC- for 4-5 months, which is what I did. My symptoms (horrendous headaches and sweats) improved but I was left with persistent hepatomeglay, raised liver enzymes, occasional sweats, and mood swings.
Intravenous Clindamycin/ Azithromycin and oral Mepron finally cleared all symptoms and signs.
My mood was immediately improved with Lamictal, which treats the underlying problem seen in most chronic Lyme patients, Limbic Seizures. I used low doses of Lamictal (25 mg) and gradually increased as needed to control the mood changes. I have remained on 150 mg twice daily as my treatments continue.
I am nearing the end of my intravenous treatments with Tigacillin and Levaquin. I am enjoying normal days on my drug holidays - which I do every 2 weeks. I will be doing IV Meropenem and oral Rifambutin before stopping IV and changing to oral medications, Rifambutin, Omnicef, and Minocycline (in 2 week cycles on and off).
I realize that pulsed therapies are controversial, but after several months of daily treatments, and once Babesia is under control, I find them effective and most importantly one can finally achieve a sense of control while rehabilitating from this disabling disease. The drug holidays are also important to see how well the immune system is coping and to give one a sense of improvement and respite from herxing. During drug holidays I recommend intravenous vitamins, infrared sauna, and juicing for a detox.
I now recommend that all Chronic Lyme patients be treated simultaneously for these 3 infections, no matter what tests show. The current tests for Bartonella, in particular are very insensitive. Assume that patients have these 3 infections, otherwise you will be chasing your tail constantly with therapy, and until Babesia is brought under control, the immune system will not strengthen, and patients will remain unwell.
Hän aloitti hoitonsa lääkeyrteillä: artemisiini ja enula useiden kuukausien ajan. Oireet palasivat 6 kk kuluttua (hikoilu, päänsärky, mielialan vaihtelut jne.). Sen jälkeen hän aloitti yhdistelmäantibioottien käytön.
"I have personally conquered Babesia Duncani I want to share my experience with you. I have since used similar treatments in patients.
I began therapies using high doses of Artemesinin (Allergy Research) with Zhang herbal Artemesiae. Dr Zhang has isolated the active ingredient of Artemesinin (the active portion of Artemesia), and I do believe his Artemesiae is very effective. I used this combination with the Cowden herb, Enula for the first several months of my treatments. Many symptoms cleared but I relapsed after 6 months developing sweats, horrific headaches, and mood swings.
I was the then treated with Doxycycline, Mepron and Zithromycin. I believe that these drugs should be given the full length of the RBC- for 4-5 months, which is what I did. My symptoms (horrendous headaches and sweats) improved but I was left with persistent hepatomeglay, raised liver enzymes, occasional sweats, and mood swings.
Intravenous Clindamycin/ Azithromycin and oral Mepron finally cleared all symptoms and signs.
My mood was immediately improved with Lamictal, which treats the underlying problem seen in most chronic Lyme patients, Limbic Seizures. I used low doses of Lamictal (25 mg) and gradually increased as needed to control the mood changes. I have remained on 150 mg twice daily as my treatments continue.
I am nearing the end of my intravenous treatments with Tigacillin and Levaquin. I am enjoying normal days on my drug holidays - which I do every 2 weeks. I will be doing IV Meropenem and oral Rifambutin before stopping IV and changing to oral medications, Rifambutin, Omnicef, and Minocycline (in 2 week cycles on and off).
I realize that pulsed therapies are controversial, but after several months of daily treatments, and once Babesia is under control, I find them effective and most importantly one can finally achieve a sense of control while rehabilitating from this disabling disease. The drug holidays are also important to see how well the immune system is coping and to give one a sense of improvement and respite from herxing. During drug holidays I recommend intravenous vitamins, infrared sauna, and juicing for a detox.
I now recommend that all Chronic Lyme patients be treated simultaneously for these 3 infections, no matter what tests show. The current tests for Bartonella, in particular are very insensitive. Assume that patients have these 3 infections, otherwise you will be chasing your tail constantly with therapy, and until Babesia is brought under control, the immune system will not strengthen, and patients will remain unwell.
Babesia microtia löydettiin Puolan koirissa olevista punkeista (2010)
Pol J Microbiol. 2010;59(2):95-7.
The molecular evidence of Babesia microti in hard ticks removed from dogs in
Warsaw (central Poland).
Zygner W, Baska P, Wisniewski M, Wedrychowicz H.
Division of Parasitology and Parasitic Diseases, Department of Preclinical
Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences,
Warsaw, Poland. wojciechzygner@yahoo.pl
The purpose of this study was to specify the occurrence and prevalence of
Babesia microti in hard ticks removed from dogs in Warsaw (central Poland).
Among 590 collected ticks, 209 were identified as Ixodes ricinus, and 381 as
Dermacentor reticulatus. B. microti DNA was detected in 11 out of 590 (1.86%)
samples of ticks. The DNA of the parasite was detected only in lysates from
female I. ricinus ticks (11 out of 193; 5.7%). The result of this study is the
first evidence of B. microti in I. ricinus ticks in Warsaw.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 20734753 [PubMed - in process]
Pol J Microbiol. 2010;59(2):95-7.
The molecular evidence of Babesia microti in hard ticks removed from dogs in
Warsaw (central Poland).
Zygner W, Baska P, Wisniewski M, Wedrychowicz H.
Division of Parasitology and Parasitic Diseases, Department of Preclinical
Sciences, Faculty of Veterinary Medicine, Warsaw University of Life Sciences,
Warsaw, Poland. wojciechzygner@yahoo.pl
The purpose of this study was to specify the occurrence and prevalence of
Babesia microti in hard ticks removed from dogs in Warsaw (central Poland).
Among 590 collected ticks, 209 were identified as Ixodes ricinus, and 381 as
Dermacentor reticulatus. B. microti DNA was detected in 11 out of 590 (1.86%)
samples of ticks. The DNA of the parasite was detected only in lysates from
female I. ricinus ticks (11 out of 193; 5.7%). The result of this study is the
first evidence of B. microti in I. ricinus ticks in Warsaw.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 20734753 [PubMed - in process]
Babesioosin voi saada verensiirron kautta. Taudin oireet vaihtelevat suuresti eri henkilöillä. Tavallisin oire on jatkuva kuumeilu. Immuunipuutoksesta kärsivillä oireet voivat olla henkeä uhkaavat.
J Clin Apher. 2010 Sep 7; [Epub ahead of print]
Autoimmunity in transfusion babesiosis: A spectrum of clinical presentations.
Herman JH, Ayache S, Olkowska D.
Transfusion Medicine Department, Thomas Jefferson University Hospital,
Philadelphia, Pennsylvania.
Transfusion-acquired babesiosis can be an asymptomatic or self-limited febrile
hemolytic illness in a healthy host. A persistent, relapsing, and/or fulminant
course with the development of life-threatening complications may be seen in
immunocompromised or splenectomized patients. As in malaria, erythrocyte
parasitemia is often associated with nonimmune hemolysis, and can be treated
with erythrocytapheresis. Just as warm autoantibodies have been reported in
malaria infection, the development of autoantibody-mediated immune hemolysis has
been reported in babesiosis. We treated a previously healthy male with multiple
injuries from a motor vehicle accident necessitating massive transfusion. Late
in the hospitalization, his blood smear revealed Babesia microti, confirmed by
PCR study and serology. This was eventually traced to a unit of blood from an
asymptomatic blood donor that was transfused during his initial trauma care.
Specific antibiotic therapy was begun, and severe hemolysis from a high parasite
burden required red blood cell exchange which led to rapid abatement of the
hemolysis. He had a positive DAT (IgG with a pan-reactive eluate) but no serum
autoantibody. This persisted for 10 days following cessation of hemolysis, and
became negative while still on antibiotics while his parasite burden became
undetectable. Reports of autoimmunity associated with community acquired
babesiosis often have severe hemolysis from their autoantibodies, but our case
shows that autoantibodies may also follow transfusion-acquired babesiosis. The
nature of the autoantigen is unknown. J. Clin. Apheresis, 2010. (c) 2010
Wiley-Liss, Inc.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 20824620 [PubMed - as supplied by publisher]
J Clin Apher. 2010 Sep 7; [Epub ahead of print]
Autoimmunity in transfusion babesiosis: A spectrum of clinical presentations.
Herman JH, Ayache S, Olkowska D.
Transfusion Medicine Department, Thomas Jefferson University Hospital,
Philadelphia, Pennsylvania.
Transfusion-acquired babesiosis can be an asymptomatic or self-limited febrile
hemolytic illness in a healthy host. A persistent, relapsing, and/or fulminant
course with the development of life-threatening complications may be seen in
immunocompromised or splenectomized patients. As in malaria, erythrocyte
parasitemia is often associated with nonimmune hemolysis, and can be treated
with erythrocytapheresis. Just as warm autoantibodies have been reported in
malaria infection, the development of autoantibody-mediated immune hemolysis has
been reported in babesiosis. We treated a previously healthy male with multiple
injuries from a motor vehicle accident necessitating massive transfusion. Late
in the hospitalization, his blood smear revealed Babesia microti, confirmed by
PCR study and serology. This was eventually traced to a unit of blood from an
asymptomatic blood donor that was transfused during his initial trauma care.
Specific antibiotic therapy was begun, and severe hemolysis from a high parasite
burden required red blood cell exchange which led to rapid abatement of the
hemolysis. He had a positive DAT (IgG with a pan-reactive eluate) but no serum
autoantibody. This persisted for 10 days following cessation of hemolysis, and
became negative while still on antibiotics while his parasite burden became
undetectable. Reports of autoimmunity associated with community acquired
babesiosis often have severe hemolysis from their autoantibodies, but our case
shows that autoantibodies may also follow transfusion-acquired babesiosis. The
nature of the autoantigen is unknown. J. Clin. Apheresis, 2010. (c) 2010
Wiley-Liss, Inc.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 20824620 [PubMed - as supplied by publisher]
Allaolevassa artikkelissa kerrotaan kahdesta aiemminn terveestä ranskalaisesta jotka sairastuivat babesioosiin punkinpureman jälkeen.
Emerg Infect Dis. 2011 Jan;17(1):114-6.
Babesiosis in immunocompetent patients, Europe.
Martinot M, Mohseni Zadeh M, Hansmann Y, Grawey I, Christmann D, Aguillon S,
Jouglin M, Chauvin A, De Briel D.
Hopitaux Civils De Colmar, Colmar, France (M. Martinot, M.M. Zadeh, I. Grawey,
S. Aguillon, D. De Briel); Hopitaux Universitaires de Strasbourg, Strasbourg,
France (Y. Hansmann, D. Christmann); Ecole Nationale Veterinaire Agroalimentaire
et de l'Alimentation Nantes-Atlantique, Nantes, France (M. Jouglin, A. Chauvin);
and Institut National de la Recherche Agronomique, Nantes (M. Jouglin, A.
Chauvin).
We report 2 cases of babesiosis in immunocompetent patients in France. A severe
influenza-like disease developed in both patients 2 weeks after they had been
bitten by ticks. Diagnosis was obtained from blood smears, and Babesia divergens
was identified by PCR in 1 case. Babesiosis in Europe occurs in healthy patients, not only in splenectomized patients.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 21192869 [PubMed - in process]
Emerg Infect Dis. 2011 Jan;17(1):114-6.
Babesiosis in immunocompetent patients, Europe.
Martinot M, Mohseni Zadeh M, Hansmann Y, Grawey I, Christmann D, Aguillon S,
Jouglin M, Chauvin A, De Briel D.
Hopitaux Civils De Colmar, Colmar, France (M. Martinot, M.M. Zadeh, I. Grawey,
S. Aguillon, D. De Briel); Hopitaux Universitaires de Strasbourg, Strasbourg,
France (Y. Hansmann, D. Christmann); Ecole Nationale Veterinaire Agroalimentaire
et de l'Alimentation Nantes-Atlantique, Nantes, France (M. Jouglin, A. Chauvin);
and Institut National de la Recherche Agronomique, Nantes (M. Jouglin, A.
Chauvin).
We report 2 cases of babesiosis in immunocompetent patients in France. A severe
influenza-like disease developed in both patients 2 weeks after they had been
bitten by ticks. Diagnosis was obtained from blood smears, and Babesia divergens
was identified by PCR in 1 case. Babesiosis in Europe occurs in healthy patients, not only in splenectomized patients.
http://eutils.ncbi.nlm.nih.gov/entrez/e ... md=prlinks
PMID: 21192869 [PubMed - in process]
Belgialaisista punkeista löydettiin Babesia EU1 ja babesia microtia. Punkkeja (1005) kerättiin kissoista ja koirista. Niistä löytyi myös borrelia-bakteereita.
http://www.liebertonline.com/doi/abs/10 ... .2009.0189
Vector-Borne and Zoonotic Diseases
First Molecular Evidence of Potentially Zoonotic Babesia microti and Babesia sp. EU1 in Ixodes ricinus Ticks in Belgium
To cite this article:
Laetitia Lempereur, Ann De Cat, Yannick Caron, Maxime Madder, Edwin Claerebout, Claude Saegerman, Bertrand Losson. Vector-Borne and Zoonotic Diseases. February 2011, 11(2): 125-130. doi:10.1089/vbz.2009.0189.
Published in Volume: 11 Issue 2: February 1, 2011
Online Ahead of Print: June 24, 2010
Abstract
We report the first molecular evidence of the presence of Babesia sp. EU1 and Babesia microti in Ixodes ricinus ticks in Belgium. A 1-year national survey collected 1005 ticks from cats and dogs. A polymerase chain reaction technique amplifying a part of the 18S rRNA gene detected Babesia spp. in 11 out of 841 selected and validated tick extracts. Subsequent sequencing identified Ba. microti (n = 3) and Babesia sp. EU1 (n = 6). This study has demonstrated a low infection rate (1.31% with 95% CI: 0.65?2.33) of Babesia spp. carriage in I. ricinus ticks in Belgium but, for the first time, reports two potentially zoonotic species belonging to this genus. Coinfection with Ba. microti and Borrelia burgdorferi sensu stricto also was demonstrated. In addition, this study clearly demonstrates that inhibitors of polymerase chain reaction amplification are present in engorged ticks.
http://www.liebertonline.com/doi/abs/10 ... .2009.0189
Vector-Borne and Zoonotic Diseases
First Molecular Evidence of Potentially Zoonotic Babesia microti and Babesia sp. EU1 in Ixodes ricinus Ticks in Belgium
To cite this article:
Laetitia Lempereur, Ann De Cat, Yannick Caron, Maxime Madder, Edwin Claerebout, Claude Saegerman, Bertrand Losson. Vector-Borne and Zoonotic Diseases. February 2011, 11(2): 125-130. doi:10.1089/vbz.2009.0189.
Published in Volume: 11 Issue 2: February 1, 2011
Online Ahead of Print: June 24, 2010
Abstract
We report the first molecular evidence of the presence of Babesia sp. EU1 and Babesia microti in Ixodes ricinus ticks in Belgium. A 1-year national survey collected 1005 ticks from cats and dogs. A polymerase chain reaction technique amplifying a part of the 18S rRNA gene detected Babesia spp. in 11 out of 841 selected and validated tick extracts. Subsequent sequencing identified Ba. microti (n = 3) and Babesia sp. EU1 (n = 6). This study has demonstrated a low infection rate (1.31% with 95% CI: 0.65?2.33) of Babesia spp. carriage in I. ricinus ticks in Belgium but, for the first time, reports two potentially zoonotic species belonging to this genus. Coinfection with Ba. microti and Borrelia burgdorferi sensu stricto also was demonstrated. In addition, this study clearly demonstrates that inhibitors of polymerase chain reaction amplification are present in engorged ticks.
Babesia tarttuu veriteitse. Paviaanit saivat tartunnan kun taudinaiheuttajaa siirrettiin niihin suonensisäisesti, lihakseen tai ihon alle. (2011)
J Am Assoc Lab Anim Sci. 2011;50(4):500-6.
Detection and Experimental Transmission of a Novel Babesia Isolate in Captive Olive Baboons (Papio cynocephalus anubis).
Reichard MV, Gray KM, Van Den Bussche RA, d'Offay JM, White GL, Simecka CM, Wolf RF.
Source
Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma, USA. mason.reichard@okstate.edu.
Abstract
Babesia spp. are tick-transmitted apicomplexan hemoparasites that infect mammalian red blood cells. Our purpose was to determine the prevalence of Babesia infection in a colony of captive baboons and to evaluate potential experimental routes of the transmission of the hemoparasite.
DNA was extracted from the blood of baboons and tested for infection with Babesia by PCR and primers that amplify the 18s rRNA gene of the parasite. The overall prevalence of infection of Babesia in the baboon population was 8.8% (73 of 830). Phylogenetic analysis of the sequenced DNA from 2 baboons revealed that the Babesia isolate found in captive baboons was a novel species most closely related (97% to 99%) to B. leo.
Blood from a Babesia-infected donor baboon was inoculated intravenously, intramuscularly, or subcutaneously into 3 naive baboons. The intravenously inoculated baboon was PCR-positive at 7 d after inoculation; the 2 baboons inoculated by other routes became PCR-positive at 10 d after inoculation.
All 3 baboons remained PCR-positive for Babesia through day 31. Baboons experimentally inoculated with the new Babesia isolate did not exhibit clinical signs of babesiosis during the experiments.
We demonstrated that captive baboons are infected with a novel Babesia isolate.
In addition we showed that Babesia can be transmitted in the absence of the organism's definitive host (ticks) by transfer of infected blood through intravenous, intramuscular, and subcutaneous routes to naive baboons.
PMID:
21838979
[PubMed - in process]
PMCID: PMC3148650
[Available on 2012/1/1]
J Am Assoc Lab Anim Sci. 2011;50(4):500-6.
Detection and Experimental Transmission of a Novel Babesia Isolate in Captive Olive Baboons (Papio cynocephalus anubis).
Reichard MV, Gray KM, Van Den Bussche RA, d'Offay JM, White GL, Simecka CM, Wolf RF.
Source
Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, Oklahoma, USA. mason.reichard@okstate.edu.
Abstract
Babesia spp. are tick-transmitted apicomplexan hemoparasites that infect mammalian red blood cells. Our purpose was to determine the prevalence of Babesia infection in a colony of captive baboons and to evaluate potential experimental routes of the transmission of the hemoparasite.
DNA was extracted from the blood of baboons and tested for infection with Babesia by PCR and primers that amplify the 18s rRNA gene of the parasite. The overall prevalence of infection of Babesia in the baboon population was 8.8% (73 of 830). Phylogenetic analysis of the sequenced DNA from 2 baboons revealed that the Babesia isolate found in captive baboons was a novel species most closely related (97% to 99%) to B. leo.
Blood from a Babesia-infected donor baboon was inoculated intravenously, intramuscularly, or subcutaneously into 3 naive baboons. The intravenously inoculated baboon was PCR-positive at 7 d after inoculation; the 2 baboons inoculated by other routes became PCR-positive at 10 d after inoculation.
All 3 baboons remained PCR-positive for Babesia through day 31. Baboons experimentally inoculated with the new Babesia isolate did not exhibit clinical signs of babesiosis during the experiments.
We demonstrated that captive baboons are infected with a novel Babesia isolate.
In addition we showed that Babesia can be transmitted in the absence of the organism's definitive host (ticks) by transfer of infected blood through intravenous, intramuscular, and subcutaneous routes to naive baboons.
PMID:
21838979
[PubMed - in process]
PMCID: PMC3148650
[Available on 2012/1/1]
"Punkkien välityksellä leviävä babesioosi voi aiheuttaa vakavan infektiotaudin, jopa kuoleman. Tartunnan voi saada myös verivalmisteista. Verenluovuttajia ei tällä hetkellä testata esim. babesioosin varalta."
Tick-borne parasite infecting U.S. blood supply, CDC says
By Julie Steenhuysen
2011
updated 2 hours 19 minutes ago
CHICAGO ? A tick-borne infection known as Babesiosis, which can cause severe disease and even death, is becoming a growing threat to the U.S. blood supply, government researchers said Monday.
There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect the infection before people donate blood.
A 31-year study by the U.S. Centers for Disease Control and Prevention now suggests the parasitic infection may be increasing.There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect the infection before people donate blood.
Babesia infections are marked by anemia, fever, chills and fatigue, but they can also cause organ failure and death.
The still rare disease is known to occur in seven U.S. states in the Northeast and Upper Midwest in the spring and summer.
But a study led by Dr. Barbara Herwaldt of the CDC, published in the Annals of Internal Medicine, found cases had occurred year-round and in states where Babesia parasites are not found -- including as far away as Texas and Florida.
States in which the parasite occurs naturally are Massachusetts, New York, Connecticut, Minnesota, Rhode Island, New Jersey and Wisconsin.
Of the 162 cases of Babesia infection caused by blood transfusions between 1979 and 2009, nearly 80 percent occurred between 2000 and 2009.
"Babesia microti has become the most frequently reported transfusion-transmitted parasite in the United States," CDC researchers wrote, far outpacing malaria infections, which accounted for 49 cases of transfusion-associated disease during the same period, including just five cases during 2000-2009.
Premature infants appear to be especially vulnerable.
A separate study published Monday in the journal Pediatrics by a team at the University of Nebraska looked at seven cases of transfusion-associated Babesiosis in premature infants.
They found blood transfusions from two infected units of blood caused all seven of the cases of Babesiosis.
Symptoms of the infections varied widely, but babies with the lowest weights at birth were at greatest risk of serious infection.
The authors warned doctors in areas in which Babesiosis occurs to be watchful for cases in premature infants exposed to blood transfusions.
The CDC researchers called for better ways to prevent and detect cases of transfusion-associated Babesiosis.
"Our findings underscore the year-round vulnerability of the U.S. blood supply -- especially, but not only -- in and near Babesiosis-endemic areas.
"They also highlight the importance of multi-agency collaborative efforts to detect, investigate, and document transfusion cases; to assess the risks for transfusion transmission; and, thereby, to inform the scope of prevention measures."
To deter transfusion-linked Babesiosis, the CDC in January said public health departments should report all cases of the infections to the CDC.
http://www.msnbc.msn.com/id/44402523/ns ... mWK5nZQLms
Tick-borne parasite infecting U.S. blood supply, CDC says
By Julie Steenhuysen
2011
updated 2 hours 19 minutes ago
CHICAGO ? A tick-borne infection known as Babesiosis, which can cause severe disease and even death, is becoming a growing threat to the U.S. blood supply, government researchers said Monday.
