Cases Of Babesiosis Research Articles

Seasonal occurrence of canine babesiosis is influenced by local climate conditions

Global warming and its effect on local climate conditions is one of the presumed underlying causes for changes in temporal and spatial distribution of vector-borne diseases. In Europe, canine babesiosis is transmitted by Dermacentor reticulatus. This hard tick species is observed to spread to new endemic areas. Within these new areas, specific local climate conditions may be responsible for sudden seasonal onset and termination of occurrence of this disease in dogs. From 2000 to 2006, 343 confirmed cases of canine babesiosis were documented at the Veterinary University of Vienna and in the Laboratory for Veterinary Diagnostic (INVITRO, Vienna). Estimated week of infection was analysed for mean air and soil temperature, relative humidity, and precipitation for each case. For seasonal start in spring, a sudden rise of air temperature up to 12 °C and defrosting of soil were essential. In autumn, the seasonal start was associated with a drop of temperature below 17 °C. Termination of occurrence of canine babesiosis, independent of season, correlated either with a sudden drop of temperature (Δ T>9 °C) with concurrent heavy rain, persistent drought, or with air temperature above 20 °C (spring/summer) or below 5 °C (autumn/winter). Relative humidity and precipitation did not have a major influence on the incidence of canine babesiosis at all. Global climate changes and adaptation of ticks to new environmental conditions introduce vector-borne diseases into new areas.

Babesiosis, Significance of Spleen Function Illustrated by Postsplenectomy Course in 3 Cases

We present 3 cases of babesiosis: (a) in a patient (50-year-old man) who, immediately after splenectomy for spleen rupture, developed fulminant Babesia infection and subsequently was treated successfully; (b) babesiosis in a patient (71-year-old man) whose spleen ruptured and his postsplenectomy course was uneventful due to the fact that Babesia infection was recognized timely and treated in the perioperative period; and (c) babesiosis in a patient (66-year-old woman) who underwent splenectomy in the past and years later developed Babesia infection with fulminant course. Three major conclusions: (1) babesiosis may cause or contribute to spleen rupture, as the first 2 cases showed; (2) babesiosis may be a severe disease in a postsplenectomy patient, independent if recent or remote, as first and third cases showed; and (3) clinical and morphological warning: babesiosis may not be readily identified after splenectomy because of overwhelming reactive thrombocythemia (first case) or may not be recognized because of overwhelming infestation not corresponding to textbook pictures or personal experience with typical cases (third case). A patient undergoing splenectomy should be carefully checked for preexisting babesiosis to ensure an uncomplicated postsplenectomy course.

Erythrocytic antioxidant defense, lipid peroxides level and blood iron, zinc and copper concentrations in dogs naturally infected with Babesia gibsoni

Babesiosis is a common tick borne disease of dogs in tropical and subtropical regions of the world caused by different species of Babesia. The present study aimed to examine erythrocyte lipid peroxide and erythrocytic antioxidant levels in dogs with clinical babesiosis, caused by Babesia gibsoni, and impact of the disease on blood iron, zinc and copper levels. The study was conducted on 10 naturally occurring cases of canine babesiosis with the history of tick infestation, erratic pyrexia, and prolonged illness. Microscopic examination of Giemsa stained peripheral blood smears confirmed B. gibsoni infection in the erythrocytes. Six apparently healthy dogs of different age, sex and breeds, brought for either health checkup or vaccination were used for comparison. Levels of erythrocytic antioxidant enzymes were significantly ( P < 0.01) higher in sick dogs than those of cytologically negative dogs (catalase: 0.192 ± 0.024 units/mg Hb vs 0.074 ± 0.004 units/mg Hb; superoxide dismutase: 0.014 ± 0.0009 units/mg Hb vs 0.006 ± 0.0008 units/mg Hb and lipid peroxide: 6.01 ± 0.30 nmol MDA/mg Hb vs 1.89 ± 0.10 nmol MDA/mg Hb). The levels of blood micronutrients were significantly low in these dogs (iron: 89.87 ± 8.12 μg/g vs 126.44 ± 14.65 μg/g; zinc: 3.67 ± 1.85 μg/g vs 5.62 ± 1.83 μg/g and copper: 0.55 ± 0.63 μg/g vs 0.65 ± 0.04 μg/g). The study demonstrated oxidative damage in dogs naturally infected with B. gibsoni. Low level of blood iron, zinc and copper seems to have an additional role in the genesis of anaemia and oxidative stress.

Human babesiosis in Germany: Just overlooked or truly new?

Tick-borne infections are among the more important vector-borne infections in the northern hemisphere. However, many facts pertaining to the epidemiology and pathogenesis of such diseases in Europe remain unclear. Human babesiosis in particular may have previously been overlooked in many parts of the world due to a lack of medical awareness and microbiological detection methods. Recently, the first two cases of human babesiosis were reported in Germany, occurring in vicinities where the presence of Babesia spp. in enzootic cycles was obvious for decades but where the risk of acquiring Babesia spp. either from ticks or from human blood products was not known before. It is important to note, though, that as with other tick-borne diseases, Babesia infections may arise in geographic areas where they have not been recorded in the past. Better molecular detection methods and strain typing of parasites are necessary to investigate the epidemiological distribution of zoonotic Babesia spp. in Europe and to clarify whether their virulence or transmissibility is strain-dependent. Therefore, further seroepidemiological and molecular epidemiological studies are urgently needed to learn more about the distribution and medical relevance of these pathogens in various parts of Europe in general and in Germany in particular.