There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect the infection before people donate blood.
A 31-year study by the U.S. Centers for Disease Control and Prevention now suggests the parasitic infection may be increasing.There are currently no diagnostic tests approved by the U.S. Food and Drug Administration that can detect the infection before people donate blood.
Babesia infections are marked by anemia, fever, chills and fatigue, but they can also cause organ failure and death.
The still rare disease is known to occur in seven U.S. states in the Northeast and Upper Midwest in the spring and summer.
But a study led by Dr. Barbara Herwaldt of the CDC, published in the Annals of Internal Medicine, found cases had occurred year-round and in states where Babesia parasites are not found -- including as far away as Texas and Florida.
States in which the parasite occurs naturally are Massachusetts, New York, Connecticut, Minnesota, Rhode Island, New Jersey and Wisconsin.
Of the 162 cases of Babesia infection caused by blood transfusions between 1979 and 2009, nearly 80 percent occurred between 2000 and 2009.
"Babesia microti has become the most frequently reported transfusion-transmitted parasite in the United States," CDC researchers wrote, far outpacing malaria infections, which accounted for 49 cases of transfusion-associated disease during the same period, including just five cases during 2000-2009.
Premature infants appear to be especially vulnerable.
A separate study published Monday in the journal Pediatrics by a team at the University of Nebraska looked at seven cases of transfusion-associated Babesiosis in premature infants.
They found blood transfusions from two infected units of blood caused all seven of the cases of Babesiosis.
Symptoms of the infections varied widely, but babies with the lowest weights at birth were at greatest risk of serious infection.
The authors warned doctors in areas in which Babesiosis occurs to be watchful for cases in premature infants exposed to blood transfusions.
The CDC researchers called for better ways to prevent and detect cases of transfusion-associated Babesiosis.
"Our findings underscore the year-round vulnerability of the U.S. blood supply -- especially, but not only -- in and near Babesiosis-endemic areas.
"They also highlight the importance of multi-agency collaborative efforts to detect, investigate, and document transfusion cases; to assess the risks for transfusion transmission; and, thereby, to inform the scope of prevention measures."
To deter transfusion-linked Babesiosis, the CDC in January said public health departments should report all cases of the infections to the CDC.
http://www.msnbc.msn.com/id/44402523/ns ... mWK5nZQLms
Re: BABESIOOSI
VIDEO: Tri Horowitz kertoo videolla babesioosista esim. Borreliosia sairastavilla. Ohjelma kestää 45 minuuttia. Hän mainitsee mm Borrelioosioireiden olevan vähintään 3 x voimakkaammat mikäli sairastaa sen lisäksi babesioosia. Oireita mm. päivä/yöhikoilu, vilutus, tunne että ei saa happea riittävästi jne. Oireet voivat vaihdella päivittäin. Hän mainitsee myös että normaalit testit eivät kykene havaitsemaan taudinaiheuttajaa.
http://link.brightcove.com/services/pla ... 0635580001
This is the full 45-minute version of a video interview with Richard Horowitz for the Poughkeepsie Journal. Lots of interesting information in this overview.
http://link.brightcove.com/services/pla ... 0635580001
This is the full 45-minute version of a video interview with Richard Horowitz for the Poughkeepsie Journal. Lots of interesting information in this overview.
Re: BABESIOOSI
John Darcyn, 68 v, oireet alkoivat n. 8 v (artikkelissa on mainittu sekä 5 että 8 v) sitten. Aiemmin urheilullinen mies ei enää kyennyt juoksemaan tai pyöräilemään. Hänellä oli voimakkaita kipuja. Hän yritti selviytyä niistä sisulla. Tauti kuitenkin eteni - hän menetti tasapainonsa, ei kyennyt vetämään paitaa päälleen, nostamaan kättään, paino aleni, uupumusta jne. Hänellä todettiin babesioosi ja borrelioosi. Nyt hän käyttää antibiootti, amoksisilliinia 8000mg/vrk vointi on alkanut parantua ja hän on aloittanut metsälläkäynnit uudelleen.
http://www.poughkeepsiejournal.com/arti ... ck_check=1
Dutchess at center of rising tick threat - More ticks, people infected with babesiosis
John Darcy, 68, of Beacon, has suffered with the tick-borne illness, babesiosis, for more than five years. Darcy, who takes 8,000 milligrams of amoxicillin each day, is feeling better now and has regained the strength needed to pull back his compound bow for deer and turkey hunting. / Spencer
Ainsley/Poughkeepsie Journal
Written by
Mary Beth Pfeiffer
Poughkeepsie Journal
Babesiosis and the Blood Supply: LYME DISEASE -- Babesiosis and the Blood Supply. Video by Chrissie Williams
ABOUT THIS SERIES
This is part 8 in a Poughkeepsie Journal series on the prevalence and problems of Lyme disease and other tick-borne illnesses. Go to www.poughkeepsiejournal.com/lyme to read previous installments on treatment and testing and to view videos on Lyme disease and babesiosis.
Related Links
Babesiosis Monday graphic (2)
CDC Babesiosis Cases by County 2011
Dutchess tick-babesia study Bard-Cary
Lyme disease counting is uncertain, imprecise
Lyme treatment guidelines flawed, researcher says
EXCLUSIVE: DICEY PATH TO LYME DISEASE DIAGNOSIS
CDC researcher answers questions on disease, tests
Where foxes thrive, Lyme disease doesn't
Tick research lags in war vs. Lyme
Editorial: Lyme disease must get a focused attention on patients
REPLAY: Lyme disease chat
Lyme Disease: Antibiotics fuel debate
Lyme disease: Writer has a bout
New tick-borne threat emerges
Lyme disease: Dutchess leads nation in cases
When John Darcy began to get sick some eight years ago, it was in slow, painful increments. An outdoorsman and athlete for years, the Beacon resident, now 68, found he could not jog or bike as far. Aging, he thought. He suffered soreness he had never known. Push through it, he told himself.
But soon he was losing his balance. He lacked the strength even to pull back his bow. He could not dress himself or lift his arm to shave.
As he lost weight and vitality, Darcy was prodded and tested for everything, it seems, but the thing it turned out to be: a burgeoning disease called babesiosis.
“It was never even mentioned,” said Darcy, 68, a retired Beacon IBMer and correction officer, who was also diagnosed with Lyme disease in a one-two tick-borne punch. “I never even heard of the word.”
That may change. Someday, perhaps not so far into the future, the so-called “emerging” malady known as babesiosis may join Lyme disease as another environmental scourge wrought by the tiny and insidious black-legged tick. And Dutchess County is at the crest of this gathering wave.
Dutchess ranks first
In 2011, Dutchess ranked first in New York state and 13th nationally in per-capita rate of the disease, according to statistics released exclusively to the Poughkeepsie Journal by the U.S. Centers for Disease Control and Prevention. The county had the nation’s third-highest number of cases, which rose from 4 in 2002 to 53 in 2011.
“The Hudson River Valley has eclipsed Long Island for Lyme disease and babesiosis,” said Dr. Alan MacDonald, a long-time Lyme researcher and Long Island pathologist. “You’re up to your neck in ticks that carry babesiosis.”
Babesiosis is a disease, like malaria, most often linked to a protozoan parasite called Babesia microti, though other strains cause illness too. It is usually treated with antibiotics and anti-malarial drugs.
Just why the disease is emerging now – long after Lyme disease hit– may have something to do with what scientists call “reservoirs” of infection: birds and mammals that infect the ticks that in turn bite people.
http://www.poughkeepsiejournal.com/arti ... ck_check=1
Dutchess at center of rising tick threat - More ticks, people infected with babesiosis
John Darcy, 68, of Beacon, has suffered with the tick-borne illness, babesiosis, for more than five years. Darcy, who takes 8,000 milligrams of amoxicillin each day, is feeling better now and has regained the strength needed to pull back his compound bow for deer and turkey hunting. / Spencer
Ainsley/Poughkeepsie Journal
Written by
Mary Beth Pfeiffer
Poughkeepsie Journal
Babesiosis and the Blood Supply: LYME DISEASE -- Babesiosis and the Blood Supply. Video by Chrissie Williams
ABOUT THIS SERIES
This is part 8 in a Poughkeepsie Journal series on the prevalence and problems of Lyme disease and other tick-borne illnesses. Go to www.poughkeepsiejournal.com/lyme to read previous installments on treatment and testing and to view videos on Lyme disease and babesiosis.
Related Links
Babesiosis Monday graphic (2)
CDC Babesiosis Cases by County 2011
Dutchess tick-babesia study Bard-Cary
Lyme disease counting is uncertain, imprecise
Lyme treatment guidelines flawed, researcher says
EXCLUSIVE: DICEY PATH TO LYME DISEASE DIAGNOSIS
CDC researcher answers questions on disease, tests
Where foxes thrive, Lyme disease doesn't
Tick research lags in war vs. Lyme
Editorial: Lyme disease must get a focused attention on patients
REPLAY: Lyme disease chat
Lyme Disease: Antibiotics fuel debate
Lyme disease: Writer has a bout
New tick-borne threat emerges
Lyme disease: Dutchess leads nation in cases
When John Darcy began to get sick some eight years ago, it was in slow, painful increments. An outdoorsman and athlete for years, the Beacon resident, now 68, found he could not jog or bike as far. Aging, he thought. He suffered soreness he had never known. Push through it, he told himself.
But soon he was losing his balance. He lacked the strength even to pull back his bow. He could not dress himself or lift his arm to shave.
As he lost weight and vitality, Darcy was prodded and tested for everything, it seems, but the thing it turned out to be: a burgeoning disease called babesiosis.
“It was never even mentioned,” said Darcy, 68, a retired Beacon IBMer and correction officer, who was also diagnosed with Lyme disease in a one-two tick-borne punch. “I never even heard of the word.”
That may change. Someday, perhaps not so far into the future, the so-called “emerging” malady known as babesiosis may join Lyme disease as another environmental scourge wrought by the tiny and insidious black-legged tick. And Dutchess County is at the crest of this gathering wave.
Dutchess ranks first
In 2011, Dutchess ranked first in New York state and 13th nationally in per-capita rate of the disease, according to statistics released exclusively to the Poughkeepsie Journal by the U.S. Centers for Disease Control and Prevention. The county had the nation’s third-highest number of cases, which rose from 4 in 2002 to 53 in 2011.
“The Hudson River Valley has eclipsed Long Island for Lyme disease and babesiosis,” said Dr. Alan MacDonald, a long-time Lyme researcher and Long Island pathologist. “You’re up to your neck in ticks that carry babesiosis.”
Babesiosis is a disease, like malaria, most often linked to a protozoan parasite called Babesia microti, though other strains cause illness too. It is usually treated with antibiotics and anti-malarial drugs.
Just why the disease is emerging now – long after Lyme disease hit– may have something to do with what scientists call “reservoirs” of infection: birds and mammals that infect the ticks that in turn bite people.
Re: BABESIOOSI
Babesioosin aiheuttaa punkkien, verensiirron tai sikiöaikana istukan kautta tarttuva prototsooa. Babesia aiheuttaa useimmiten päänsärkyä ja uupumusta, mutta toisinaan myös vakavia neurologisia oireita esim. tajuttomuutta.
http://dx.doi.org/10.1016/B978-0-444-53490-3.00014-5, How to Cite or Link Using DOI
Neurological manifestations of human babesiosis
Sahar Usmani-Brown1,
John J. Halperin2,
Peter J. Krause1, Corresponding author contact information, E-mail the corresponding author
1 Yale School of Public Health and Yale School of Medicine, New Haven, CT, USA
2 Overlook Medical Center, Summit, NJ and Mount Sinai School of Medicine, New York, NY, USA
Abstract
Babesiosis is a worldwide emerging infectious disease caused by intraerythrocytic protozoa that are transmitted by Ixodid ticks, or less commonly through blood transfusion or transplacentally. Although headache and lethargy are common symptoms, babesiosis is uncommonly associated with specific neurological dysfunction in humans. Decreased level of consciousness or coma are rare complications that are associated with severe and often fatal disease but the pathogenesis is unclear.
Re: BABESIOOSI
Babesia:Uhka verensiirroille. (2013)
http://www.plospathogens.org/article/in ... at.1003387
Babesia: An Emerging Infectious Threat in Transfusion Medicine
July 11, 2013
Cheryl A. Lobo mail,
Jeny R. Cursino-Santos,
Andy Alhassan,
Marilis Rodrigues
What Is Babesiosis?
Babesiosis is an emerging zoonosis caused by protozoan parasites of the genus Babesia. The disease is endemic primarily in the Northeast and upper Midwestern United States. The genus Babesia comprises multiple species of apicomplexan parasites that infect red cells of many vertebrate hosts. Babesia divide and replicate in the hosts' red blood cells and are called piroplasms due to their pear-shaped appearance within the RBCs (Figure 1). They are transmitted by ixodid tick vectors as they feed on a blood meal from the host [1]. Babesiosis has long been recognized as an economically important disease of cattle, but only in the last 40 years has Babesia been recognized as an important pathogen in man.
thumbnail
Download:
PPT
PowerPoint slide
PNG
larger image (3.54MB)
TIFF
original image (3.49MB)
Figure 1. Different forms of Babesia divergens in human RBCs as seen on a Giemsa-stained smear from in vitro cultured parasites (ring, dividing figure eights, Maltese cross parasites, and multiply infected RBCs).
doi:10.1371/journal.ppat.1003387.g001
The majority of cases in the United States are caused by B. microti and occur in the Northeast and upper Midwest [2]. A small number of infections caused by B. duncani and B. duncani–like organisms have been reported on the West Coast from California to Washington State [3]. Additionally, B. divergens–like organisms have been reported in Kentucky, Missouri, and Washington State [4]. In Europe, almost all reported cases have been due to B. divergens, and a few have been caused by the EU1 species, now called B. venatorum [5], [6]. Sporadic cases of babesiosis have also been reported in Asia, Africa, Australia, and South America [7].
The symptomatic spectrum of human babesiosis is broad, ranging from clinically silent infections to intense malaria-like episodes resulting occasionally in death. When present, symptoms typically are nonspecific (fever, headache, and myalgia) [8]. Human babesiosis is a zoonosis, and the natural acquisition of human disease is the result of interactions with established zoonotic cycles. Emerging diseases are defined as “novel, re-emerging, or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.” Because of the increasing number of human infections since 1990, human babesiosis can be considered an emerging disease [7]. A number of factors have contributed to the “emergence” of human babesiosis, including a heightened awareness among physicians, a changing ecology, and a larger population of immunocompromised individuals, where fatalities have occurred. This led the Centers for Disease Control and Prevention to add babesiosis to the list of nationally notifiable diseases in 2011.
Why Has Babesiosis Become a Major Transfusion Threat?
In the United States, almost 5 million recipients undergo blood transfusions annually. These transfusion recipients are at potential risk of exposure to transmissible pathogens like Babesia from donor blood [9]. This is because, besides their natural route of transmission, the parasite is also transmitted by transfusion of blood products, as its red cell location provides an appropriate niche to facilitate its transmission. In fact, as the frequency of clinical cases has risen, there has been an associated increase in transfusion-transmitted Babesia (TTB) [10], making babesiosis the most frequent transfusion-transmitted infection with approximately 162 cases reported since 1980 and 12 associated fatalities in the period 2005–2008 [9], [10]. The major reason for this increase is that babesiosis can be asymptomatic, indeed clinically silent, in healthy adults who are the dominant blood donors. In one study, asymptomatic individuals who tested negative for Babesia in Giemsa smears had detectable amounts of B. microti DNA in their blood for three months [11]. Blood transfusion recipients generally present with more severe illness, as they have at least one of the risk factors for severe babesiosis, including extremes in age, lack of a spleen, hemoglobinopathies, cancers, HIV, and use of immunosuppressive therapy [9]. In these patients, babesiosis may be refractory to standard antimicrobial therapy [12] and may result in prolonged illness or death. Historically, babesiosis has been treated with a weekly course of clindamycin and quinine [13]. However, this combination of drugs can be so debilitating in some patients that it prevents successful completion of therapy. Physicians now recommend the equally effective combination of azithromycin and atovaquone [14]. Unfortunately, recent reports indicate that B. microti may become resistant to azithromycin-atovaquone in highly immunocompromised patients [12]. This drug resistance needs to be investigated further in the public health context. Among the 18 cases of TTB identified by the hemovigilance program at the American Red Cross between 2005 and 2007, ~30% had a fatal outcome [15]. Some studies suggest a transmission risk as high as 1 per 601 blood units in areas of the highest prevalence [16]. To complicate this situation further, B. microti is known to survive and remain viable under blood storage conditions (4°C) for up to 35 days in RBCs and indefinitely in cryopreserved RBCs [17].
What Is the Status of Current Blood-Banking Safeguards against Babesiosis?
The current strategy of blood screening, nationwide, to prevent transfusion-transmitted babesiosis (TTB) relies on a donor questionnaire to identify potential deferrals [10]. Donors who answer in the affirmative to a query of having a history of babesiosis are barred from donating from that day forward. This reliance on donor response to risk factor questions has many shortcomings as can be seen by the substantial increase in TTB in the last ten years. While it permanently excludes prospective blood donors with a history of babesiosis, it appears to be of limited value, presumably because infected blood donors experience asymptomatic infection or remain infectious long after symptoms have resolved. This current policy also impacts the blood supply because infectivity may be finite and patients who have had symptomatic babesiosis in the past might no longer be infectious. Systematic laboratory screening of the blood supply in the form of state-of-the-art FDA-licensed serological and nucleic acid testing (NAT) assays is available for many blood-borne pathogens like HIV and hepatitis to prevent their spread by transfusion. Unfortunately, the lack of comparable, sensitive screens available for vector-transmitted protozoal parasites like Babesia has resulted in the current complete dependence on a donor response questionnaire to safeguard the nation's blood supply.
What Tests Are Currently Available to Detect Babesia?
The major barrier to preventing parasite transmission is the absence of a licensed assay to detect the parasite in blood donors. At the diagnostic level, there are both antibody and DNA detection tests available that are not suitable for blood donor screening for a number of reasons. The qPCR detection assays for B. microti exploit the gene encoding 18s rRNA as the template [18], [19] and have the advantage of detecting the parasite, if present, through the entire course of infection. As a diagnostic it is an efficient screen, as it is used to detect symptomatic infection where both parasite levels and volume of blood available for testing are high. Screening of donor blood for infectious organisms typically relies on a few milliliter sample of blood taken for analysis. As the parasite is present at a very low parasitemia in donor blood, this small sample of blood may not harbor sufficient parasites to yield a detectable amplification signal. This sampling limitation is currently the major impediment to deploying qPCR assays in donor blood testing. The antibody detection assay currently in use as a diagnostic is an immunofluorescence assay (IFA) screening for antibodies in sera of blood donors to smears of fixed parasites grown in hamster or mouse RBCs [18], [19]. Although rigorous data on the kinetics of the immune response to the parasite is not available, the window period in early infection, where antibodies are not present in circulation, may result in missed detection. Similarly, after the infection is resolved, antibodies may persist, resulting in erroneous positives that will exclude donors from giving blood. A high-throughput platform to enable use of IFA technology would also have to be developed to facilitate its use as a mass donor screen. Even when IFA and qPCR tests are combined, limitations persist, presenting an urgent need for a more sensitive and specific blood screening assay that can be used at blood centers for Babesia detection.
Would Pathogen Reduction and/or Inactivation Technology Work for Babesia?
Pathogen reduction and inactivation technologies represent a different approach from testing donors for recognized pathogens. If sufficiently broad-spectrum and robust, they may prevent transmission of many emerging blood-borne infectious agents in the future, if they do not harm the recipient or blood component. Multiple pathogen inactivation (PI) technologies for the treatment of platelet or plasma components have been developed and are in routine use, based on methylene blue, psoralen, and riboflavin technologies. As Babesia is an intra-erythrocytic parasite, PI technologies would have to target the red cell component of the blood. No pathogen reduction technology for RBC units is commercially available at the present time, although there are two major platforms that are poised to change this status. The first is a technology (Cerus Corporation, Concord, California) based on the use of S-303, an intercalator group that inserts into the helical region of the nucleic acid, an effector group that allows covalent modification of nucleic acid, and a central frangible bond that allows degradation of the compound [20]. The second is the Mirasol PRT system (TerumoBCT Biotechnologies, Lakewood, Colorado), which uses a riboflavin additive that is UV light-activated to treat platelets, plasma, and whole blood [21]. Both processes have been shown to be effective against a variety of blood-borne pathogens, including Babesia species [22] (Cursino-Santos et al., unpublished data).
In summary, TTB has become one of the most commonly reported transfusion-transmitted infections in the United States. Thus, there is an urgent need to develop sensitive and specific methods for screening for this pathogen or alternative methods for eliminating it from the blood supply. Uncovering the basic biology of the parasite, including the identification of immuno-dominant antigens that could be used in designing more sensitive screens, may represent the path forward.
References
1. Lantos PM, Krause PJ (2002) Babesiosis: similar to malaria but different. Pediatr Ann 31: 192–197.
CrossRef
PubMed/NCBI
Google Scholar
2. Leiby DA (2011) Transfusion-transmitted Babesia spp.: bull's-eye on Babesia microti. Clin Microbiol Rev 24: 14–28. doi: 10.1128/cmr.00022-10.
CrossRef
PubMed/NCBI
Google Scholar
3. Conrad PA, Kjemtrup AM, Carreno RA, Thomford J, Wainwright K, et al. (2006) Description of Babesia duncani n.sp. (Apicomplexa: Babesiidae) from humans and its differentiation from other piroplasms. Int J Parasitol 36: 779–789. doi: 10.1016/j.ijpara.2006.03.008.
CrossRef
PubMed/NCBI
Google Scholar
4. Herwaldt B, Persing DH, Precigout EA, Goff WL, Mathiesen DA, et al. (1996) A fatal case of babesiosis in Missouri: identification of another piroplasm that infects humans. Ann Intern Med 124: 643–650. doi: 10.7326/0003-4819-124-7-199604010-00004.
CrossRef
PubMed/NCBI
Google Scholar
5. Gigandet L, Stauffer E, Douet V, Rais O, Moret J, et al. (2011) Prevalence of three zoonotic Babesia species in Ixodes ricinus (Linne, 1758) nymphs in a suburban forest in Switzerland. Vector Borne Zoonotic Dis 11: 363–366. doi: 10.1089/vbz.2010.0195.
CrossRef
PubMed/NCBI
Google Scholar
6. Gray JS (2006) Identity of the causal agents of human babesiosis in Europe. Int J Med Microbiol 296(Suppl 40): 131–136. doi: 10.1016/j.ijmm.2006.01.029.
CrossRef
PubMed/NCBI
Google Scholar
7. Kjemtrup AM, Conrad PA (2000) Human babesiosis: an emerging tick-borne disease. Int J Parasitol 30: 1323–1337. doi: 10.1016/s0020-7519(00)00137-5.
CrossRef
PubMed/NCBI
Google Scholar
8. Ruebush TK 2nd, Juranek DD, Chisholm ES, Snow PC, Healy GR, et al. (1977) Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections. N Engl J Med 297: 825–827. doi: 10.1056/nejm197710132971511.
CrossRef
PubMed/NCBI
Google Scholar
9. Gubernot DM, Nakhasi HL, Mied PA, Asher DM, Epstein JS, et al. (2009) Transfusion-transmitted babesiosis in the United States: summary of a workshop. Transfusion 49: 2759–2771. doi: 10.1111/j.1537-2995.2009.02429.x.
CrossRef
PubMed/NCBI
Google Scholar
10. Leiby DA (2011) Transfusion-associated babesiosis: shouldn't we be ticked off? Ann Intern Med 155: 556–557. doi: 10.7326/0003-4819-155-8-201110180-00363.
CrossRef
PubMed/NCBI
Google Scholar
11. Krause PJ, Spielman A, Telford SR 3rd, Sikand VK, McKay K, et al. (1998) Persistent parasitemia after acute babesiosis. N Engl J Med 339: 160–165. doi: 10.1056/nejm199807163390304.
CrossRef
PubMed/NCBI
Google Scholar
12. Wormser GP, Prasad A, Neuhaus E, Joshi S, Nowakowski J, et al. (2010) Emergence of resistance to azithromycin-atovaquone in immunocompromised patients with Babesia microti infection. Clin Infect Dis 50: 381–386. doi: 10.1086/649859.
CrossRef
PubMed/NCBI
Google Scholar
13. Wittner M, Rowin KS, Tanowitz HB, Hobbs JF, Saltzman S, et al. (1982) Successful chemotherapy of transfusion babesiosis. Ann Intern Med 96: 601–604. doi: 10.7326/0003-4819-96-5-601.
CrossRef
PubMed/NCBI
Google Scholar
14. Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, et al. (2000) Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 343: 1454–1458. doi: 10.1056/nejm200011163432004.
CrossRef
PubMed/NCBI
Google Scholar
15. Tonnetti L, Eder AF, Dy B, Kennedy J, Pisciotto P, et al. (2009) Transfusion-transmitted Babesia microti identified through hemovigilance. Transfusion 49: 2557–2563. doi: 10.1111/j.1537-2995.2009.02317.x.
CrossRef
PubMed/NCBI
Google Scholar
16. Gerber MA, Shapiro ED, Krause PJ, Cable RG, Badon SJ, et al. (1994) The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 170: 231–234. doi: 10.1093/infdis/170.1.231.
CrossRef
PubMed/NCBI
Google Scholar
17. Eberhard ML, Walker EM, Steurer FJ (1995) Survival and infectivity of Babesia in blood maintained at 25 C and 2–4 C. J Parasitol 81: 790–792. doi: 10.2307/3283978.
CrossRef
PubMed/NCBI
Google Scholar
18. Johnson ST, Van Tassell ER, Tonnetti L, Cable RG, Berardi VP, et al. (2013) Babesia microti real-time polymerase chain reaction testing of Connecticut blood donors: potential implications for screening algorithms. Transfusion E-pub ahead of print. doi:10.1111/trf.12125.
19. Young C, Chawla A, Berardi V, Padbury J, Skowron G, et al. (2012) Preventing transfusion-transmitted babesiosis: preliminary experience of the first laboratory-based blood donor screening program. Transfusion 52: 1523–1529. doi: 10.1111/j.1537-2995.2012.03612.x.
CrossRef
PubMed/NCBI
Google Scholar
20. Cancelas JA, Dumont LJ, Rugg N, Szczepiorkowski ZM, Herschel L, et al. (2011) Stored red blood cell viability is maintained after treatment with a second-generation S-303 pathogen inactivation process. Transfusion 51: 2367–2376. doi: 10.1111/j.1537-2995.2011.03163.x.
CrossRef
PubMed/NCBI
Google Scholar
21. Reddy HL, Doane SK, Keil SD, Marschner S, Goodrich RP (2013) Development of a riboflavin and ultraviolet light-based device to treat whole blood. Transfusion 53(Suppl 1): 131S–136S. doi: 10.1111/trf.12047.
CrossRef
PubMed/NCBI
Google Scholar
22. Tonnetti L, Thorp AM, Reddy HL, Keil SD, Goodrich RP, et al. (2012) Riboflavin and ultraviolet light reduce the infectivity of Babesia microti in whole blood. Transfusion 53: 860–867. doi: 10.1111/j.1537-2995.2012.03791.x.
http://www.plospathogens.org/article/in ... at.1003387
Babesia: An Emerging Infectious Threat in Transfusion Medicine
July 11, 2013
Cheryl A. Lobo mail,
Jeny R. Cursino-Santos,
Andy Alhassan,
Marilis Rodrigues
What Is Babesiosis?
Babesiosis is an emerging zoonosis caused by protozoan parasites of the genus Babesia. The disease is endemic primarily in the Northeast and upper Midwestern United States. The genus Babesia comprises multiple species of apicomplexan parasites that infect red cells of many vertebrate hosts. Babesia divide and replicate in the hosts' red blood cells and are called piroplasms due to their pear-shaped appearance within the RBCs (Figure 1). They are transmitted by ixodid tick vectors as they feed on a blood meal from the host [1]. Babesiosis has long been recognized as an economically important disease of cattle, but only in the last 40 years has Babesia been recognized as an important pathogen in man.
thumbnail
Download:
PPT
PowerPoint slide
PNG
larger image (3.54MB)
TIFF
original image (3.49MB)
Figure 1. Different forms of Babesia divergens in human RBCs as seen on a Giemsa-stained smear from in vitro cultured parasites (ring, dividing figure eights, Maltese cross parasites, and multiply infected RBCs).
doi:10.1371/journal.ppat.1003387.g001
The majority of cases in the United States are caused by B. microti and occur in the Northeast and upper Midwest [2]. A small number of infections caused by B. duncani and B. duncani–like organisms have been reported on the West Coast from California to Washington State [3]. Additionally, B. divergens–like organisms have been reported in Kentucky, Missouri, and Washington State [4]. In Europe, almost all reported cases have been due to B. divergens, and a few have been caused by the EU1 species, now called B. venatorum [5], [6]. Sporadic cases of babesiosis have also been reported in Asia, Africa, Australia, and South America [7].
The symptomatic spectrum of human babesiosis is broad, ranging from clinically silent infections to intense malaria-like episodes resulting occasionally in death. When present, symptoms typically are nonspecific (fever, headache, and myalgia) [8]. Human babesiosis is a zoonosis, and the natural acquisition of human disease is the result of interactions with established zoonotic cycles. Emerging diseases are defined as “novel, re-emerging, or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.” Because of the increasing number of human infections since 1990, human babesiosis can be considered an emerging disease [7]. A number of factors have contributed to the “emergence” of human babesiosis, including a heightened awareness among physicians, a changing ecology, and a larger population of immunocompromised individuals, where fatalities have occurred. This led the Centers for Disease Control and Prevention to add babesiosis to the list of nationally notifiable diseases in 2011.
Why Has Babesiosis Become a Major Transfusion Threat?
In the United States, almost 5 million recipients undergo blood transfusions annually. These transfusion recipients are at potential risk of exposure to transmissible pathogens like Babesia from donor blood [9]. This is because, besides their natural route of transmission, the parasite is also transmitted by transfusion of blood products, as its red cell location provides an appropriate niche to facilitate its transmission. In fact, as the frequency of clinical cases has risen, there has been an associated increase in transfusion-transmitted Babesia (TTB) [10], making babesiosis the most frequent transfusion-transmitted infection with approximately 162 cases reported since 1980 and 12 associated fatalities in the period 2005–2008 [9], [10]. The major reason for this increase is that babesiosis can be asymptomatic, indeed clinically silent, in healthy adults who are the dominant blood donors. In one study, asymptomatic individuals who tested negative for Babesia in Giemsa smears had detectable amounts of B. microti DNA in their blood for three months [11]. Blood transfusion recipients generally present with more severe illness, as they have at least one of the risk factors for severe babesiosis, including extremes in age, lack of a spleen, hemoglobinopathies, cancers, HIV, and use of immunosuppressive therapy [9]. In these patients, babesiosis may be refractory to standard antimicrobial therapy [12] and may result in prolonged illness or death. Historically, babesiosis has been treated with a weekly course of clindamycin and quinine [13]. However, this combination of drugs can be so debilitating in some patients that it prevents successful completion of therapy. Physicians now recommend the equally effective combination of azithromycin and atovaquone [14]. Unfortunately, recent reports indicate that B. microti may become resistant to azithromycin-atovaquone in highly immunocompromised patients [12]. This drug resistance needs to be investigated further in the public health context. Among the 18 cases of TTB identified by the hemovigilance program at the American Red Cross between 2005 and 2007, ~30% had a fatal outcome [15]. Some studies suggest a transmission risk as high as 1 per 601 blood units in areas of the highest prevalence [16]. To complicate this situation further, B. microti is known to survive and remain viable under blood storage conditions (4°C) for up to 35 days in RBCs and indefinitely in cryopreserved RBCs [17].
What Is the Status of Current Blood-Banking Safeguards against Babesiosis?
The current strategy of blood screening, nationwide, to prevent transfusion-transmitted babesiosis (TTB) relies on a donor questionnaire to identify potential deferrals [10]. Donors who answer in the affirmative to a query of having a history of babesiosis are barred from donating from that day forward. This reliance on donor response to risk factor questions has many shortcomings as can be seen by the substantial increase in TTB in the last ten years. While it permanently excludes prospective blood donors with a history of babesiosis, it appears to be of limited value, presumably because infected blood donors experience asymptomatic infection or remain infectious long after symptoms have resolved. This current policy also impacts the blood supply because infectivity may be finite and patients who have had symptomatic babesiosis in the past might no longer be infectious. Systematic laboratory screening of the blood supply in the form of state-of-the-art FDA-licensed serological and nucleic acid testing (NAT) assays is available for many blood-borne pathogens like HIV and hepatitis to prevent their spread by transfusion. Unfortunately, the lack of comparable, sensitive screens available for vector-transmitted protozoal parasites like Babesia has resulted in the current complete dependence on a donor response questionnaire to safeguard the nation's blood supply.
What Tests Are Currently Available to Detect Babesia?
The major barrier to preventing parasite transmission is the absence of a licensed assay to detect the parasite in blood donors. At the diagnostic level, there are both antibody and DNA detection tests available that are not suitable for blood donor screening for a number of reasons. The qPCR detection assays for B. microti exploit the gene encoding 18s rRNA as the template [18], [19] and have the advantage of detecting the parasite, if present, through the entire course of infection. As a diagnostic it is an efficient screen, as it is used to detect symptomatic infection where both parasite levels and volume of blood available for testing are high. Screening of donor blood for infectious organisms typically relies on a few milliliter sample of blood taken for analysis. As the parasite is present at a very low parasitemia in donor blood, this small sample of blood may not harbor sufficient parasites to yield a detectable amplification signal. This sampling limitation is currently the major impediment to deploying qPCR assays in donor blood testing. The antibody detection assay currently in use as a diagnostic is an immunofluorescence assay (IFA) screening for antibodies in sera of blood donors to smears of fixed parasites grown in hamster or mouse RBCs [18], [19]. Although rigorous data on the kinetics of the immune response to the parasite is not available, the window period in early infection, where antibodies are not present in circulation, may result in missed detection. Similarly, after the infection is resolved, antibodies may persist, resulting in erroneous positives that will exclude donors from giving blood. A high-throughput platform to enable use of IFA technology would also have to be developed to facilitate its use as a mass donor screen. Even when IFA and qPCR tests are combined, limitations persist, presenting an urgent need for a more sensitive and specific blood screening assay that can be used at blood centers for Babesia detection.
Would Pathogen Reduction and/or Inactivation Technology Work for Babesia?
Pathogen reduction and inactivation technologies represent a different approach from testing donors for recognized pathogens. If sufficiently broad-spectrum and robust, they may prevent transmission of many emerging blood-borne infectious agents in the future, if they do not harm the recipient or blood component. Multiple pathogen inactivation (PI) technologies for the treatment of platelet or plasma components have been developed and are in routine use, based on methylene blue, psoralen, and riboflavin technologies. As Babesia is an intra-erythrocytic parasite, PI technologies would have to target the red cell component of the blood. No pathogen reduction technology for RBC units is commercially available at the present time, although there are two major platforms that are poised to change this status. The first is a technology (Cerus Corporation, Concord, California) based on the use of S-303, an intercalator group that inserts into the helical region of the nucleic acid, an effector group that allows covalent modification of nucleic acid, and a central frangible bond that allows degradation of the compound [20]. The second is the Mirasol PRT system (TerumoBCT Biotechnologies, Lakewood, Colorado), which uses a riboflavin additive that is UV light-activated to treat platelets, plasma, and whole blood [21]. Both processes have been shown to be effective against a variety of blood-borne pathogens, including Babesia species [22] (Cursino-Santos et al., unpublished data).
In summary, TTB has become one of the most commonly reported transfusion-transmitted infections in the United States. Thus, there is an urgent need to develop sensitive and specific methods for screening for this pathogen or alternative methods for eliminating it from the blood supply. Uncovering the basic biology of the parasite, including the identification of immuno-dominant antigens that could be used in designing more sensitive screens, may represent the path forward.
References
1. Lantos PM, Krause PJ (2002) Babesiosis: similar to malaria but different. Pediatr Ann 31: 192–197.
CrossRef
PubMed/NCBI
Google Scholar
2. Leiby DA (2011) Transfusion-transmitted Babesia spp.: bull's-eye on Babesia microti. Clin Microbiol Rev 24: 14–28. doi: 10.1128/cmr.00022-10.
CrossRef
PubMed/NCBI
Google Scholar
3. Conrad PA, Kjemtrup AM, Carreno RA, Thomford J, Wainwright K, et al. (2006) Description of Babesia duncani n.sp. (Apicomplexa: Babesiidae) from humans and its differentiation from other piroplasms. Int J Parasitol 36: 779–789. doi: 10.1016/j.ijpara.2006.03.008.
CrossRef
PubMed/NCBI
Google Scholar
4. Herwaldt B, Persing DH, Precigout EA, Goff WL, Mathiesen DA, et al. (1996) A fatal case of babesiosis in Missouri: identification of another piroplasm that infects humans. Ann Intern Med 124: 643–650. doi: 10.7326/0003-4819-124-7-199604010-00004.
CrossRef
PubMed/NCBI
Google Scholar
5. Gigandet L, Stauffer E, Douet V, Rais O, Moret J, et al. (2011) Prevalence of three zoonotic Babesia species in Ixodes ricinus (Linne, 1758) nymphs in a suburban forest in Switzerland. Vector Borne Zoonotic Dis 11: 363–366. doi: 10.1089/vbz.2010.0195.
CrossRef
PubMed/NCBI
Google Scholar
6. Gray JS (2006) Identity of the causal agents of human babesiosis in Europe. Int J Med Microbiol 296(Suppl 40): 131–136. doi: 10.1016/j.ijmm.2006.01.029.
CrossRef
PubMed/NCBI
Google Scholar
7. Kjemtrup AM, Conrad PA (2000) Human babesiosis: an emerging tick-borne disease. Int J Parasitol 30: 1323–1337. doi: 10.1016/s0020-7519(00)00137-5.
CrossRef
PubMed/NCBI
Google Scholar
8. Ruebush TK 2nd, Juranek DD, Chisholm ES, Snow PC, Healy GR, et al. (1977) Human babesiosis on Nantucket Island. Evidence for self-limited and subclinical infections. N Engl J Med 297: 825–827. doi: 10.1056/nejm197710132971511.
CrossRef
PubMed/NCBI
Google Scholar
9. Gubernot DM, Nakhasi HL, Mied PA, Asher DM, Epstein JS, et al. (2009) Transfusion-transmitted babesiosis in the United States: summary of a workshop. Transfusion 49: 2759–2771. doi: 10.1111/j.1537-2995.2009.02429.x.
CrossRef
PubMed/NCBI
Google Scholar
10. Leiby DA (2011) Transfusion-associated babesiosis: shouldn't we be ticked off? Ann Intern Med 155: 556–557. doi: 10.7326/0003-4819-155-8-201110180-00363.
CrossRef
PubMed/NCBI
Google Scholar
11. Krause PJ, Spielman A, Telford SR 3rd, Sikand VK, McKay K, et al. (1998) Persistent parasitemia after acute babesiosis. N Engl J Med 339: 160–165. doi: 10.1056/nejm199807163390304.
CrossRef
PubMed/NCBI
Google Scholar
12. Wormser GP, Prasad A, Neuhaus E, Joshi S, Nowakowski J, et al. (2010) Emergence of resistance to azithromycin-atovaquone in immunocompromised patients with Babesia microti infection. Clin Infect Dis 50: 381–386. doi: 10.1086/649859.
CrossRef
PubMed/NCBI
Google Scholar
13. Wittner M, Rowin KS, Tanowitz HB, Hobbs JF, Saltzman S, et al. (1982) Successful chemotherapy of transfusion babesiosis. Ann Intern Med 96: 601–604. doi: 10.7326/0003-4819-96-5-601.
CrossRef
PubMed/NCBI
Google Scholar
14. Krause PJ, Lepore T, Sikand VK, Gadbaw J Jr, Burke G, et al. (2000) Atovaquone and azithromycin for the treatment of babesiosis. N Engl J Med 343: 1454–1458. doi: 10.1056/nejm200011163432004.
CrossRef
PubMed/NCBI
Google Scholar
15. Tonnetti L, Eder AF, Dy B, Kennedy J, Pisciotto P, et al. (2009) Transfusion-transmitted Babesia microti identified through hemovigilance. Transfusion 49: 2557–2563. doi: 10.1111/j.1537-2995.2009.02317.x.
CrossRef
PubMed/NCBI
Google Scholar
16. Gerber MA, Shapiro ED, Krause PJ, Cable RG, Badon SJ, et al. (1994) The risk of acquiring Lyme disease or babesiosis from a blood transfusion. J Infect Dis 170: 231–234. doi: 10.1093/infdis/170.1.231.
CrossRef
PubMed/NCBI
Google Scholar
17. Eberhard ML, Walker EM, Steurer FJ (1995) Survival and infectivity of Babesia in blood maintained at 25 C and 2–4 C. J Parasitol 81: 790–792. doi: 10.2307/3283978.
CrossRef
PubMed/NCBI
Google Scholar
18. Johnson ST, Van Tassell ER, Tonnetti L, Cable RG, Berardi VP, et al. (2013) Babesia microti real-time polymerase chain reaction testing of Connecticut blood donors: potential implications for screening algorithms. Transfusion E-pub ahead of print. doi:10.1111/trf.12125.
19. Young C, Chawla A, Berardi V, Padbury J, Skowron G, et al. (2012) Preventing transfusion-transmitted babesiosis: preliminary experience of the first laboratory-based blood donor screening program. Transfusion 52: 1523–1529. doi: 10.1111/j.1537-2995.2012.03612.x.
CrossRef
PubMed/NCBI
Google Scholar
20. Cancelas JA, Dumont LJ, Rugg N, Szczepiorkowski ZM, Herschel L, et al. (2011) Stored red blood cell viability is maintained after treatment with a second-generation S-303 pathogen inactivation process. Transfusion 51: 2367–2376. doi: 10.1111/j.1537-2995.2011.03163.x.
CrossRef
PubMed/NCBI
Google Scholar
21. Reddy HL, Doane SK, Keil SD, Marschner S, Goodrich RP (2013) Development of a riboflavin and ultraviolet light-based device to treat whole blood. Transfusion 53(Suppl 1): 131S–136S. doi: 10.1111/trf.12047.
CrossRef
PubMed/NCBI
Google Scholar
22. Tonnetti L, Thorp AM, Reddy HL, Keil SD, Goodrich RP, et al. (2012) Riboflavin and ultraviolet light reduce the infectivity of Babesia microti in whole blood. Transfusion 53: 860–867. doi: 10.1111/j.1537-2995.2012.03791.x.
Re: BABESIOOSI
"Monissa tapauksissa mikrobien määrä on vähäinen ja testi siitä syystä virheellisesti negatiiivinen. Tällaista tavataan erityisesti kroonisesti sairaiden kohdalla."
"In many cases, parasitemia may be very low and infected patients may have negative smears. This is especially likely in chronic infections in non-splenectomized
patients."
http://www.dhmh.state.md.us/labs/pdf/cr ... itilnk.pdf
-------------------------------------------
https://sites.google.com/site/marylandl ... es/babesia
Babesiosis
UPDATE 2011- Babesia duncani (aka WA1) is normally described in patients on the west coast (USA). Doctors have also been testing east coast patients and finding they are infected with the B. duncani strain, often in addition to being infected with the Babesia microti strain. The Babesia duncani strain can not be detected on the standard Babesia microti tests. Your doctor should order both the Babesia duncani test along with the Babesia microti test if Babesiosis is suspected.
General Information: Many Lyme disease patients have one or more tick borne co-infections. In addition to the Lyme infection, patients can also be infected with tick-borne mycoplasma, a rickettsia and/or a protozoa. One study indicates over 1/2 of the Babesiosis patients also have Lyme disease.
Symptoms: The parasite that causes Babesiosis destroys red blood cells and can cause a malaria-like (relapsing) illness which can be fatal (10%- 28% fatality rate). Symptoms can include dizziness, depression, fever, chills, waves of sweats, mood swings, drenching night sweats, feelings of being off-balance, muscle pains, breathing difficulties (air hunger), sensitivity to light, headaches and malaise.
Patients with Babesiosis may also experience episodes of vomiting, bleeding tendencies, acute respiratory distress syndrome, dark colored urine (blood in urine), anemia, swollen spleen (can rupture in some cases), enlarged liver, congestive heart failure, respiratory failure, renal failure, bruising, jaundice, pulmonary edema, myocardial infarction, anorexia, evidence of shock and encephalopathy. Symptoms may range from mild to severe.
Testing: Many doctors familiar with babesiosis will diagnose and treat based on history and symptoms due to the failure of many tests to detect the infection, especially the longer the person has been infected. Antibody tests from Quest Lab (multiple strains) and PCR tests for babesiosis can be useful if positive, but a negative result does not rule out the disease. The organism is rarely seen in blood smears. Testing can be done at IGeneX Lab or other labs.
Treatment: A combination of Atovaquone (Mepron) and Zithromax or Baixin is currently being used to treat Babesiosis.** This combination is reported to have less potential side effects than quinine and clindamyacin.
Re-treatment or long term treatment is often needed in chronic and long-standing cases. Patients may experience a worsening of the condition and symptoms while treating Babesiosis (reported in some to be on the 3-4 day, and then again at the 3-4 week mark). Once this occurs, they will enter into a recovery phase.
** Please see the Babesiosis treatment youtube video [Dr. Horowitz] by clicking here.
Babesia Infecting Blood Cells
"In many cases, parasitemia may be very low and infected patients may have negative smears. This is especially likely in chronic infections in non-splenectomized
patients."
http://www.dhmh.state.md.us/labs/pdf/cr ... itilnk.pdf
-------------------------------------------
https://sites.google.com/site/marylandl ... es/babesia
Babesiosis
UPDATE 2011- Babesia duncani (aka WA1) is normally described in patients on the west coast (USA). Doctors have also been testing east coast patients and finding they are infected with the B. duncani strain, often in addition to being infected with the Babesia microti strain. The Babesia duncani strain can not be detected on the standard Babesia microti tests. Your doctor should order both the Babesia duncani test along with the Babesia microti test if Babesiosis is suspected.
General Information: Many Lyme disease patients have one or more tick borne co-infections. In addition to the Lyme infection, patients can also be infected with tick-borne mycoplasma, a rickettsia and/or a protozoa. One study indicates over 1/2 of the Babesiosis patients also have Lyme disease.
Symptoms: The parasite that causes Babesiosis destroys red blood cells and can cause a malaria-like (relapsing) illness which can be fatal (10%- 28% fatality rate). Symptoms can include dizziness, depression, fever, chills, waves of sweats, mood swings, drenching night sweats, feelings of being off-balance, muscle pains, breathing difficulties (air hunger), sensitivity to light, headaches and malaise.
Patients with Babesiosis may also experience episodes of vomiting, bleeding tendencies, acute respiratory distress syndrome, dark colored urine (blood in urine), anemia, swollen spleen (can rupture in some cases), enlarged liver, congestive heart failure, respiratory failure, renal failure, bruising, jaundice, pulmonary edema, myocardial infarction, anorexia, evidence of shock and encephalopathy. Symptoms may range from mild to severe.
Testing: Many doctors familiar with babesiosis will diagnose and treat based on history and symptoms due to the failure of many tests to detect the infection, especially the longer the person has been infected. Antibody tests from Quest Lab (multiple strains) and PCR tests for babesiosis can be useful if positive, but a negative result does not rule out the disease. The organism is rarely seen in blood smears. Testing can be done at IGeneX Lab or other labs.
Treatment: A combination of Atovaquone (Mepron) and Zithromax or Baixin is currently being used to treat Babesiosis.** This combination is reported to have less potential side effects than quinine and clindamyacin.
Re-treatment or long term treatment is often needed in chronic and long-standing cases. Patients may experience a worsening of the condition and symptoms while treating Babesiosis (reported in some to be on the 3-4 day, and then again at the 3-4 week mark). Once this occurs, they will enter into a recovery phase.
** Please see the Babesiosis treatment youtube video [Dr. Horowitz] by clicking here.
Babesia Infecting Blood Cells
BABEOOSI ON LISÄÄNTYVÄ INFEKTIO SAIRAUS
MITEN LISÄÄNTYVÄ PUNKKIPOHJAINEN PATOGEENI VÄLTTÄÄ HAVAITSEMISEN
https://m.phys.org/news/2019-06-emergin ... RSW8LH14iw
Ihmisen babesioosi on kehittyvä tartuntatauti, jonka ihmisille siirtää punkit. Yale-tutkijoiden tiimi on havainnut, miten Babesia microti , yksi kahdesta Babesia- loisen lajista, joka levittää tautia Yhdysvalloissa, on yhteydessä isäntäänsä.
Parasiitit ja muut patogeenit erittävät yleensä proteiineja immuunijärjestelmän välttämiseksi tai isännän solujen rakenteen muuttamiseksi sopeutumaan ja selviytymään. Käyttämällä erilaisia tekniikoita, kuten elektronimikroskopiaa , Yale-tutkijat tutkivat, miten B. microti vie isäntäänsä antigeenejä - vieraita aineita tai immuunivastetta aiheuttavia toksiineja. He havaitsivat, että B. microti kapseloi antigeenit vesikkeleihin (kalvorakkula), jotka kehittyvät loisen kalvosta ja muodostavat vesikkelien ketjuja isännän punasoluissa. Nämä vesikkelit viedään myöhemmin infektoituneista punasoluista isännän plasmaan.
"Olemme juuri koskettaneet jäävuoren kärkiä ymmärryksessämme Babesia-patogeenisuudesta", sanoo Choukri Ben Mamoun, tartuntatautien ja mikrobien patogeneesin apulaisprofessori . "Diagnostisesta näkökulmasta tiedämme nyt, kuinka parasiitti voi viedä useita antigeenejä . Tämä havainto auttaa meitä käyttämään uusia teknologioita arkaluonteisten testien kehittämiseksi aktiivisten Babesia- infektioiden havaitsemiseksi ."
Verrattuna muihin loisiin , kaksi suurta Babesia-lajia, jotka tarttuvat ihmisiin, B. microti ja B. duncani , ovat erittäin kestäviä nykyisille hoitoille . Jos nämä loiset käyttävät samoja vesikkelikoneita, joilla detektoidaan babesioosin tartunnan hoitoon tarkoitettuja lääkkeitä, se voisi selittää, miksi lääkkeet eivät ole voimakkaita tai miksi tarvitaan suuri annos, sanovat tutkijat.
https://m.phys.org/news/2019-06-emergin ... RSW8LH14iw
Ihmisen babesioosi on kehittyvä tartuntatauti, jonka ihmisille siirtää punkit. Yale-tutkijoiden tiimi on havainnut, miten Babesia microti , yksi kahdesta Babesia- loisen lajista, joka levittää tautia Yhdysvalloissa, on yhteydessä isäntäänsä.
Parasiitit ja muut patogeenit erittävät yleensä proteiineja immuunijärjestelmän välttämiseksi tai isännän solujen rakenteen muuttamiseksi sopeutumaan ja selviytymään. Käyttämällä erilaisia tekniikoita, kuten elektronimikroskopiaa , Yale-tutkijat tutkivat, miten B. microti vie isäntäänsä antigeenejä - vieraita aineita tai immuunivastetta aiheuttavia toksiineja. He havaitsivat, että B. microti kapseloi antigeenit vesikkeleihin (kalvorakkula), jotka kehittyvät loisen kalvosta ja muodostavat vesikkelien ketjuja isännän punasoluissa. Nämä vesikkelit viedään myöhemmin infektoituneista punasoluista isännän plasmaan.
"Olemme juuri koskettaneet jäävuoren kärkiä ymmärryksessämme Babesia-patogeenisuudesta", sanoo Choukri Ben Mamoun, tartuntatautien ja mikrobien patogeneesin apulaisprofessori . "Diagnostisesta näkökulmasta tiedämme nyt, kuinka parasiitti voi viedä useita antigeenejä . Tämä havainto auttaa meitä käyttämään uusia teknologioita arkaluonteisten testien kehittämiseksi aktiivisten Babesia- infektioiden havaitsemiseksi ."
Verrattuna muihin loisiin , kaksi suurta Babesia-lajia, jotka tarttuvat ihmisiin, B. microti ja B. duncani , ovat erittäin kestäviä nykyisille hoitoille . Jos nämä loiset käyttävät samoja vesikkelikoneita, joilla detektoidaan babesioosin tartunnan hoitoon tarkoitettuja lääkkeitä, se voisi selittää, miksi lääkkeet eivät ole voimakkaita tai miksi tarvitaan suuri annos, sanovat tutkijat.
BABESIOOSI RUOTSISSA JA EUROOPASSA
https://lakartidningen.se/klinik-och-ve ... E.facebook
Babesioosi ihmisillä Ruotsissa ja Euroopassa
Ruotsalaisten ihmisten keskuudessa satunnaisia tapauksia on kuvattu viime vuosikymmeninä, muun muassa Halmstadissa ja Göteborgissa, joissa viivästynyt diagnoosi yhdessä tapauksessa aiheutti suhteellisen vakavan sairauden ennen kuin oikea hoito pystyttiin aloittamaan. Uppsalaisessa tapauksessa 34-vuotias jolla pernanpoisto, mutta muuten terve mies sairastui suhteellisen nopeasti vakavasti , joka vaati tehohoitoa monielin vajaatoimintaan. Muutaman päivän hoidon jälkeen verinäytteiden mikroskooppinen tutkimus paljasti massiivisen parasitemian ja Babesian eroavaisuuksia 40 prosentissa punasoluista; kunnollisen hoidon aloittamisen jälkeen potilas parani nopeasti [4].
Hiljattain Lundista saadussa tapauksessa kuvailimme pitkittynyttä sairausjaksoa, jossa oli useita laitoshoitotapauksia, joissa epäselviä kuumejaksoja potilaalla, jolla on aiemmin ollut hematologinen pahanlaatuisuus ja pernan poisto sairaushistoriassa. Parannusta ei tapahtunut huolimatta laaja-alaisesta bakteeri-, virus- ja sienihoidosta. Useita leukosyyttien tutkimuksia tehtiin mikroskoopilla sekä luuytimestä että verestä ilman, että loisia havaittiin, huolimatta useiden prosentin parasitemioista toistuvasti (joka nähtiin punasolujen tutkimuksessa, kun diagnoosi oli tiedossa). Lopulta Babesia venatorum -loiset havaittiin vahingossa verinäytteestä, ja potilas parani nopeasti riittävällä hoidolla [5].
Nämä tapausraportit havainnollistavat viivästynyttä diagnoosia, joka johtuu siitä, että babesioosin diagnoosi on usein klinikan päivittäisen toiminnan ulkopuolella. Ne osoittavat myös mahdollisesti kuolemaan johtavia sairauksia, jos oikeaa diagnoosia ei olisi voitu määrittää.
Olemme Skånessa äskettäin osoittaneet, että merkittävällä osalla Lymen taudin saaneista ihmisistä (16,3 prosenttia) oli vasta-aineita joko Babesia divergensia tai Babesia microtia vastaan verrattuna terveeseen kontrolliryhmään, jossa 2,5 prosentilla oli vasta-aineita mitä tahansa Babesia-lajia vastaan [6] . Yksilöt, joilla oli Babesia-vasta-aineita, löydettiin hajallaan pääasiassa vain IgG-vasteilla, mutta oli myös henkilöitä, joilla oli positiiviset IgM-tiitterit merkkejä meneillään olevasta tai äskettäisestä infektiosta.
Tulosten mukaan Babesia-tartunnat voivat olla yllättävän yleisiä Ruotsissa punkkien puremille altistuneiden ihmisten keskuudessa.
Saksassa tehtiin samanlainen tutkimus Lymen tautia sairastavilla potilailla, joissa Babesia-vasta-aineiden seroprevalenssi oli 11,5 prosenttia [7].
On myös olemassa riski, että Babesia on suuri ongelma potilailla, joilla on immuunijärjestelmään vaikuttavia sairauksia [8]. Tutkimuksessa, jossa käytettiin DNA:ta taudinaiheuttajan havaitsemiseen, vahvistettiin, että ihmisillä oli todellakin havaittu Babesia microti [9]. Jopa immuunivapaat potilaat voivat saada vakavan sairauden [10, 11].
Jos verrataan Babesian ja Lymen taudin esiintyvyyttä punkeissa Etelä-Ruotsissa [1, 12] vasta-ainetutkimuksemme [6] tuloksiin, ne ovat varsin yhtäpitäviä, mikä vahvistaa olettamusta, että ihmisillä, joilla on vasta-aineita Babesialle, todella oli tällainen infektio.
Tunnettu Yhdysvalloissa - pelätään verensiirtolääketieteessä
Yhdysvalloissa tietoisuus babesioista on erilaista. Erityisesti Babesia microti -lajin aiheuttamia infektioita on diagnosoitu. Yhdeksää osavaltiota pidetään Babesia endeemisenä, ja ne kattavat lähes koko potilaiden raportoinnin. Vuonna 2017 ilmoitettiin 2 368 tapausta kaikista hieman alle 60 000 puutiaisen levittämän sairauden tapauksesta, jotka ilmoitettiin Yhdysvaltain kansallisen kansanterveysviraston sairauksien valvonta- ja ehkäisykeskukselle (CDC). Puolet babesioosipotilaista tarvitsi laitoshoitoa, jonka mediaanihoitojakso oli 4 päivää [13]. Taudin kuolleisuus näissä materiaaleissa oli 0,5 prosenttia, mutta se oli merkittävästi korkeampi samanaikaisen immunosuppression yhteydessä tai jos infektio tapahtui verensiirron kautta [14, 15].
Yhdysvalloissa on raportoitu yli 200 verensiirtoa aiheuttavaa Babesia-infektiota. Tutkimus tiivistää 3 799 babesioositapausta New Yorkin osavaltiosta vuosina 2004–2015. Näistä 55 tarttui verensiirrossa, joista 2 (4 prosenttia) oli kuolemaan johtava [16]. Ruotsissa luovutettu veri seulotaan ennen verensiirtoa useiden tekijöiden varalta veren saajien suojelemiseksi, koska he ovat usein alttiita uusille infektioille. Babesian seulontaa ei kuitenkaan ole.
Yhdysvalloissa erytrosyyttitiivisteessä olevaa Babesiaa pidetään nykyään mikrobi-infektiona, joka yhdessä verihiutale tiivisteessä olevan Staphylococcus aureuksen kanssa aiheuttaa suurimman verensiirto kuolleisuuden. Yhdysvaltain elintarvike- ja lääkeviraston (FDA) kokoelma kuolemaan johtaneista verensiirto komplikaatioista Yhdysvalloissa vuosina 2012–2016 osoittaa, että 4 19:stä verensiirron välityksellä tarttuneesta mikrobi infektiosta (21 prosenttia) liittyi Babesiaan. liittyy Staphylococcus aureukseen [17].
Asianomaiset Yhdysvaltain viranomaiset suosittelevat nyt, että verensiirrot seulotaan Babesian varalta endeemisissä osavaltioissa, ja pakolliset määräykset ovat käynnissä sen jälkeen, kun FDA 2018 on hyväksynyt kaksi vasta-aineiden havaitsemis menetelmää ja DNA:ta. On myös ehdotettu, että seulonta suoritetaan kaikissa osavaltioissa Yhdysvalloissa [18–21].
Babesioosi ihmisillä Ruotsissa ja Euroopassa
Ruotsalaisten ihmisten keskuudessa satunnaisia tapauksia on kuvattu viime vuosikymmeninä, muun muassa Halmstadissa ja Göteborgissa, joissa viivästynyt diagnoosi yhdessä tapauksessa aiheutti suhteellisen vakavan sairauden ennen kuin oikea hoito pystyttiin aloittamaan. Uppsalaisessa tapauksessa 34-vuotias jolla pernanpoisto, mutta muuten terve mies sairastui suhteellisen nopeasti vakavasti , joka vaati tehohoitoa monielin vajaatoimintaan. Muutaman päivän hoidon jälkeen verinäytteiden mikroskooppinen tutkimus paljasti massiivisen parasitemian ja Babesian eroavaisuuksia 40 prosentissa punasoluista; kunnollisen hoidon aloittamisen jälkeen potilas parani nopeasti [4].
Hiljattain Lundista saadussa tapauksessa kuvailimme pitkittynyttä sairausjaksoa, jossa oli useita laitoshoitotapauksia, joissa epäselviä kuumejaksoja potilaalla, jolla on aiemmin ollut hematologinen pahanlaatuisuus ja pernan poisto sairaushistoriassa. Parannusta ei tapahtunut huolimatta laaja-alaisesta bakteeri-, virus- ja sienihoidosta. Useita leukosyyttien tutkimuksia tehtiin mikroskoopilla sekä luuytimestä että verestä ilman, että loisia havaittiin, huolimatta useiden prosentin parasitemioista toistuvasti (joka nähtiin punasolujen tutkimuksessa, kun diagnoosi oli tiedossa). Lopulta Babesia venatorum -loiset havaittiin vahingossa verinäytteestä, ja potilas parani nopeasti riittävällä hoidolla [5].
Nämä tapausraportit havainnollistavat viivästynyttä diagnoosia, joka johtuu siitä, että babesioosin diagnoosi on usein klinikan päivittäisen toiminnan ulkopuolella. Ne osoittavat myös mahdollisesti kuolemaan johtavia sairauksia, jos oikeaa diagnoosia ei olisi voitu määrittää.
Olemme Skånessa äskettäin osoittaneet, että merkittävällä osalla Lymen taudin saaneista ihmisistä (16,3 prosenttia) oli vasta-aineita joko Babesia divergensia tai Babesia microtia vastaan verrattuna terveeseen kontrolliryhmään, jossa 2,5 prosentilla oli vasta-aineita mitä tahansa Babesia-lajia vastaan [6] . Yksilöt, joilla oli Babesia-vasta-aineita, löydettiin hajallaan pääasiassa vain IgG-vasteilla, mutta oli myös henkilöitä, joilla oli positiiviset IgM-tiitterit merkkejä meneillään olevasta tai äskettäisestä infektiosta.
Tulosten mukaan Babesia-tartunnat voivat olla yllättävän yleisiä Ruotsissa punkkien puremille altistuneiden ihmisten keskuudessa.
Saksassa tehtiin samanlainen tutkimus Lymen tautia sairastavilla potilailla, joissa Babesia-vasta-aineiden seroprevalenssi oli 11,5 prosenttia [7].
On myös olemassa riski, että Babesia on suuri ongelma potilailla, joilla on immuunijärjestelmään vaikuttavia sairauksia [8]. Tutkimuksessa, jossa käytettiin DNA:ta taudinaiheuttajan havaitsemiseen, vahvistettiin, että ihmisillä oli todellakin havaittu Babesia microti [9]. Jopa immuunivapaat potilaat voivat saada vakavan sairauden [10, 11].
Jos verrataan Babesian ja Lymen taudin esiintyvyyttä punkeissa Etelä-Ruotsissa [1, 12] vasta-ainetutkimuksemme [6] tuloksiin, ne ovat varsin yhtäpitäviä, mikä vahvistaa olettamusta, että ihmisillä, joilla on vasta-aineita Babesialle, todella oli tällainen infektio.
Tunnettu Yhdysvalloissa - pelätään verensiirtolääketieteessä
Yhdysvalloissa tietoisuus babesioista on erilaista. Erityisesti Babesia microti -lajin aiheuttamia infektioita on diagnosoitu. Yhdeksää osavaltiota pidetään Babesia endeemisenä, ja ne kattavat lähes koko potilaiden raportoinnin. Vuonna 2017 ilmoitettiin 2 368 tapausta kaikista hieman alle 60 000 puutiaisen levittämän sairauden tapauksesta, jotka ilmoitettiin Yhdysvaltain kansallisen kansanterveysviraston sairauksien valvonta- ja ehkäisykeskukselle (CDC). Puolet babesioosipotilaista tarvitsi laitoshoitoa, jonka mediaanihoitojakso oli 4 päivää [13]. Taudin kuolleisuus näissä materiaaleissa oli 0,5 prosenttia, mutta se oli merkittävästi korkeampi samanaikaisen immunosuppression yhteydessä tai jos infektio tapahtui verensiirron kautta [14, 15].
Yhdysvalloissa on raportoitu yli 200 verensiirtoa aiheuttavaa Babesia-infektiota. Tutkimus tiivistää 3 799 babesioositapausta New Yorkin osavaltiosta vuosina 2004–2015. Näistä 55 tarttui verensiirrossa, joista 2 (4 prosenttia) oli kuolemaan johtava [16]. Ruotsissa luovutettu veri seulotaan ennen verensiirtoa useiden tekijöiden varalta veren saajien suojelemiseksi, koska he ovat usein alttiita uusille infektioille. Babesian seulontaa ei kuitenkaan ole.
Yhdysvalloissa erytrosyyttitiivisteessä olevaa Babesiaa pidetään nykyään mikrobi-infektiona, joka yhdessä verihiutale tiivisteessä olevan Staphylococcus aureuksen kanssa aiheuttaa suurimman verensiirto kuolleisuuden. Yhdysvaltain elintarvike- ja lääkeviraston (FDA) kokoelma kuolemaan johtaneista verensiirto komplikaatioista Yhdysvalloissa vuosina 2012–2016 osoittaa, että 4 19:stä verensiirron välityksellä tarttuneesta mikrobi infektiosta (21 prosenttia) liittyi Babesiaan. liittyy Staphylococcus aureukseen [17].
Asianomaiset Yhdysvaltain viranomaiset suosittelevat nyt, että verensiirrot seulotaan Babesian varalta endeemisissä osavaltioissa, ja pakolliset määräykset ovat käynnissä sen jälkeen, kun FDA 2018 on hyväksynyt kaksi vasta-aineiden havaitsemis menetelmää ja DNA:ta. On myös ehdotettu, että seulonta suoritetaan kaikissa osavaltioissa Yhdysvalloissa [18–21].
Re: BABESIOOSI
BORRELIOOSI JA BABESIA
https://www.lymedisease.org/wendy-adams ... TRbom--THs
Saman pureman aikana voi jopa tarttua useita infektioita. Useiden infektioiden aiheuttamat hämmentävät ja päällekkäiset sairausoireet tekevät lääkäreille erittäin vaikeaksi tunnistaa, diagnosoida ja hoitaa eri infektioita.
Borrelia burgdorferi ja Babesia
Yleisimmin raportoitu punkkien levittämä tauti Lymen taudin jälkeen on babesioosi, jonka aiheuttaa Babesia-loisen aiheuttama infektio. Tämä loinen, aivan kuten serkkunsa Plasmodium falciparum (malaria), saastuttaa punasoluja ja voi aiheuttaa anemiaa, trombosytopeniaa (alhainen verihiutaleiden määrä) ja muita vakavia, joskus hengenvaarallisia oireita.
Babesia microti, Yhdysvaltojen yleisin tarttuva loinen, löytyy tyypillisesti siellä, missä Lymen tauti esiintyy – Koillis-, Keski-Atlantilla ja Keskilännessä, vaikka useimmat raportoidut tapaukset tulevat koillisesta.
Mutta miksi tämä maantiede on päällekkäinen Lymen taudin kanssa? Osoittautuu, että B. burgdorferin esiintyminen ekosysteemissä helpottaa Ba microtin muodostumista punkeissa.
Todennäköisesti rinnakkaisinfektiot
Tämä tarkoittaa, että punkit paikoissa, joissa on Babesia-tartunnat, ovat myös todennäköisemmin yhdessä B. burgdorferi -tartunnan saaneet. Ainakin yksi tutkimus hiirillä, joilla oli samanaikaisesti Babesia- ja Borrelia-infektio, osoitti, että Babesia esti hankittua immuunivastetta, mukaan lukien B- ja T-solujen tuotanto, niin että Borrelian (Lymen) oireet lisääntyivät.
Erityisesti Borrelia voi vaikuttaa synnynnäiseen immuunijärjestelmään – mikä tarkoittaa, että samanaikaisesti tartunnan saanut henkilö ei ehkä pysty muodostamaan riittävää immuunivastetta kummassakaan vaiheessa taistellakseen kumpaakaan taudinaiheuttajaa vastaan optimaalisesti.
Babesia on erityinen huolenaihe lääkäreille ja tutkijoille muutamista syistä. Kuten Borrelia, tartunnan saanut äiti voi siirtää loisen istukan kautta sikiöön. Tuloksena oleva infektio voi olla vaarallinen vastasyntyneelle, ja se on dokumentoitu tapauksessa, jossa raskaana olevaa äitiä ei testattu babesioosin varalta Lymen diagnoosista huolimatta.
Toinen Babesian huolestuttava syy on sen tunkeutuminen verenkiertoon. Babesia voi selviytyä veripankkiolosuhteista, ja satoja tapauksia on dokumentoitu verensiirtojen kautta.
Tartunnan saaneet elinsiirrot ovat myös johtaneet Babesian leviämiseen ja tätä reittiä tapahtuva tartunta on erityisen ongelmallista. Elinsiirtopotilaiden on otettava immunosuppressantteja, jotta he eivät hylkää uutta elintä, jolloin he ovat entistä alttiimpia opportunistisille infektioille.
Babesia duncani – "vasen rannikko" Babesia?
Kuten aiemmin todettiin, Babesia on erityinen patogeenien perhe tai "suku", ja suvussa on erilaisia lajeja Pohjois-Amerikan eri alueilla.
Yhdysvaltain länsirannikolla on ainakin yksi laji, joka saastuttaa ihmisiä: Babesia duncani (Babesia divergens on löydetty myös Washingtonin osavaltiosta).
B. duncani ei näytä olevan läheistä sukua B. microtille. Pikemminkin se on läheisempi sukua Babesia gibsonille, koirista löytyvälle lajille ja Theileria-nimiselle loiselle.
Vaikka B. duncani -tapauksia on raportoitu hyvin vähän, jotkut tutkimukset viittaavat siihen, että sitä on löydetty ihmisten infektioista myös muilla Pohjois-Amerikan alueilla, ja kirjallisuudessa on verensiirtoon liittyviä tapauksia.
Mielenkiintoista on, että Kaliforniasta peräisin olevat kannat - vaikka ne näyttävät samalta mikroskoopilla - eroavat geneettisesti muista tunnetuista Babesia-kannoista (erityisesti kannasta nimeltä WA1) länsirannikolla. Siksi jopa saman B. duncani -lajin sisällä on merkittävää geneettistä monimuotoisuutta.
1990-luvulla tehdyt seroprevalenssitutkimukset (jotka mittaavat vasta-aineita suuresta veriseeruminäytteiden populaatiosta) osoittivat, että 3 prosentilla Mendocinon piirikunnan Lymen endeemisessä yhteisössä olevista ihmisistä oli vasta-aineita ja 16 prosentilla Fort Ordissa Montereyn piirikunnassa olevista sotilaista oli vasta-aineita. vasta-aineet B. duncania vastaan.
Huolimatta B. duncanin ja Lyme Borrelian alueellisuudesta Kaliforniassa, Oregonissa ja Washingtonissa, B. duncania ei kuitenkaan ole omituisesti löydetty Ixodes pacificus -puutiaisista (läntinen mustajalkainen). Nämä ovat punkkeja, jotka kantavat ja levittävät B. burgdorferi -bakteeria Länsi-Yhdysvalloissa.
https://www.lymedisease.org/wendy-adams ... TRbom--THs
Saman pureman aikana voi jopa tarttua useita infektioita. Useiden infektioiden aiheuttamat hämmentävät ja päällekkäiset sairausoireet tekevät lääkäreille erittäin vaikeaksi tunnistaa, diagnosoida ja hoitaa eri infektioita.
Borrelia burgdorferi ja Babesia
Yleisimmin raportoitu punkkien levittämä tauti Lymen taudin jälkeen on babesioosi, jonka aiheuttaa Babesia-loisen aiheuttama infektio. Tämä loinen, aivan kuten serkkunsa Plasmodium falciparum (malaria), saastuttaa punasoluja ja voi aiheuttaa anemiaa, trombosytopeniaa (alhainen verihiutaleiden määrä) ja muita vakavia, joskus hengenvaarallisia oireita.
Babesia microti, Yhdysvaltojen yleisin tarttuva loinen, löytyy tyypillisesti siellä, missä Lymen tauti esiintyy – Koillis-, Keski-Atlantilla ja Keskilännessä, vaikka useimmat raportoidut tapaukset tulevat koillisesta.
Mutta miksi tämä maantiede on päällekkäinen Lymen taudin kanssa? Osoittautuu, että B. burgdorferin esiintyminen ekosysteemissä helpottaa Ba microtin muodostumista punkeissa.
Todennäköisesti rinnakkaisinfektiot
Tämä tarkoittaa, että punkit paikoissa, joissa on Babesia-tartunnat, ovat myös todennäköisemmin yhdessä B. burgdorferi -tartunnan saaneet. Ainakin yksi tutkimus hiirillä, joilla oli samanaikaisesti Babesia- ja Borrelia-infektio, osoitti, että Babesia esti hankittua immuunivastetta, mukaan lukien B- ja T-solujen tuotanto, niin että Borrelian (Lymen) oireet lisääntyivät.
Erityisesti Borrelia voi vaikuttaa synnynnäiseen immuunijärjestelmään – mikä tarkoittaa, että samanaikaisesti tartunnan saanut henkilö ei ehkä pysty muodostamaan riittävää immuunivastetta kummassakaan vaiheessa taistellakseen kumpaakaan taudinaiheuttajaa vastaan optimaalisesti.
Babesia on erityinen huolenaihe lääkäreille ja tutkijoille muutamista syistä. Kuten Borrelia, tartunnan saanut äiti voi siirtää loisen istukan kautta sikiöön. Tuloksena oleva infektio voi olla vaarallinen vastasyntyneelle, ja se on dokumentoitu tapauksessa, jossa raskaana olevaa äitiä ei testattu babesioosin varalta Lymen diagnoosista huolimatta.
Toinen Babesian huolestuttava syy on sen tunkeutuminen verenkiertoon. Babesia voi selviytyä veripankkiolosuhteista, ja satoja tapauksia on dokumentoitu verensiirtojen kautta.
Tartunnan saaneet elinsiirrot ovat myös johtaneet Babesian leviämiseen ja tätä reittiä tapahtuva tartunta on erityisen ongelmallista. Elinsiirtopotilaiden on otettava immunosuppressantteja, jotta he eivät hylkää uutta elintä, jolloin he ovat entistä alttiimpia opportunistisille infektioille.
Babesia duncani – "vasen rannikko" Babesia?
Kuten aiemmin todettiin, Babesia on erityinen patogeenien perhe tai "suku", ja suvussa on erilaisia lajeja Pohjois-Amerikan eri alueilla.
Yhdysvaltain länsirannikolla on ainakin yksi laji, joka saastuttaa ihmisiä: Babesia duncani (Babesia divergens on löydetty myös Washingtonin osavaltiosta).
B. duncani ei näytä olevan läheistä sukua B. microtille. Pikemminkin se on läheisempi sukua Babesia gibsonille, koirista löytyvälle lajille ja Theileria-nimiselle loiselle.
Vaikka B. duncani -tapauksia on raportoitu hyvin vähän, jotkut tutkimukset viittaavat siihen, että sitä on löydetty ihmisten infektioista myös muilla Pohjois-Amerikan alueilla, ja kirjallisuudessa on verensiirtoon liittyviä tapauksia.
Mielenkiintoista on, että Kaliforniasta peräisin olevat kannat - vaikka ne näyttävät samalta mikroskoopilla - eroavat geneettisesti muista tunnetuista Babesia-kannoista (erityisesti kannasta nimeltä WA1) länsirannikolla. Siksi jopa saman B. duncani -lajin sisällä on merkittävää geneettistä monimuotoisuutta.
1990-luvulla tehdyt seroprevalenssitutkimukset (jotka mittaavat vasta-aineita suuresta veriseeruminäytteiden populaatiosta) osoittivat, että 3 prosentilla Mendocinon piirikunnan Lymen endeemisessä yhteisössä olevista ihmisistä oli vasta-aineita ja 16 prosentilla Fort Ordissa Montereyn piirikunnassa olevista sotilaista oli vasta-aineita. vasta-aineet B. duncania vastaan.
Huolimatta B. duncanin ja Lyme Borrelian alueellisuudesta Kaliforniassa, Oregonissa ja Washingtonissa, B. duncania ei kuitenkaan ole omituisesti löydetty Ixodes pacificus -puutiaisista (läntinen mustajalkainen). Nämä ovat punkkeja, jotka kantavat ja levittävät B. burgdorferi -bakteeria Länsi-Yhdysvalloissa.
KASVITIETEELLISET LÄÄKKEET BABESIAA VASTAAN
https://www.frontiersin.org/articles/10 ... yUxrG7N_rs
Kasvitieteelliset lääkkeet Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum ja Alchornea cordifolia osoittavat estävää toimintaa Babesia duncania vastaan
Yumin Zhang 1 , Hector Alvarez-Manzo 1 , Jacob Leone 2 , Sunjya Schweig 3 ja Ying Zhang 4*
1 Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, Yhdysvallat
2 FOCUS Health Group, Naturopathic, Novato, CA, Yhdysvallat
3 California Center for Functional Medicine, Kensington, CA, Yhdysvallat
4 Valtion avainlaboratorio infektiotautien diagnosoimiseksi ja hoitamiseksi, Kansallinen infektiotautien kliininen tutkimuskeskus, ensimmäinen sidossairaala, Zhejiangin yliopiston lääketieteellinen korkeakoulu, Hangzhou, Kiina
Ihmisen babesioosi on CDC:n raportoitava sairaus Yhdysvalloissa, ja se tunnustetaan nousevaksi terveysriskiksi monissa osissa maailmaa. Nykyinen ihmisen babesioosin hoito ei ole optimaalinen hoidon epäonnistumisen ja ei-toivottujen sivuvaikutusten vuoksi.
Nykyinen ihmisen babesioosin hoito ei ole optimaalinen hoidon epäonnistumisen ja ei-toivottujen sivuvaikutusten vuoksi. Vaikka Babesia duncani kuvattiin ensimmäisen kerran lähes 30 vuotta sitten, tarvitaan lisätutkimuksia sen patogeneesin selvittämiseksi ja optimaalisen hoito-ohjelman selvittämiseksi. Tässä seuloimme kasviperäisiä lääkkeitä koskevan paneelin ja tunnistimme Cryptolepis sanguinolenta , Artemisia annua , Scutellaria baicalensis, Alchornea cordifolia ja Polygonum cuspidatum olevan hyvä in vitro estävä vaikutus B. duncania vastaanhamsterin erytrosyyttimallissa.
Johdanto
Babesioosi on punasoluja tartuttavan Babesia -loisen aiheuttama sairaus . Babesia -suku kuuluu apicomplexan-suvun ryhmään, ja yli 100 Babesia - lajia on tunnistettu ( Birkenheuer et al., 2006 ). Kuitenkin vain muutaman näistä on dokumentoitu tartuttavan ihmisiä. Babesia divergens , Babesia microti ja Babesia duncani aiheuttavat eniten ihmisten babesioositapauksia maailmanlaajuisesti. Useimmat ihmisen babesioositartunnat Yhdysvalloissa ovat B. microti- ja B. duncani -bakteerin aiheuttamia , ja Euroopassa suurin osa raportoiduista tapauksista johtuu B. divergensistä (Vannier ja Krause, 2012 ). Kaikki nämä Babesia - lajit voivat tarttua Ixodes punkeista, jotka ovat myös Borrelia - spirokeettojen varastoja, jotka aiheuttavat Lymen tautia.
Viime aikoina Dermacentor albipictus on osallisena Babesia duncanin pätevänä punkkivektorina ( Swei et al., 2019 ). Epidemiologiset tutkimukset ovat dokumentoineet, että jopa 23 %:lla potilaista, joilla on babesioosi, oli myös samanaikainen Lymen tauti ( Diuk-Wasser et al., 2016 ), ja samanaikaisesti tartunnan saaneet potilaat voivat kokea enemmän oireita pidempään kuin ne, joilla on yksinään Lymen tauti ( Krause ). et ai., 1996 ; Krause et ai., 2002). Puutiaisen pureman kautta tapahtuvan tartunnan lisäksi ihmisen babesioositartuntaa on raportoitu myös verensiirron, elinsiirron ja raskauden aikana ( Lux et al., 2003 ; Leiby, 2006 ).
Babesioosin kliiniset oireet vaihtelevat oireettomasta vakaviin, ja potilaiden yleisiä kliinisiä oireita ovat kuume, vilunväristykset ja hikoilu. Potilailla, joilla on immunologisia sairauksia, jotka saavat immunosuppressiivisia hoitoja, ja niillä, joille on tehty pernaleikkaus, on lisääntynyt riski saada vakavammat oireet ja jopa kuolema ( Vannier et al., 2015 ).
Eläimet, kuten hiiret, gerbiilit ja hamsterit, ovat alttiita B. duncani -tartunnalle intraperitoneaalisella injektiolla. Eläinmalleilla tehdyt tutkimukset osoittavat, että B. duncanilla on erilainen patogeneesi kuin B. microtilla siinä mielessä, että B. microti -tartunnan saaneiden hamstereiden parasitemia voi aluksi olla hyvin korkea, mutta sitten laskea havaitsemattomalle tasolle useiden viikkojen kuluessa. Sitä vastoin B. duncani voi aiheuttaa vakavan akuutin taudin ja kuoleman hamstereissa 10 päivän sisällä rokotuksen jälkeen ( Kjemtrup ja Conrad, 2000 ). Hiirimalleissa B. duncani voi aiheuttaa vakavampia esiintymiä ja korkeampia kuolleisuusasteita kuin B. microti ( Moro et al., 1998 ). Morfologian suhteen B. duncanin ja B. microtin välillä ei ole ilmeistä eroa erytrosyyttisten vaiheiden välillä , kuitenkin perustuen 18S-RNA-geenin, ITS2 -geenin, cytb -geenin ja coxI :n fylogeneettiseen analyysiin.geeni, B. duncani osoittaa selkeän evoluutiolinjan verrattuna B. microtiin ja muihin Babesia - lajeihin ( Virji et al., 2019 ).
Nykyisissä ihmisen babesioosin hoitomenetelmissä käytetään usein lääkkeitä, kuten atovakoni, atsitromysiini, klindamysiini, kiniini ja niiden yhdistelmiä ( Smith et al., 2020 ). Nämä hoito-ohjelmat eivät kuitenkaan ole optimaalisia, ja niihin liittyy hoidon epäonnistumisia ja merkittäviä sivuvaikutuksia ( Kjemtrup ja Conrad, 2000 ), jopa immuunikompetenteilla potilailla ( Krause et ai., 1998 ; Gonzalez et ai., 2014 ). Jotkut Babesia - infektiot voivat olla pysyviä, ja uusiutuminen voi tapahtua jopa kaksi vuotta hoidon jälkeen ( Krause et al., 2008 ; Raffalli ja Wormser, 2016 ). Lisäksi on osoitettu, että B. duncaniosoitti odottamattoman korkeaa toleranssia atovakonille, atsitromysiinille, klindamysiinille ja kiniinille in vitro ( Abraham et al., 2018 ), ja B. duncani saattoi kasvaa uudelleen in vitro sen jälkeen, kun se oli altistunut korkeille pitoisuuksille atovakonia tai atsitromysiiniä 3 päivän ajan ( Zhang et al., 2020 ). Siksi on kehitettävä vaihtoehtoisia tehokkaampia antimikrobisia aineita ja hoito-ohjelmia, joilla on vähemmän sivuvaikutuksia.
Muinaiset kulttuurit käyttivät kasviperäisiä lääkkeitä, ja niiden turvallisuus ja tehokkuus on dokumentoitu useilla perinteisen lääketieteen järjestelmillä, kuten Ayurveda ja perinteinen kiinalainen lääketiede ( Borchardt, 2002 ; Jaiswal et al., 2016 ). Tuoreen raportin mukaan kasvitieteellisten tuotteiden haittavaikutukset todettiin harvinaisiksi ( Di Lorenzo et al., 2015 ). Aiemmassa tutkimuksessa olemme seuloneet eteeristen öljyjen paneelin ja havainneet, että valkosipuliöljy, mustapippuri ja niiden ainesosat osoittivat hyvää aktiivisuutta B. duncania vastaan hamsterin erytrosyyttimallissa ( Zhang et al., 2020).). Nämä havainnot osoittivat, että kasveista ja yrteistä uutetut luonnontuotteet voivat toimia mahdollisena lähteenä lupaaville yhdisteille loislääkkeille. Tässä tutkimuksessa käytimme samaa hamsterin erytrosyyttimallia B. duncanin eston seulomiseen käyttämällä 46 yrttiuutteen paneelia, joista monet ovat hyödyllisiä babesioosin ja siihen liittyvien sairauksien hoidossa kasviperäisiä lääkkeitä koskevan Buhner-kirjan mukaan. ( Buhner, 2015 ) tai aiemmissa in vitro -tutkimuksissamme on osoitettu olevan antimikrobisia vaikutuksia ( Feng J. et al., 2020 ). Tuloksemme tunnistivat Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Alchornea cordifolia ja Polygonum cuspidatumja niiden bioaktiiviset yhdisteet, joilla on hyvä vaikutus B. duncania vastaan .
Kasvitieteelliset lääkkeet Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum ja Alchornea cordifolia osoittavat estävää toimintaa Babesia duncania vastaan
Yumin Zhang 1 , Hector Alvarez-Manzo 1 , Jacob Leone 2 , Sunjya Schweig 3 ja Ying Zhang 4*
1 Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, Yhdysvallat
2 FOCUS Health Group, Naturopathic, Novato, CA, Yhdysvallat
3 California Center for Functional Medicine, Kensington, CA, Yhdysvallat
4 Valtion avainlaboratorio infektiotautien diagnosoimiseksi ja hoitamiseksi, Kansallinen infektiotautien kliininen tutkimuskeskus, ensimmäinen sidossairaala, Zhejiangin yliopiston lääketieteellinen korkeakoulu, Hangzhou, Kiina
Ihmisen babesioosi on CDC:n raportoitava sairaus Yhdysvalloissa, ja se tunnustetaan nousevaksi terveysriskiksi monissa osissa maailmaa. Nykyinen ihmisen babesioosin hoito ei ole optimaalinen hoidon epäonnistumisen ja ei-toivottujen sivuvaikutusten vuoksi.
Nykyinen ihmisen babesioosin hoito ei ole optimaalinen hoidon epäonnistumisen ja ei-toivottujen sivuvaikutusten vuoksi. Vaikka Babesia duncani kuvattiin ensimmäisen kerran lähes 30 vuotta sitten, tarvitaan lisätutkimuksia sen patogeneesin selvittämiseksi ja optimaalisen hoito-ohjelman selvittämiseksi. Tässä seuloimme kasviperäisiä lääkkeitä koskevan paneelin ja tunnistimme Cryptolepis sanguinolenta , Artemisia annua , Scutellaria baicalensis, Alchornea cordifolia ja Polygonum cuspidatum olevan hyvä in vitro estävä vaikutus B. duncania vastaanhamsterin erytrosyyttimallissa.
Johdanto
Babesioosi on punasoluja tartuttavan Babesia -loisen aiheuttama sairaus . Babesia -suku kuuluu apicomplexan-suvun ryhmään, ja yli 100 Babesia - lajia on tunnistettu ( Birkenheuer et al., 2006 ). Kuitenkin vain muutaman näistä on dokumentoitu tartuttavan ihmisiä. Babesia divergens , Babesia microti ja Babesia duncani aiheuttavat eniten ihmisten babesioositapauksia maailmanlaajuisesti. Useimmat ihmisen babesioositartunnat Yhdysvalloissa ovat B. microti- ja B. duncani -bakteerin aiheuttamia , ja Euroopassa suurin osa raportoiduista tapauksista johtuu B. divergensistä (Vannier ja Krause, 2012 ). Kaikki nämä Babesia - lajit voivat tarttua Ixodes punkeista, jotka ovat myös Borrelia - spirokeettojen varastoja, jotka aiheuttavat Lymen tautia.
Viime aikoina Dermacentor albipictus on osallisena Babesia duncanin pätevänä punkkivektorina ( Swei et al., 2019 ). Epidemiologiset tutkimukset ovat dokumentoineet, että jopa 23 %:lla potilaista, joilla on babesioosi, oli myös samanaikainen Lymen tauti ( Diuk-Wasser et al., 2016 ), ja samanaikaisesti tartunnan saaneet potilaat voivat kokea enemmän oireita pidempään kuin ne, joilla on yksinään Lymen tauti ( Krause ). et ai., 1996 ; Krause et ai., 2002). Puutiaisen pureman kautta tapahtuvan tartunnan lisäksi ihmisen babesioositartuntaa on raportoitu myös verensiirron, elinsiirron ja raskauden aikana ( Lux et al., 2003 ; Leiby, 2006 ).
Babesioosin kliiniset oireet vaihtelevat oireettomasta vakaviin, ja potilaiden yleisiä kliinisiä oireita ovat kuume, vilunväristykset ja hikoilu. Potilailla, joilla on immunologisia sairauksia, jotka saavat immunosuppressiivisia hoitoja, ja niillä, joille on tehty pernaleikkaus, on lisääntynyt riski saada vakavammat oireet ja jopa kuolema ( Vannier et al., 2015 ).
Eläimet, kuten hiiret, gerbiilit ja hamsterit, ovat alttiita B. duncani -tartunnalle intraperitoneaalisella injektiolla. Eläinmalleilla tehdyt tutkimukset osoittavat, että B. duncanilla on erilainen patogeneesi kuin B. microtilla siinä mielessä, että B. microti -tartunnan saaneiden hamstereiden parasitemia voi aluksi olla hyvin korkea, mutta sitten laskea havaitsemattomalle tasolle useiden viikkojen kuluessa. Sitä vastoin B. duncani voi aiheuttaa vakavan akuutin taudin ja kuoleman hamstereissa 10 päivän sisällä rokotuksen jälkeen ( Kjemtrup ja Conrad, 2000 ). Hiirimalleissa B. duncani voi aiheuttaa vakavampia esiintymiä ja korkeampia kuolleisuusasteita kuin B. microti ( Moro et al., 1998 ). Morfologian suhteen B. duncanin ja B. microtin välillä ei ole ilmeistä eroa erytrosyyttisten vaiheiden välillä , kuitenkin perustuen 18S-RNA-geenin, ITS2 -geenin, cytb -geenin ja coxI :n fylogeneettiseen analyysiin.geeni, B. duncani osoittaa selkeän evoluutiolinjan verrattuna B. microtiin ja muihin Babesia - lajeihin ( Virji et al., 2019 ).
Nykyisissä ihmisen babesioosin hoitomenetelmissä käytetään usein lääkkeitä, kuten atovakoni, atsitromysiini, klindamysiini, kiniini ja niiden yhdistelmiä ( Smith et al., 2020 ). Nämä hoito-ohjelmat eivät kuitenkaan ole optimaalisia, ja niihin liittyy hoidon epäonnistumisia ja merkittäviä sivuvaikutuksia ( Kjemtrup ja Conrad, 2000 ), jopa immuunikompetenteilla potilailla ( Krause et ai., 1998 ; Gonzalez et ai., 2014 ). Jotkut Babesia - infektiot voivat olla pysyviä, ja uusiutuminen voi tapahtua jopa kaksi vuotta hoidon jälkeen ( Krause et al., 2008 ; Raffalli ja Wormser, 2016 ). Lisäksi on osoitettu, että B. duncaniosoitti odottamattoman korkeaa toleranssia atovakonille, atsitromysiinille, klindamysiinille ja kiniinille in vitro ( Abraham et al., 2018 ), ja B. duncani saattoi kasvaa uudelleen in vitro sen jälkeen, kun se oli altistunut korkeille pitoisuuksille atovakonia tai atsitromysiiniä 3 päivän ajan ( Zhang et al., 2020 ). Siksi on kehitettävä vaihtoehtoisia tehokkaampia antimikrobisia aineita ja hoito-ohjelmia, joilla on vähemmän sivuvaikutuksia.
Muinaiset kulttuurit käyttivät kasviperäisiä lääkkeitä, ja niiden turvallisuus ja tehokkuus on dokumentoitu useilla perinteisen lääketieteen järjestelmillä, kuten Ayurveda ja perinteinen kiinalainen lääketiede ( Borchardt, 2002 ; Jaiswal et al., 2016 ). Tuoreen raportin mukaan kasvitieteellisten tuotteiden haittavaikutukset todettiin harvinaisiksi ( Di Lorenzo et al., 2015 ). Aiemmassa tutkimuksessa olemme seuloneet eteeristen öljyjen paneelin ja havainneet, että valkosipuliöljy, mustapippuri ja niiden ainesosat osoittivat hyvää aktiivisuutta B. duncania vastaan hamsterin erytrosyyttimallissa ( Zhang et al., 2020).). Nämä havainnot osoittivat, että kasveista ja yrteistä uutetut luonnontuotteet voivat toimia mahdollisena lähteenä lupaaville yhdisteille loislääkkeille. Tässä tutkimuksessa käytimme samaa hamsterin erytrosyyttimallia B. duncanin eston seulomiseen käyttämällä 46 yrttiuutteen paneelia, joista monet ovat hyödyllisiä babesioosin ja siihen liittyvien sairauksien hoidossa kasviperäisiä lääkkeitä koskevan Buhner-kirjan mukaan. ( Buhner, 2015 ) tai aiemmissa in vitro -tutkimuksissamme on osoitettu olevan antimikrobisia vaikutuksia ( Feng J. et al., 2020 ). Tuloksemme tunnistivat Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Alchornea cordifolia ja Polygonum cuspidatumja niiden bioaktiiviset yhdisteet, joilla on hyvä vaikutus B. duncania vastaan .
Re: BABESIOOSI
https://www.mdpi.com/2076-0817/10/11/14 ... ljX085rXKk
5. Ihmisen babesioosi Euroopassa
5.1. Yleiskatsaus
Ensimmäinen dokumentoitu ihmisen babesioositapaus kaikkialla maailmassa raportoitiin entisessä Jugoslaviassa vuonna 1957 [ 33 ]. Sairastunut potilas oli viljelijä, jolta oli poistettu perna ja joka menehtyi vakavaan hemolyyttiseen anemiaan. Loislajeja ei koskaan määritetty, mutta B. bovis löydettiin hänen hoitamistaan nautakarjasta [ 120 ]. Sen jälkeen Euroopan mantereella on raportoitu yli 50 babesioositapausta [ 1 , 5 , 121 , 122 , 123 ]. Euroopassa vallitseva taudinaiheuttaja on B. divergens, mutta B. microti ja B. venatorum on tunnistettu harvoissa tapauksissa [35 , 124 , 125 ]. Kanariansaarilla (Espanja) on raportoitu tapaus B. divergensin kaltaisesta infektiosta [ 8 ]. Hildebrandtin et ai. kattava katsaus ihmisen babesioosiin Euroopassa. (2021) dokumentoi yhteensä 51 alkuperäistä tapausta, joista 35 johtui B. divergensistä , 11 B. microtista ja 5 B. venatorumista [ 2 ]. Epidemiologiset tutkimukset ovat osoittaneet B. divergensin ja siihen liittyvän puutiaisvektorin Ixodes ricinuksen laajalle levinneen koko Euroopassa [ 126 ]]. Viimeaikaiset seroprevalenssiraportit viittaavat paljon korkeampaan kliiniseen ilmaantuvuuteen kuin tähän mennessä olemassa olevassa kirjallisuudessa on kuvattu [ 127 ]. Todellisen babesioosin esiintyvyyden kvantifiointi kaikkialla Euroopassa on edelleen haaste, koska oireet ilmenevät usein epäspesifisesti, immuunikyvyttömät yksilöt ovat usein oireettomia ja babesioosi ei ole ilmoitettavissa oleva sairaus monissa maissa [ 128 ].
5.2. Babesia eroaa
B. divergens on ihmisen babesioosin ensisijainen aiheuttaja Euroopassa ja endeeminen Euroopan nautapopulaatiossa. Gray (2006) kuvaili ekologisia maisemia maissa, joissa naudan babesioosia esiintyy eniten, ja niillä on merkittäviä punkkipopulaatioita "karkeilla avoimilla kukkuloilla tai kosteilla matalalla niityillä" ja "jos metsämaa on usein karjan laidunten vieressä" [ 129 ]. Yli puolet eurooppalaisista babesioositapauksista on raportoitu Ranskassa ja Brittein saarilla, ja vähintään 10 muuta maata on edustettuna yksittäisissä tapausraporteissa [ 31 , 122 , 130 , 131 , 132 , 133]. Babesioosin levinneisyyden kerrotaan lisääntyvän, ja Euroopan tautien ehkäisy- ja valvontakeskus on tunnistanut useita tähän suuntaukseen vaikuttavia tekijöitä: punkkipopulaatioihin vaikuttavat maiseman muutokset, hirvipopulaatioiden kasvu, ihmisen toiminta saastuneilla alueilla ja taudinaiheuttajien leviäminen karjan liikkumisen kautta ( https: //www.ecdc.europa.eu/en/all-topics-z/babe ... babesiosis , käytetty 27. heinäkuuta 2021). Viime aikoina on havaittu tautien ilmaantumista yhä pohjoisemmilla leveysasteilla Euroopassa. Mysterud ja kollegat analysoivat pitkittäisiä punkkivälitteisten tautien esiintyvyystietoja Norjasta ja havaitsivat, että tämä ilmaantuminen liittyy punkkivektorin jakautumiseen [ 134 ]. I. ricinus on B. divergensin ensisijainen vektorija on laajalti levinnyt ympäri Eurooppaa [ 135 ]. Ensisijaisia isäntälajeja ovat kesynaudat, [ 126 ], metsäpeura ja muut hirvieläimiä (esim. hirvi, punapeura, poro, sikapeura) [ 136 ].
B. divergens -infektioille on ominaista fulminantti sairaus, ja kaikki tapaukset muutamaa lukuun ottamatta on raportoitu aspleniapotilailla [ 5 , 123 , 128 ]. Tekijöitä, jotka altistavat potilaat vakavalle sairaudelle, ovat äärimmäinen ikä ja muut syyt immuunipuutteiseen kliiniseen tilaan [ 122 , 137 ]. 1–3 viikon itämisajan jälkeen B. divergensin oireet etenevät yleensä nopeasti, ja niihin liittyy korkea kuume, vilunväristykset, hikoilu, päänsärky, lihaskipu, hemolyyttinen anemia ja hemoglobinuria [ 5 ]. B. divergensiin liittyvä kuolleisuusUsein monielinten vajaatoiminnasta johtuvan infektion arvioitiin aiemmin olevan jopa 42 %, mutta se paranee. Parempien tulosten uskotaan johtuvan ensisijaisesti aggressiivisemmasta hoidosta, mukaan lukien suonensisäiset antibiootit ja vaihtotransfuusion varhainen käyttö [ 5 ]. Kaksi äskettäistä julkaisua on kyseenalaistanut tämän "klassisen kuvauksen babesioosista Euroopassa". Martinot et ai. kuvasi kaksi poikkeuksellista vakavaa babesioositapausta terveillä, nuorilla, immunokompetenteilla potilailla Ranskassa, ja Gonzalez kuvasi samanlaisen tapauksen Espanjassa [ 123 , 138 ].
5.3. Babesia venatorum
B. venatorum on nouseva kansanterveysongelma Euroopassa laajalle levinneen zoonoosinsa vuoksi [ 136 ]. B. venatorum , joka tunnettiin aiemmin nimellä Babesia sp. EU1 on läheistä sukua B. divergensille ja B. odocoileille [ 35 , 139 ]. Villiisäntiä ovat kauri ja hirvi [ 136 ]. Loinen on havaittu myös vankeudessa pidetyissä poroissa ja kotieläiminä pidetyissä lampaissa [ 75 , 140 , 141 , 142 ]. I. ricinuspunkki toimii sekä vektorina että säiliönä. Ihmisissä esiintyviä tapauksia on tähän mennessä raportoitu Itävallassa, Saksassa ja Italiassa [ 35 , 124 ]. Tapausraporteissa on kuvattu taudin ilmenemismuotoja, jotka vaihtelevat lievistä kohtalaisen vaikeisiin ja jotka häviävät antimikrobisella hoidolla, jopa asplenian ja lymfooman yhteydessä. B. venatorum -infektion kliininen esitys on yleensä lievempi kuin B. divergensin [ 5 ].
5.4. Babesia microti
B. microti -tartuntatapauksia on raportoitu Itävallasta, Saksasta, Italiasta, Puolasta, Espanjasta ja Sveitsistä [ 35 , 125 , 143 , 144 , 145 , 146 ]. Ensimmäinen todiste ihmisen B. microti -infektiosta Euroopassa oli raportti seropositiivisista Sveitsin asukkaista vuonna 2002 [ 147 ]. Useat serotutkimukset ovat osoittaneet laajan valikoiman B. microti -seropositiivisuutta riippuen sijainnista ja tutkimuspopulaatiosta (esim. suuret yleisöt, metsätyöntekijät, Lymen taudin sairaat henkilöt). B. microtiseropositiivisuus on vaihdellut 0,5 %:sta 32 %:iin tutkimuspopulaatioissa Belgiassa, Ranskassa, Saksassa, Italiassa, Puolassa, Ruotsissa ja Sveitsissä [ 139 , 147 , 148 , 149 , 150 , 151 , 152 , 153 ] Lisäksi Hunfeld et al. (2002) raportoivat, että Saksassa punkeille altistuneiden potilaiden IgG:n seroprevalenssi oli korkeampi B. microtilla (9,3 %) kuin B. divergensillä (4,9 %). [ 139 ] Nämä seroprevalenssitiedot osoittavat, että Euroopassa on enemmän ihmisen B. microti -infektioita kuin tällä hetkellä tunnistetaan.
5. Ihmisen babesioosi Euroopassa
5.1. Yleiskatsaus
Ensimmäinen dokumentoitu ihmisen babesioositapaus kaikkialla maailmassa raportoitiin entisessä Jugoslaviassa vuonna 1957 [ 33 ]. Sairastunut potilas oli viljelijä, jolta oli poistettu perna ja joka menehtyi vakavaan hemolyyttiseen anemiaan. Loislajeja ei koskaan määritetty, mutta B. bovis löydettiin hänen hoitamistaan nautakarjasta [ 120 ]. Sen jälkeen Euroopan mantereella on raportoitu yli 50 babesioositapausta [ 1 , 5 , 121 , 122 , 123 ]. Euroopassa vallitseva taudinaiheuttaja on B. divergens, mutta B. microti ja B. venatorum on tunnistettu harvoissa tapauksissa [35 , 124 , 125 ]. Kanariansaarilla (Espanja) on raportoitu tapaus B. divergensin kaltaisesta infektiosta [ 8 ]. Hildebrandtin et ai. kattava katsaus ihmisen babesioosiin Euroopassa. (2021) dokumentoi yhteensä 51 alkuperäistä tapausta, joista 35 johtui B. divergensistä , 11 B. microtista ja 5 B. venatorumista [ 2 ]. Epidemiologiset tutkimukset ovat osoittaneet B. divergensin ja siihen liittyvän puutiaisvektorin Ixodes ricinuksen laajalle levinneen koko Euroopassa [ 126 ]]. Viimeaikaiset seroprevalenssiraportit viittaavat paljon korkeampaan kliiniseen ilmaantuvuuteen kuin tähän mennessä olemassa olevassa kirjallisuudessa on kuvattu [ 127 ]. Todellisen babesioosin esiintyvyyden kvantifiointi kaikkialla Euroopassa on edelleen haaste, koska oireet ilmenevät usein epäspesifisesti, immuunikyvyttömät yksilöt ovat usein oireettomia ja babesioosi ei ole ilmoitettavissa oleva sairaus monissa maissa [ 128 ].
5.2. Babesia eroaa
B. divergens on ihmisen babesioosin ensisijainen aiheuttaja Euroopassa ja endeeminen Euroopan nautapopulaatiossa. Gray (2006) kuvaili ekologisia maisemia maissa, joissa naudan babesioosia esiintyy eniten, ja niillä on merkittäviä punkkipopulaatioita "karkeilla avoimilla kukkuloilla tai kosteilla matalalla niityillä" ja "jos metsämaa on usein karjan laidunten vieressä" [ 129 ]. Yli puolet eurooppalaisista babesioositapauksista on raportoitu Ranskassa ja Brittein saarilla, ja vähintään 10 muuta maata on edustettuna yksittäisissä tapausraporteissa [ 31 , 122 , 130 , 131 , 132 , 133]. Babesioosin levinneisyyden kerrotaan lisääntyvän, ja Euroopan tautien ehkäisy- ja valvontakeskus on tunnistanut useita tähän suuntaukseen vaikuttavia tekijöitä: punkkipopulaatioihin vaikuttavat maiseman muutokset, hirvipopulaatioiden kasvu, ihmisen toiminta saastuneilla alueilla ja taudinaiheuttajien leviäminen karjan liikkumisen kautta ( https: //www.ecdc.europa.eu/en/all-topics-z/babe ... babesiosis , käytetty 27. heinäkuuta 2021). Viime aikoina on havaittu tautien ilmaantumista yhä pohjoisemmilla leveysasteilla Euroopassa. Mysterud ja kollegat analysoivat pitkittäisiä punkkivälitteisten tautien esiintyvyystietoja Norjasta ja havaitsivat, että tämä ilmaantuminen liittyy punkkivektorin jakautumiseen [ 134 ]. I. ricinus on B. divergensin ensisijainen vektorija on laajalti levinnyt ympäri Eurooppaa [ 135 ]. Ensisijaisia isäntälajeja ovat kesynaudat, [ 126 ], metsäpeura ja muut hirvieläimiä (esim. hirvi, punapeura, poro, sikapeura) [ 136 ].
B. divergens -infektioille on ominaista fulminantti sairaus, ja kaikki tapaukset muutamaa lukuun ottamatta on raportoitu aspleniapotilailla [ 5 , 123 , 128 ]. Tekijöitä, jotka altistavat potilaat vakavalle sairaudelle, ovat äärimmäinen ikä ja muut syyt immuunipuutteiseen kliiniseen tilaan [ 122 , 137 ]. 1–3 viikon itämisajan jälkeen B. divergensin oireet etenevät yleensä nopeasti, ja niihin liittyy korkea kuume, vilunväristykset, hikoilu, päänsärky, lihaskipu, hemolyyttinen anemia ja hemoglobinuria [ 5 ]. B. divergensiin liittyvä kuolleisuusUsein monielinten vajaatoiminnasta johtuvan infektion arvioitiin aiemmin olevan jopa 42 %, mutta se paranee. Parempien tulosten uskotaan johtuvan ensisijaisesti aggressiivisemmasta hoidosta, mukaan lukien suonensisäiset antibiootit ja vaihtotransfuusion varhainen käyttö [ 5 ]. Kaksi äskettäistä julkaisua on kyseenalaistanut tämän "klassisen kuvauksen babesioosista Euroopassa". Martinot et ai. kuvasi kaksi poikkeuksellista vakavaa babesioositapausta terveillä, nuorilla, immunokompetenteilla potilailla Ranskassa, ja Gonzalez kuvasi samanlaisen tapauksen Espanjassa [ 123 , 138 ].
5.3. Babesia venatorum
B. venatorum on nouseva kansanterveysongelma Euroopassa laajalle levinneen zoonoosinsa vuoksi [ 136 ]. B. venatorum , joka tunnettiin aiemmin nimellä Babesia sp. EU1 on läheistä sukua B. divergensille ja B. odocoileille [ 35 , 139 ]. Villiisäntiä ovat kauri ja hirvi [ 136 ]. Loinen on havaittu myös vankeudessa pidetyissä poroissa ja kotieläiminä pidetyissä lampaissa [ 75 , 140 , 141 , 142 ]. I. ricinuspunkki toimii sekä vektorina että säiliönä. Ihmisissä esiintyviä tapauksia on tähän mennessä raportoitu Itävallassa, Saksassa ja Italiassa [ 35 , 124 ]. Tapausraporteissa on kuvattu taudin ilmenemismuotoja, jotka vaihtelevat lievistä kohtalaisen vaikeisiin ja jotka häviävät antimikrobisella hoidolla, jopa asplenian ja lymfooman yhteydessä. B. venatorum -infektion kliininen esitys on yleensä lievempi kuin B. divergensin [ 5 ].
5.4. Babesia microti
B. microti -tartuntatapauksia on raportoitu Itävallasta, Saksasta, Italiasta, Puolasta, Espanjasta ja Sveitsistä [ 35 , 125 , 143 , 144 , 145 , 146 ]. Ensimmäinen todiste ihmisen B. microti -infektiosta Euroopassa oli raportti seropositiivisista Sveitsin asukkaista vuonna 2002 [ 147 ]. Useat serotutkimukset ovat osoittaneet laajan valikoiman B. microti -seropositiivisuutta riippuen sijainnista ja tutkimuspopulaatiosta (esim. suuret yleisöt, metsätyöntekijät, Lymen taudin sairaat henkilöt). B. microtiseropositiivisuus on vaihdellut 0,5 %:sta 32 %:iin tutkimuspopulaatioissa Belgiassa, Ranskassa, Saksassa, Italiassa, Puolassa, Ruotsissa ja Sveitsissä [ 139 , 147 , 148 , 149 , 150 , 151 , 152 , 153 ] Lisäksi Hunfeld et al. (2002) raportoivat, että Saksassa punkeille altistuneiden potilaiden IgG:n seroprevalenssi oli korkeampi B. microtilla (9,3 %) kuin B. divergensillä (4,9 %). [ 139 ] Nämä seroprevalenssitiedot osoittavat, että Euroopassa on enemmän ihmisen B. microti -infektioita kuin tällä hetkellä tunnistetaan.
Re: IHMISEN BABEOOSIN SYDÄNKOMPLIKAATIOT
https://academic.oup.com/cid/advance-ar ... m=fulltext
Julkaisija Oxford University Press Infectious Diseases Society of America -järjestön puolesta (IDSA)
LEHDEN ARTIKKELI KORJATTU TODISTE
Ihmisen babesioosin sydänkomplikaatiot
Anne Spichler-Moffarah , Emily Ong , Jane O'Bryan , Peter J Krause
Clinical Infectious Diseases , ciac525, https://doi.org/10.1093/cid/ciac525
Julkaistu: 19 elokuuta 2022 Artikkelin historia
Abstrakti
Tausta
Ihmisen babesioosi on maailmanlaajuisesti leviävä punkkien välittämä sairaus, jonka aiheuttavat erytrosyyttiset alkueläimet. Useimmilla potilailla on lievä tai kohtalainen sairaus, mutta hengenvaarallisia komplikaatioita voi esiintyä. Vaikka sydänkomplikaatiot ovat yleisiä, sydänsairauksien koko kirjo ja esiintymistiheys, riskitekijät ja tulokset sydänkomplikaatioita kärsivillä potilailla ovat epäselviä. Näin ollen teimme ennätyskartoituksen sydänkomplikaatioista potilailla, joilla on babesioosi, jotka on otettu Yale-New Havenin sairaalaan viimeisen vuosikymmenen aikana, jotta voitaisiin paremmin karakterisoida babesioosin sydänkomplikaatioita.
menetelmät
Tarkistimme kaikkien Yale-New Havenin sairaalaan tammikuusta 2011 lokakuuhun 2021 otettujen babesioosia sairastavien aikuispotilaiden potilastiedot, jotka vahvistettiin Babesia - loisten tunnistamisella ohuesta verinäytteestä ja/tai polymeraasiketjureaktiosta. Lymen taudin ja muiden punkkien välittämien tautien yhteisinfektioiden esiintyminen kirjattiin.
Tulokset
Tutkimukseen osallistuneista 163 potilaasta 32:lla (19,6 %) oli ≥1 sydänkomplikaatio sairaalahoidon aikana. Yleisimmät sydänkomplikaatiot olivat eteisvärinä (9,4 %), sydämen vajaatoiminta (8,6 %), korjattu QT-ajan piteneminen (8,0 %) ja sydämen iskemia (6,8 %). Sydän- ja verisuonitautien riskitekijät tai aiemmat sydänsairaudet eivät liittyneet merkittävästi sydänkomplikaatioiden kehittymiseen. Sydänkomplikaatioiden ryhmässä esiintyi enemmän korkea-asteista parasitemiaa (> 10 %) ( P < 0,001), sekä sairaalahoidon mediaanipituus ( P < 0,001) että tehohoitojakson pituus oli pidempi ( P < 0,001) ja korkeampi kuolleisuus ( P = 0,02) kuin ryhmässä, jolla ei ollut sydänkomplikaatioita.
Johtopäätökset
Akuutin babesioosin sydänkomplikaatiot ovat yleisiä, ja niitä esiintyi noin viidesosassa tästä potilasnäytteestä. Lisätutkimuksia tarvitaan babesioosin vakavuuden ja sydänsairauksien välisen suhteen selvittämiseksi.
Babesia microti , babesioosi , komplikaatiot , sydän , ihminen
Ongelmaosio: Pääartikkeli
© Tekijä(t) 2022. Julkaisija Oxford University Press Infectious Diseases Society of America -järjestön puolesta. Kaikki oikeudet pidätetään. Saadaksesi käyttöoikeudet, lähetä sähköpostia osoitteeseen journals.permissions@oup.com
Tämä artikkeli on julkaistu ja jaettu Oxford University Pressin Standard Journals -julkaisumallin ehtojen mukaisesti ( https://academic.oup.com/journals/pages ... tion_model )
Julkaisija Oxford University Press Infectious Diseases Society of America -järjestön puolesta (IDSA)
LEHDEN ARTIKKELI KORJATTU TODISTE
Ihmisen babesioosin sydänkomplikaatiot
Anne Spichler-Moffarah , Emily Ong , Jane O'Bryan , Peter J Krause
Clinical Infectious Diseases , ciac525, https://doi.org/10.1093/cid/ciac525
Julkaistu: 19 elokuuta 2022 Artikkelin historia
Abstrakti
Tausta
Ihmisen babesioosi on maailmanlaajuisesti leviävä punkkien välittämä sairaus, jonka aiheuttavat erytrosyyttiset alkueläimet. Useimmilla potilailla on lievä tai kohtalainen sairaus, mutta hengenvaarallisia komplikaatioita voi esiintyä. Vaikka sydänkomplikaatiot ovat yleisiä, sydänsairauksien koko kirjo ja esiintymistiheys, riskitekijät ja tulokset sydänkomplikaatioita kärsivillä potilailla ovat epäselviä. Näin ollen teimme ennätyskartoituksen sydänkomplikaatioista potilailla, joilla on babesioosi, jotka on otettu Yale-New Havenin sairaalaan viimeisen vuosikymmenen aikana, jotta voitaisiin paremmin karakterisoida babesioosin sydänkomplikaatioita.
menetelmät
Tarkistimme kaikkien Yale-New Havenin sairaalaan tammikuusta 2011 lokakuuhun 2021 otettujen babesioosia sairastavien aikuispotilaiden potilastiedot, jotka vahvistettiin Babesia - loisten tunnistamisella ohuesta verinäytteestä ja/tai polymeraasiketjureaktiosta. Lymen taudin ja muiden punkkien välittämien tautien yhteisinfektioiden esiintyminen kirjattiin.
Tulokset
Tutkimukseen osallistuneista 163 potilaasta 32:lla (19,6 %) oli ≥1 sydänkomplikaatio sairaalahoidon aikana. Yleisimmät sydänkomplikaatiot olivat eteisvärinä (9,4 %), sydämen vajaatoiminta (8,6 %), korjattu QT-ajan piteneminen (8,0 %) ja sydämen iskemia (6,8 %). Sydän- ja verisuonitautien riskitekijät tai aiemmat sydänsairaudet eivät liittyneet merkittävästi sydänkomplikaatioiden kehittymiseen. Sydänkomplikaatioiden ryhmässä esiintyi enemmän korkea-asteista parasitemiaa (> 10 %) ( P < 0,001), sekä sairaalahoidon mediaanipituus ( P < 0,001) että tehohoitojakson pituus oli pidempi ( P < 0,001) ja korkeampi kuolleisuus ( P = 0,02) kuin ryhmässä, jolla ei ollut sydänkomplikaatioita.
Johtopäätökset
Akuutin babesioosin sydänkomplikaatiot ovat yleisiä, ja niitä esiintyi noin viidesosassa tästä potilasnäytteestä. Lisätutkimuksia tarvitaan babesioosin vakavuuden ja sydänsairauksien välisen suhteen selvittämiseksi.
Babesia microti , babesioosi , komplikaatiot , sydän , ihminen
Ongelmaosio: Pääartikkeli
© Tekijä(t) 2022. Julkaisija Oxford University Press Infectious Diseases Society of America -järjestön puolesta. Kaikki oikeudet pidätetään. Saadaksesi käyttöoikeudet, lähetä sähköpostia osoitteeseen journals.permissions@oup.com
Tämä artikkeli on julkaistu ja jaettu Oxford University Pressin Standard Journals -julkaisumallin ehtojen mukaisesti ( https://academic.oup.com/journals/pages ... tion_model )
Re: FAKTAA BABEOOSISTA, Euroopan tautien ehkäisy- ja valvontakeskus
https://www.ecdc.europa.eu/en/infectiou ... babesiosis
Euroopan tautien ehkäisy- ja valvontakeskus
Euroopan unionin virasto
Faktaa babesioosista
Babesioosi on sairaus, jonka aiheuttaa Babesia spp . -loinen, joka saastuttaa ja tuhoaa punasoluja. Tautia välittävät pääasiassa punkit, jotka saavat tartunnan ruokkiessaan tartunnan saaneita nautaeläimiä, kauriita ja jyrsijöitä, jotka ovat tämän loisen päävarasto.
Vaikka useimmat infektiot menevät ohi ilman oireita, jotkut ihmiset voivat sairastua ja heillä voi esiintyä flunssan kaltaisia oireita, kuten kuumetta, vilunväristyksiä, lihassärkyä, väsymystä sekä keltaisuutta (ihon keltaisuutta sappisairauden vuoksi). Vakavia, munuaisiin tai keuhkoihin vaikuttavia tapauksia saattaa esiintyä ja ne voivat johtaa kuolemaan.
Ihmisen babesioosi-infektiota hoidetaan antibiooteilla ja kiniinillä. Rokotetta ei ole saatavilla.
1. Infektoivan organismin nimi ja luonne
Viisi Babesia -lajia on kuvattu zoonoottiseksi maailmassa. Yleensä ihmisen babesioosin epidemiologia on monimutkainen ja epävarma näiden Babesia - lajien monimuotoisuuden vuoksi.
Babesia -lajin leviäminen ihmisiin Euroopassa johtuu pääasiassa Ixodes ricinuksesta. Tämän punkin levinneisyys ja esiintymistiheys viittaa siihen, että ihmisen babesioosia voi esiintyä missä tahansa osassa Eurooppaa. Euroopassa julkaistut 39 ihmistapausta olivat kliinisesti vakavia, ja niiden syynä oli B. divergens , B. venatorum (EU1) ja B. microti . Babesia -lajin muodollista tunnistamista ei kuitenkaan tehdä kaikissa tapauksissa.
Naudan B. divergens babesioosi on laajalle levinnyt Euroopan mantereella ja ihmisillä on raportoitu tapauksia eri maissa. EU:n merentakaisten alueiden joukossa yhden ihmisen tapauksen on katsottu johtuvan B. divergensistä , joka tapahtui Kanariansaarilla. Euroopan ulkopuolella ihmisen babesioosia esiintyy pääasiassa Yhdysvalloissa. Patogeenisiä tekijöitä ovat B. microti, B. duncani n sp. ja MO1-tyypin B. sp . Muita tapauksia on raportoitu Afrikasta, Meksikosta, Japanista, Taiwanista ja Intiasta ( B. microti tai tunnistamaton Babesia ).
2. Kliiniset ominaisuudet
Useimmat infektiot näyttävät pysyvän oireettomana. Kliinisissä tapauksissa itämisaika vaihtelee yhdestä kahdeksaan viikkoa, mutta oireiden ilmaantuminen viivästyy pitkittyneen oireettoman infektion jälkeen useiden kuukausien jälkeen. Babesioosin kliinisten oireiden voimakkuus ihmisillä vaihtelee lievästä vaikeaan. Alkaen epäspesifisistä flunssan kaltaisista oireista, akuutti sairaus alkaa yleensä intravaskulaarisella hemolyysillä, joka aiheuttaa hemoglobinuriaa ja lieviä tai vaikeita oireita, mukaan lukien hemolyysistä johtuva keltaisuus, epäsäännöllinen korkea kuume, päänsärky, vilunväristykset, lihaskipu. Tämä voi kestää useista päivistä muutamaan kuukauteen. Shokin kaltainen oireyhtymä, johon liittyy munuaisten vajaatoimintaa ja keuhkoödeemaa, voi ilmaantua ja voi olla hengenvaarallinen.
3. Tarttuminen
3.1 Säiliö eläimet
Nautakarja, metskihirvi ja jyrsijät ovat B. divergensin , B. venatorumin ja B. microtin varastoja . Ixodes ricinus -punkki on myös B. divergensin ja B. venatorumin säiliö, koska alkueläimet kulkeutuvat munasarjan läpi ja transstadiaalisesti punkkiisännässä.
3.2 Tarttumis tapa
Euroopassa tartunta tapahtuu pääasiassa Ixodes ricinus -pukinpureman kautta . Ihmisten verensiirron aiheuttama infektio on myös dokumentoitu. Harvinaisia tapauksia synnynnäisestä tartunnasta on kuvattu.
3.3 Riskiryhmät
Ihmisillä tapauksia esiintyy useimmiten potilailla, joilta on poistettu perna tai joilla on immuunipuutos.
Punkeille altistuminen on tärkein tartunnan riskitekijä.
4. Ennaltaehkäisytoimenpiteet
Ennaltaehkäisy rajoittuu punkkien puremien välttämiseen ja henkilökohtaisten suojatoimenpiteiden edistämiseen punkkeja vastaan, kiinnittäen erityistä huomiota potilaisiin, joilta on poistettu perna ja joilla on immunologinen heikkous.
Mahdollista verensiirron aiheuttamaa infektioriskiä on hallittava erityisesti potilailla, joilta on poistettu perna tai joilla on immunologinen heikkous. Ihmisen babesioosi on Euroopassa mahdollisesti vakava, joten nopea diagnoosi on välttämätöntä hoidon aloittamiseksi kliinisen infektioepäilyn jälkeen.
Euroopan tautien ehkäisy- ja valvontakeskus
Euroopan unionin virasto
Faktaa babesioosista
Babesioosi on sairaus, jonka aiheuttaa Babesia spp . -loinen, joka saastuttaa ja tuhoaa punasoluja. Tautia välittävät pääasiassa punkit, jotka saavat tartunnan ruokkiessaan tartunnan saaneita nautaeläimiä, kauriita ja jyrsijöitä, jotka ovat tämän loisen päävarasto.
Vaikka useimmat infektiot menevät ohi ilman oireita, jotkut ihmiset voivat sairastua ja heillä voi esiintyä flunssan kaltaisia oireita, kuten kuumetta, vilunväristyksiä, lihassärkyä, väsymystä sekä keltaisuutta (ihon keltaisuutta sappisairauden vuoksi). Vakavia, munuaisiin tai keuhkoihin vaikuttavia tapauksia saattaa esiintyä ja ne voivat johtaa kuolemaan.
Ihmisen babesioosi-infektiota hoidetaan antibiooteilla ja kiniinillä. Rokotetta ei ole saatavilla.
1. Infektoivan organismin nimi ja luonne
Viisi Babesia -lajia on kuvattu zoonoottiseksi maailmassa. Yleensä ihmisen babesioosin epidemiologia on monimutkainen ja epävarma näiden Babesia - lajien monimuotoisuuden vuoksi.
Babesia -lajin leviäminen ihmisiin Euroopassa johtuu pääasiassa Ixodes ricinuksesta. Tämän punkin levinneisyys ja esiintymistiheys viittaa siihen, että ihmisen babesioosia voi esiintyä missä tahansa osassa Eurooppaa. Euroopassa julkaistut 39 ihmistapausta olivat kliinisesti vakavia, ja niiden syynä oli B. divergens , B. venatorum (EU1) ja B. microti . Babesia -lajin muodollista tunnistamista ei kuitenkaan tehdä kaikissa tapauksissa.
Naudan B. divergens babesioosi on laajalle levinnyt Euroopan mantereella ja ihmisillä on raportoitu tapauksia eri maissa. EU:n merentakaisten alueiden joukossa yhden ihmisen tapauksen on katsottu johtuvan B. divergensistä , joka tapahtui Kanariansaarilla. Euroopan ulkopuolella ihmisen babesioosia esiintyy pääasiassa Yhdysvalloissa. Patogeenisiä tekijöitä ovat B. microti, B. duncani n sp. ja MO1-tyypin B. sp . Muita tapauksia on raportoitu Afrikasta, Meksikosta, Japanista, Taiwanista ja Intiasta ( B. microti tai tunnistamaton Babesia ).
2. Kliiniset ominaisuudet
Useimmat infektiot näyttävät pysyvän oireettomana. Kliinisissä tapauksissa itämisaika vaihtelee yhdestä kahdeksaan viikkoa, mutta oireiden ilmaantuminen viivästyy pitkittyneen oireettoman infektion jälkeen useiden kuukausien jälkeen. Babesioosin kliinisten oireiden voimakkuus ihmisillä vaihtelee lievästä vaikeaan. Alkaen epäspesifisistä flunssan kaltaisista oireista, akuutti sairaus alkaa yleensä intravaskulaarisella hemolyysillä, joka aiheuttaa hemoglobinuriaa ja lieviä tai vaikeita oireita, mukaan lukien hemolyysistä johtuva keltaisuus, epäsäännöllinen korkea kuume, päänsärky, vilunväristykset, lihaskipu. Tämä voi kestää useista päivistä muutamaan kuukauteen. Shokin kaltainen oireyhtymä, johon liittyy munuaisten vajaatoimintaa ja keuhkoödeemaa, voi ilmaantua ja voi olla hengenvaarallinen.
3. Tarttuminen
3.1 Säiliö eläimet
Nautakarja, metskihirvi ja jyrsijät ovat B. divergensin , B. venatorumin ja B. microtin varastoja . Ixodes ricinus -punkki on myös B. divergensin ja B. venatorumin säiliö, koska alkueläimet kulkeutuvat munasarjan läpi ja transstadiaalisesti punkkiisännässä.
3.2 Tarttumis tapa
Euroopassa tartunta tapahtuu pääasiassa Ixodes ricinus -pukinpureman kautta . Ihmisten verensiirron aiheuttama infektio on myös dokumentoitu. Harvinaisia tapauksia synnynnäisestä tartunnasta on kuvattu.
3.3 Riskiryhmät
Ihmisillä tapauksia esiintyy useimmiten potilailla, joilta on poistettu perna tai joilla on immuunipuutos.
Punkeille altistuminen on tärkein tartunnan riskitekijä.
4. Ennaltaehkäisytoimenpiteet
Ennaltaehkäisy rajoittuu punkkien puremien välttämiseen ja henkilökohtaisten suojatoimenpiteiden edistämiseen punkkeja vastaan, kiinnittäen erityistä huomiota potilaisiin, joilta on poistettu perna ja joilla on immunologinen heikkous.
Mahdollista verensiirron aiheuttamaa infektioriskiä on hallittava erityisesti potilailla, joilta on poistettu perna tai joilla on immunologinen heikkous. Ihmisen babesioosi on Euroopassa mahdollisesti vakava, joten nopea diagnoosi on välttämätöntä hoidon aloittamiseksi kliinisen infektioepäilyn jälkeen.
Re: BABESIOOSI
https://www.treatlyme.net/guide/how-to-diagnose-babesia
Martin Ross
Useita eri kantoja erilaisilla esityksillä
Babesia-lajeja on monia. Joidenkin arvioiden mukaan kantoja on 15 tai enemmän.Tunnetuimmat kannat ovat B. microti ja B. duncani. Uusimmat tutkimukset viittaavat siihen, että merkittävin kanta ihmisillä, joilla on krooninen Lymen tauti ja siihen liittyvät punkkien välittämät infektiot, on B. odecoilei.
Kuinka Babesia aiheuttaa ongelmia
Babesia-kannat infektoivat punasoluja. Akuutisti tämä voi johtaa punasolujen repeämiseen ja anemiaan.
Kroonisesti tartunnan saaneet punasolut kietoutuvat veren hyytymisproteiiniin, jota kutsutaan fibriiniksi. Nämä fibriiniin käärittyjen tartunnan saaneet solut muodostavat pesiä. Nämä pesät kiinnittyvät verisuonten seinämiin rajoittaen veren virtausta pienimmässä verisuonissa. Tämä johtaa rajoittuneeseen verenvirtaukseen kehon jokaiseen elinjärjestelmään, mikä aiheuttaa koko järjestelmän oireita ja ongelmia.
Sekä akuutti että krooninen babesia laukaisee ylimääräisiä valkosolujen sytokiineja, mikä johtaa lukuisiin ongelmiin, kuten immuunivasteen heikkenemiseen, unettomuuteen, väsymykseen, ajatteluongelmiin, hormonaalisiin toimintahäiriöihin, kehon kipuihin ja jopa neurologisiin toimintahäiriöihin. Lue lisää sytokiineista kohdasta Control Cytokines: Lymen oireiden ja immuunijärjestelmän korjaamisen opas .
Oireet
Akuutit Babesian oireet
Akuutteja babesian oireita ovat kuume, kehon kivut, hengenahdistus (ilmannälkä), päänsäryt ja väsymys. Nämä oireet johtuvat akuutista valkosolujen sytokiinien lisääntymisestä tai anemiasta, joka kehittyy punasolujen ja pernan osallistumisesta.
Kroonisen Babesian oireet
Krooniset babesian oireet voivat koskea useimpia kehon elimiä. Näitä voivat olla huomattava väsymys, liikunta- tai aktiivisuusintoleranssi, muisti- ja ajatteluongelmat, lihaskivut, ilmannälkä, sydämen lyöminen tai hyppiminen, alhainen verenpaine seistessä, paniikkikohtaukset, yöhikoilu, migreeni, otsapäänsärky, lämpötilan sietokyky (kuuma). yksi minuutti, kylmä seuraavana), epätasapainon tunne kävellessä ja lisääntyneet deja vu -jaksot.
Yksi Babesian fyysinen merkki on lukuisten pienten kirsikanpunaisten täplien äkillinen kehittyminen iholle.
Martin Ross
Useita eri kantoja erilaisilla esityksillä
Babesia-lajeja on monia. Joidenkin arvioiden mukaan kantoja on 15 tai enemmän.Tunnetuimmat kannat ovat B. microti ja B. duncani. Uusimmat tutkimukset viittaavat siihen, että merkittävin kanta ihmisillä, joilla on krooninen Lymen tauti ja siihen liittyvät punkkien välittämät infektiot, on B. odecoilei.
Kuinka Babesia aiheuttaa ongelmia
Babesia-kannat infektoivat punasoluja. Akuutisti tämä voi johtaa punasolujen repeämiseen ja anemiaan.
Kroonisesti tartunnan saaneet punasolut kietoutuvat veren hyytymisproteiiniin, jota kutsutaan fibriiniksi. Nämä fibriiniin käärittyjen tartunnan saaneet solut muodostavat pesiä. Nämä pesät kiinnittyvät verisuonten seinämiin rajoittaen veren virtausta pienimmässä verisuonissa. Tämä johtaa rajoittuneeseen verenvirtaukseen kehon jokaiseen elinjärjestelmään, mikä aiheuttaa koko järjestelmän oireita ja ongelmia.
Sekä akuutti että krooninen babesia laukaisee ylimääräisiä valkosolujen sytokiineja, mikä johtaa lukuisiin ongelmiin, kuten immuunivasteen heikkenemiseen, unettomuuteen, väsymykseen, ajatteluongelmiin, hormonaalisiin toimintahäiriöihin, kehon kipuihin ja jopa neurologisiin toimintahäiriöihin. Lue lisää sytokiineista kohdasta Control Cytokines: Lymen oireiden ja immuunijärjestelmän korjaamisen opas .
Oireet
Akuutit Babesian oireet
Akuutteja babesian oireita ovat kuume, kehon kivut, hengenahdistus (ilmannälkä), päänsäryt ja väsymys. Nämä oireet johtuvat akuutista valkosolujen sytokiinien lisääntymisestä tai anemiasta, joka kehittyy punasolujen ja pernan osallistumisesta.
Kroonisen Babesian oireet
Krooniset babesian oireet voivat koskea useimpia kehon elimiä. Näitä voivat olla huomattava väsymys, liikunta- tai aktiivisuusintoleranssi, muisti- ja ajatteluongelmat, lihaskivut, ilmannälkä, sydämen lyöminen tai hyppiminen, alhainen verenpaine seistessä, paniikkikohtaukset, yöhikoilu, migreeni, otsapäänsärky, lämpötilan sietokyky (kuuma). yksi minuutti, kylmä seuraavana), epätasapainon tunne kävellessä ja lisääntyneet deja vu -jaksot.
Yksi Babesian fyysinen merkki on lukuisten pienten kirsikanpunaisten täplien äkillinen kehittyminen iholle.
Re: BABESIOOSI VOI TARTTUA VÄLITTÖMÄSTI PUNKIN PUREMAN JÄLKEEN
https://danielcameronmd.com/how-long-ti ... LtgN1wtl1w
KUINKA KAUAN KESTÄÄ, ETTÄ PUNKKI VÄLITTÄÄ BABESIAN?
Babesia-tapausten määrä on nousussa - todellinen huolenaihe, varsinkin kun tämä punkin levittämä patogeeni voi tarttua välittömästi punkin pureman jälkeen. Cook ja kollegat kuvaavat tutkimuksessaan "Lymen borrelioosi: katsaus taudin siirtoaikaan punkin kiinnittymisen jälkeen" erilaisia aikajaksoja, jotka voivat kestää yksilön tartunnan saamiseen punkin levittämän patogeenin mukaan.
Tohtori Daniel Cameron
Tutkimus on erityisen kiinnostava, kun otetaan huomioon uutiset, että Babesia-tapaukset ovat nousussa. Centers of Disease Control and Prevention (CDC) tuoreen sairastuvuus ja kuolleisuus viikoittaisen raportin (MMWR) mukaan Babesia-tapausten määrä on lisääntynyt hälyttävästi Yhdysvaltojen koillisosassa [1] Kahdeksan tämän alueen osavaltiota ilmoitti tapausten suurin nousu. Näitä osavaltioita olivat: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island ja Vermont.
CDC:n mukaan kestää 24-48 tuntia punkin pureman levittämiseen Lymen taudista, kirjoitti Scott et al. [2] Muut tutkimukset ovat osoittaneet lähetysajan olevan vielä lyhyempi. Cookin ym. mukaan aika, joka kuluu punkin levittämiseen Lymen tautiin, oli alle 16 tuntia, varsinkin jos sylkirauhaset ovat tulehtuneet. [3]
Samaan aikaan, koska Babesia voi asua punkin sylkirauhasissa, se voi tarttua välittömästi, kun punkki alkaa ottaa veriateriaa, Scott kirjoitti.
"Punkkien kiinnittymisen ja [Babesian] leviämisen välillä ei ole armonaikaa", kirjoitti Scott.
KUINKA KAUAN KESTÄÄ, ETTÄ PUNKKI VÄLITTÄÄ BABESIAN?
Babesia-tapausten määrä on nousussa - todellinen huolenaihe, varsinkin kun tämä punkin levittämä patogeeni voi tarttua välittömästi punkin pureman jälkeen. Cook ja kollegat kuvaavat tutkimuksessaan "Lymen borrelioosi: katsaus taudin siirtoaikaan punkin kiinnittymisen jälkeen" erilaisia aikajaksoja, jotka voivat kestää yksilön tartunnan saamiseen punkin levittämän patogeenin mukaan.
Tohtori Daniel Cameron
Tutkimus on erityisen kiinnostava, kun otetaan huomioon uutiset, että Babesia-tapaukset ovat nousussa. Centers of Disease Control and Prevention (CDC) tuoreen sairastuvuus ja kuolleisuus viikoittaisen raportin (MMWR) mukaan Babesia-tapausten määrä on lisääntynyt hälyttävästi Yhdysvaltojen koillisosassa [1] Kahdeksan tämän alueen osavaltiota ilmoitti tapausten suurin nousu. Näitä osavaltioita olivat: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island ja Vermont.
CDC:n mukaan kestää 24-48 tuntia punkin pureman levittämiseen Lymen taudista, kirjoitti Scott et al. [2] Muut tutkimukset ovat osoittaneet lähetysajan olevan vielä lyhyempi. Cookin ym. mukaan aika, joka kuluu punkin levittämiseen Lymen tautiin, oli alle 16 tuntia, varsinkin jos sylkirauhaset ovat tulehtuneet. [3]
Samaan aikaan, koska Babesia voi asua punkin sylkirauhasissa, se voi tarttua välittömästi, kun punkki alkaa ottaa veriateriaa, Scott kirjoitti.
"Punkkien kiinnittymisen ja [Babesian] leviämisen välillä ei ole armonaikaa", kirjoitti Scott.
Re: BABESIA-INFEKTIO LAUKAISEE AUTOIMMUUNIVERISOLUHÄIRIÖN
https://danielcameronmd.com/babesia-aut ... zzlLHZUHoE
BABESIA-INFEKTIO LAUKAISEE AUTOIMMUUNIVERISOLUHÄIRIÖN
Lue lisää yllä olevasta linkistä.
"Esitetty tapaus on harvinainen esitys babesioosiin liittyvästä wAIHA:sta henkilöllä, jolla on toimiva perna."
Laboratoriokokeissa paljastui akuutti anemia ja lievä trombosytopenia.
Lisätutkimuksia tehtiin Lymen taudin ja muiden punkkien välittämien sairauksien varalta, koska potilas ilmoitti viettäneensä aikaa ulkona punkkien endeemisellä alueella.
Testitulokset olivat positiivisia Babesia microtille. "…lopullinen diagnoosimme oli babesioosista johtuva wAIHA", kirjoittajat toteavat.
Potilaan oireet hävisivät täysin Babesia-hoidon jälkeen atovakonilla ja atsitromysiinillä sekä prednisonilla.
BABESIA-INFEKTIO LAUKAISEE AUTOIMMUUNIVERISOLUHÄIRIÖN
Lue lisää yllä olevasta linkistä.
"Esitetty tapaus on harvinainen esitys babesioosiin liittyvästä wAIHA:sta henkilöllä, jolla on toimiva perna."
Laboratoriokokeissa paljastui akuutti anemia ja lievä trombosytopenia.
Lisätutkimuksia tehtiin Lymen taudin ja muiden punkkien välittämien sairauksien varalta, koska potilas ilmoitti viettäneensä aikaa ulkona punkkien endeemisellä alueella.
Testitulokset olivat positiivisia Babesia microtille. "…lopullinen diagnoosimme oli babesioosista johtuva wAIHA", kirjoittajat toteavat.
Potilaan oireet hävisivät täysin Babesia-hoidon jälkeen atovakonilla ja atsitromysiinillä sekä prednisonilla.
Re: BABESIOOSI
https://www.mdpi.com/2076-0817/13/1/81? ... 4MRlNhbCVw
Lue lisää yllä olevasta linkistä
Babesian ja Borrelian samanaikainen tartunta Ixodes ricinus -tickissä – laiminlyöty kansanterveysongelma Euroopassa?
kirjoittaja Thomas GT Jaenson1,Jeremy S. Gray2,†,Per-Eric Lindgren3,4,†jaPeter Wilhelmsson3,4,*,†
1 Evoluutiobiologian keskus, Organismibiologian laitos, Uppsalan yliopisto, Norbyvägen 18d, SE-752 36 Uppsala, Ruotsi
2 UCD School of Biology and Environmental Science, University College Dublin, D04 N2E5 Dublin, Irlanti
3 Tulehdus- ja infektioosasto, Biolääketieteen ja kliinisten tieteiden laitos, Linköpingin yliopisto, SE-581 83 Linköping, Ruotsi
4 Kliinisen mikrobiologian laitos, Region Jönköping County, SE-551 11 Jönköping, Sweden
† Nämä kirjoittajat osallistuivat yhtä paljon tähän työhön.
Abstrakti
Ixodes ricinus -nymfit ja ihmisistä poistetut aikuiset sekä linnuista toukat ja nymfit on analysoitu Babesia- ja Borrelia -lajien tartunnan varalta aiemmin erikseen julkaistuissa tutkimuksissa. Tässä käytämme samaa tietojoukkoa tutkiaksemme punkkien Babesia- ja Borrelia -lajien yhteisinfektiokuviota . Tarjoamme myös yleiskatsauksen sekä zoonoottisilla Babesia- että Borrelia -lajilla tartunnan saaneen I. ricinuksen ekologiaan ja mahdolliseen kansanterveyteen Ruotsissa . Ihmisistä poistetuista 1952 nymfistä ja aikuisista punkeista 3,1 % oli PCR-positiivisia Babesia spp. Näistä Babesia -positiivisista punkeista 43 % oli samanaikaisesti Borrelia -positiivisia. Linnuista poistetuista 1046:sta I. ricinus -lajin epäkypsästä eläimestä 2,5 % oli Babesia -positiivisia, joista 38 % oli yhdessä Borrelia- lajin tartuttamia. Tämä tutkimus osoittaa, että Ruotsissa ihmisiä tai lintuja tartuttamassa I. ricinuksessa mahdollisesti zoonoottisia Babesia- alkueläimiä esiintyy joskus yhdessä ihmisen patogeenisten Borrelia spp. Diagnostiset testit Babesia spp. infektioita tehdään harvoin Euroopassa, ja tämän taudinaiheuttajan lääketieteellinen merkitys Euroopassa voidaan aliarvioida.
Avainsanat:Babesia ; Borrelia ; babesioosi ; yhdistelmäinfektio ; Ixodes ricinus ; Lymen borrelioosi ; Ruotsi
1. Esittely
1.1. Tavoitteet
Tämän artikkelin päätavoitteena on käsitellä Babesia spp. ja Borrelia spp. punkeissa Euroopassa. Asianomaisten patogeenien esiintyminen ja vuorovaikutus tarkastellaan ensin ja liittyvät aikaisempiin tietoihin zoonoottisista Babesia -lajeista Euroopassa, niiden nisäkäsvarastoista ja punkkivektoreista, puutiaisissa samanaikaisesti esiintyvistä mikro-organismeista, punkkien samanaikaisista tartunnoista useamman kuin yhden punkin levittämän patogeenilajin kanssa, sekä Babesia + Borrelia -yhteisinfektioiden aiheuttamat ihmisten sairaudet . Sitten Ruotsissa tehtiin tutkimuksia, joissa selvitettiin Borrelia spp. ja Babesia spp. ihmisiltä tai linnuilta poistettuja punkkeja. Keskustelu-osiossa käsitellään ihmisten Babesia + Borrelia -yhteisinfektioita, mahdollisuutta, että esiintyy havaitsemattomia yhteisinfektioita, mahdollisuutta, että jotkin oireet jatkuvassa LB-tapauksessa voivat johtua mukana tulevasta babesioosista ja punkkien levittämien patogeenien tartuttaman verensiirron mahdollista merkitystä. mukaan lukien Babesia- loiset. Loppuhuomautuksen jälkeen on osio ehdotuksista tutkimustarpeista.
Lue lisää yllä olevasta linkistä
Babesian ja Borrelian samanaikainen tartunta Ixodes ricinus -tickissä – laiminlyöty kansanterveysongelma Euroopassa?
kirjoittaja Thomas GT Jaenson1,Jeremy S. Gray2,†,Per-Eric Lindgren3,4,†jaPeter Wilhelmsson3,4,*,†
1 Evoluutiobiologian keskus, Organismibiologian laitos, Uppsalan yliopisto, Norbyvägen 18d, SE-752 36 Uppsala, Ruotsi
2 UCD School of Biology and Environmental Science, University College Dublin, D04 N2E5 Dublin, Irlanti
3 Tulehdus- ja infektioosasto, Biolääketieteen ja kliinisten tieteiden laitos, Linköpingin yliopisto, SE-581 83 Linköping, Ruotsi
4 Kliinisen mikrobiologian laitos, Region Jönköping County, SE-551 11 Jönköping, Sweden
† Nämä kirjoittajat osallistuivat yhtä paljon tähän työhön.
Abstrakti
Ixodes ricinus -nymfit ja ihmisistä poistetut aikuiset sekä linnuista toukat ja nymfit on analysoitu Babesia- ja Borrelia -lajien tartunnan varalta aiemmin erikseen julkaistuissa tutkimuksissa. Tässä käytämme samaa tietojoukkoa tutkiaksemme punkkien Babesia- ja Borrelia -lajien yhteisinfektiokuviota . Tarjoamme myös yleiskatsauksen sekä zoonoottisilla Babesia- että Borrelia -lajilla tartunnan saaneen I. ricinuksen ekologiaan ja mahdolliseen kansanterveyteen Ruotsissa . Ihmisistä poistetuista 1952 nymfistä ja aikuisista punkeista 3,1 % oli PCR-positiivisia Babesia spp. Näistä Babesia -positiivisista punkeista 43 % oli samanaikaisesti Borrelia -positiivisia. Linnuista poistetuista 1046:sta I. ricinus -lajin epäkypsästä eläimestä 2,5 % oli Babesia -positiivisia, joista 38 % oli yhdessä Borrelia- lajin tartuttamia. Tämä tutkimus osoittaa, että Ruotsissa ihmisiä tai lintuja tartuttamassa I. ricinuksessa mahdollisesti zoonoottisia Babesia- alkueläimiä esiintyy joskus yhdessä ihmisen patogeenisten Borrelia spp. Diagnostiset testit Babesia spp. infektioita tehdään harvoin Euroopassa, ja tämän taudinaiheuttajan lääketieteellinen merkitys Euroopassa voidaan aliarvioida.
Avainsanat:Babesia ; Borrelia ; babesioosi ; yhdistelmäinfektio ; Ixodes ricinus ; Lymen borrelioosi ; Ruotsi
1. Esittely
1.1. Tavoitteet
Tämän artikkelin päätavoitteena on käsitellä Babesia spp. ja Borrelia spp. punkeissa Euroopassa. Asianomaisten patogeenien esiintyminen ja vuorovaikutus tarkastellaan ensin ja liittyvät aikaisempiin tietoihin zoonoottisista Babesia -lajeista Euroopassa, niiden nisäkäsvarastoista ja punkkivektoreista, puutiaisissa samanaikaisesti esiintyvistä mikro-organismeista, punkkien samanaikaisista tartunnoista useamman kuin yhden punkin levittämän patogeenilajin kanssa, sekä Babesia + Borrelia -yhteisinfektioiden aiheuttamat ihmisten sairaudet . Sitten Ruotsissa tehtiin tutkimuksia, joissa selvitettiin Borrelia spp. ja Babesia spp. ihmisiltä tai linnuilta poistettuja punkkeja. Keskustelu-osiossa käsitellään ihmisten Babesia + Borrelia -yhteisinfektioita, mahdollisuutta, että esiintyy havaitsemattomia yhteisinfektioita, mahdollisuutta, että jotkin oireet jatkuvassa LB-tapauksessa voivat johtua mukana tulevasta babesioosista ja punkkien levittämien patogeenien tartuttaman verensiirron mahdollista merkitystä. mukaan lukien Babesia- loiset. Loppuhuomautuksen jälkeen on osio ehdotuksista tutkimustarpeista.
Re: Babesian ja Borrelioosin samanaikainen infektio Tick Ixodes ricinus
Babesian ja bCoinfection of Babesia and Borrelia in the Tick Ixodes ricinus—A Neglected Public Health Issue in Europe? - PMC (nih.gov)
Lue lisää yllä olevasta linkistä, Babesia spp:n esiintyvyys Ixodes ricinuksessa Pohjois-Euroopassa on esitetty Taulukko 1. Suomen luvut mukana.
Babesian ja borrelian samanaikainen infektio Tick Ixodes ricinus - laiminlyöty kansanterveysongelma Euroopassa?
Abstrakti
Ihmisistä poistettuja Ixodes ricinus -nymfejä ja aikuisia sekä linnuista poistettuja toukkia ja nymfejä on analysoitu Babesia- ja Borrelia-lajien tartunnan varalta aiemmin erikseen julkaistuissa tutkimuksissa. Tässä käytämme samaa tietojoukkoa tutkiaksemme Babesia- ja Borrelia-lajien samanaikaista infektiomallia punkeissa. Tarjoamme myös yleiskatsauksen sekä zoonoottisten Babesia- että Borrelia-lajien saastuttaman I. ricinuksen ekologiasta ja mahdollisesta kansanterveydellisestä merkityksestä Ruotsissa. Ihmisiltä vuonna 1952 poistetuista nymfeistä ja aikuisista punkeista 3,1 % oli PCR-positiivisia Babesia spp:lle. Näistä babesiapositiivisista punkeista 43% oli samanaikaisesti Borrelia-positiivisia. Linnuista poistetuista 1046 I. ricinus -epäkypsästä 2,5% oli Babesia-positiivisia, joista 38% oli samanaikaisesti Borrelia-lajien kanssa. Tämä tutkimus osoittaa, että I. ricinus -tartunnassa ihmisillä tai linnuilla Ruotsissa mahdollisesti zoonoottisia Babesia-alkueläimiä esiintyy joskus samanaikaisesti ihmispatogeenisen Borrelia spp:n kanssa. Babesia spp. -infektion diagnostisia testejä tehdään harvoin Euroopassa, ja tämän patogeenin lääketieteellistä merkitystä Euroopassa voidaan aliarvioida.
1.1. Tavoitteet
Tämän artikkelin päätavoitteena on käsitellä Babesia spp:n ja Borrelia spp:n samanaikaisten infektioiden merkitystä punkeissa Euroopassa. Merkityksellisten taudinaiheuttajien esiintymistä ja vuorovaikutusta tarkastellaan ensin, ja ne liittyvät aiempiin tietoihin, jotka koskevat zoonoottisia Babesia-lajeja Euroopassa, niiden nisäkäsvarastoja ja puutiaisvektoreita, samanaikaisesti esiintyviä mikro-organismeja punkeissa, punkkien samanaikaisia infektioita useamman kuin yhden puutiaisvälitteisen patogeenilajin kanssa ja Babesia+Borrelia-samanaikaisinfektioiden aiheuttamia ihmisillä esiintyviä sairauksia. Sitten esitellään Ruotsissa tehtyjä tutkimuksia, joissa tutkitaan Borrelia spp:n ja Babesia spp:n samanaikaisia infektioita ihmisiltä tai linnuilta poistetuissa punkeissa. Keskusteluosio käsittelee Babesia+Borrelia-samanaikaisia infektioita ihmisillä, havaitsemattomien samanaikaisten infektioiden mahdollisuutta, mahdollisuutta, että jotkut oireet jatkuvissa LB-tapauksissa voivat johtua siihen liittyvästä babesioosista, ja punkkien levittämillä patogeeneillä, mukaan lukien Babesia-loiset, infektoidun verensiirron mahdollista merkitystä. Loppuhuomautusten jälkeen on osio ehdotetuista tutkimustarpeista.
Lue lisää yllä olevasta linkistä, Babesia spp:n esiintyvyys Ixodes ricinuksessa Pohjois-Euroopassa on esitetty Taulukko 1. Suomen luvut mukana.
Babesian ja borrelian samanaikainen infektio Tick Ixodes ricinus - laiminlyöty kansanterveysongelma Euroopassa?
Abstrakti
Ihmisistä poistettuja Ixodes ricinus -nymfejä ja aikuisia sekä linnuista poistettuja toukkia ja nymfejä on analysoitu Babesia- ja Borrelia-lajien tartunnan varalta aiemmin erikseen julkaistuissa tutkimuksissa. Tässä käytämme samaa tietojoukkoa tutkiaksemme Babesia- ja Borrelia-lajien samanaikaista infektiomallia punkeissa. Tarjoamme myös yleiskatsauksen sekä zoonoottisten Babesia- että Borrelia-lajien saastuttaman I. ricinuksen ekologiasta ja mahdollisesta kansanterveydellisestä merkityksestä Ruotsissa. Ihmisiltä vuonna 1952 poistetuista nymfeistä ja aikuisista punkeista 3,1 % oli PCR-positiivisia Babesia spp:lle. Näistä babesiapositiivisista punkeista 43% oli samanaikaisesti Borrelia-positiivisia. Linnuista poistetuista 1046 I. ricinus -epäkypsästä 2,5% oli Babesia-positiivisia, joista 38% oli samanaikaisesti Borrelia-lajien kanssa. Tämä tutkimus osoittaa, että I. ricinus -tartunnassa ihmisillä tai linnuilla Ruotsissa mahdollisesti zoonoottisia Babesia-alkueläimiä esiintyy joskus samanaikaisesti ihmispatogeenisen Borrelia spp:n kanssa. Babesia spp. -infektion diagnostisia testejä tehdään harvoin Euroopassa, ja tämän patogeenin lääketieteellistä merkitystä Euroopassa voidaan aliarvioida.
1.1. Tavoitteet
Tämän artikkelin päätavoitteena on käsitellä Babesia spp:n ja Borrelia spp:n samanaikaisten infektioiden merkitystä punkeissa Euroopassa. Merkityksellisten taudinaiheuttajien esiintymistä ja vuorovaikutusta tarkastellaan ensin, ja ne liittyvät aiempiin tietoihin, jotka koskevat zoonoottisia Babesia-lajeja Euroopassa, niiden nisäkäsvarastoja ja puutiaisvektoreita, samanaikaisesti esiintyviä mikro-organismeja punkeissa, punkkien samanaikaisia infektioita useamman kuin yhden puutiaisvälitteisen patogeenilajin kanssa ja Babesia+Borrelia-samanaikaisinfektioiden aiheuttamia ihmisillä esiintyviä sairauksia. Sitten esitellään Ruotsissa tehtyjä tutkimuksia, joissa tutkitaan Borrelia spp:n ja Babesia spp:n samanaikaisia infektioita ihmisiltä tai linnuilta poistetuissa punkeissa. Keskusteluosio käsittelee Babesia+Borrelia-samanaikaisia infektioita ihmisillä, havaitsemattomien samanaikaisten infektioiden mahdollisuutta, mahdollisuutta, että jotkut oireet jatkuvissa LB-tapauksissa voivat johtua siihen liittyvästä babesioosista, ja punkkien levittämillä patogeeneillä, mukaan lukien Babesia-loiset, infektoidun verensiirron mahdollista merkitystä. Loppuhuomautusten jälkeen on osio ehdotetuista tutkimustarpeista.