Emerging Epidemics of Babesiosis in Hematology Consultation at a University Hospital.

Babesiosis was first reported in NY in 1975. 560 cases were reported from 1986–2001 in NY, mostly from Long island. Human babesiosis is a tick- borne disease caused by B.microti in the US. Most of the cases occur between May and August in the north eastern states. The risk factors for severe disease include older age, asplenia, immunocompromised state. As the same tick is the vector for lyme disease and ehrlichiosis, co-infection can occur. In this abstract we report ten cases of babesiosis encountered in hematology consultation since 2005, with 5 cases occurring this year. The patients' ages ranged between 36–84 yrs. Three patients had neither travel history nor tick bite /outdoor activity. Three patients were immunocompromised (AML, CLL, HIV). Most common presentations were malaise, nausea, and high fever. Two patients had splenomegaly. Six patients had hyperbilirubinemia, anemia and thrombocytopenia. Three patients were also positive for lyme disease. One patient developed splenic rupture. All the patients recovered after treatment with atovoquone and azithromycin. This series of case reports emphasizes the varied atypical presentations of babesioisis including uncommon season of occurrence, absence of a rash or tickbite history, co-existing infection with Lyme disease and complications including splenic rupture.

Pulmonary complications of babesiosis: case report and literature review

Reported here is a rare case of babesiosis with pulmonary complications followed by a review of the literature. Babesiosis presents clinically as a malaria-like illness with fever, chills, headache, fatigue with lymphopenia, atypical lymphocytes, mildly or transiently elevated serum transaminases, thrombocytopenia, and increased lactate dehydrogenase (LDH) levels. The diagnosis of babesiosis is based on identification of Babesia spp. on a peripheral blood smear. Babesiosis is usually mild in normal hosts, but it may be severe or even fatal in asplenic patients. Pulmonary manifestations are rare in babesiosis, but non-cardiogenic pulmonary edema (NCPE) is the most frequent manifestation. NCPE in babesiosis does not appear to be related to the degree of parasitemia or splenic function and its onset may be early or late. NCPE usually resolves rapidly with supportive treatment; it is rarely fatal. Clinicians should suspect NCPE in patients with babesiosis who acutely develop shortness of breath and have chest radiograph findings compatible with acute pulmonary edema without cardiomegaly or pleural effusions.

A quantitative PCR assay for the detection and quantification of Babesia bovis and B. bigemina

The haemoparasites Babesia bovis and Babesia bigemina affect cattle over vast areas of the tropics and temperate parts of the world. Microscopic examination of blood smears allows the detection of clinical cases of babesiosis, but this procedure lacks sensitivity when parasitaemia levels are low. In addition, differentiating between similar haemoparasites can be very difficult. Molecular diagnostic procedures can, however, overcome these problems. This paper reports a quantitative PCR (qPCR) assay involving the use of SYBR Green. Based on the amplification of a small fragment of the cytochrome b gene, this method shows both high sensitivity and specificity, and allows quantification of parasite DNA. In tests, reproducible quantitative results were obtained over the range of 0.1 ng to 0.1 fg of parasite DNA. Melting curve analysis differentiated between B. bovis and B. bigemina. To assess the performance of the new qPCR procedure it was used to screen for babesiosis in 40 cows and 80 horses. B. bigemina was detected in five cows (three of these were also found to be positive by standard PCR techniques targeting the 18S rRNA gene). In addition, B. bovis was detected in one horse and B. bigemina in two horses using the proposed method, while none was found positive by ribosomal standard PCR. The sequences of the B. bigemina cytochrome b and 18S rRNA genes were completely conserved in isolates from Spain and Argentina, while those of B. bovis showed moderate polymorphism.

Clinical management of babesiosis in dogs with homeopathic Crotalus horridus 200C

Homeopathic Crotalus horridus 200C was evaluated in 13 clinical cases of babesiosis in dogs, compared with another 20 clinical cases treated with diminazine. Babesiosis is an important tropical tick-borne haemoprotozoan disease in dogs clinically manifested by anorexia, dehydration, temperature, dullness/depression, diarrhoea/constipation, pale mucosa, hepatomegaly, vomiting/nausea, splenomegaly, distended abdomen/ascites, yellow coloured urine, emaciation/weight loss, and occular discharge. The diagnosis of babesiosis was based on cytological evidence of Babesia gibsoni in freshly prepared blood smears. The dogs were treated with oral C. horridus 200C, 4 pills four times daily for 14 days ( n=13) or diminazine aceturate 5 mg/kg single intramuscularly dose ( n=20). All the dogs were administered 5% Dextrose normal saline at 60 ml/ kg intravenously for 4 days. Initial clinical scores were similar in both groups and showed similar progressive improvement with the two treatments over 14 days. Parasitaemia also improved in both groups, but haematological values showed no change. No untoward reactions were observed. It appears that C. horridus is as effective in causing clinical recovery in moderate cases of canine babesiosis caused by Babesia gibsoni as the standard drug diminazine. Large scale randomized trials are indicated for more conclusive results.

Molecular Survey ofBabesia microti, EhrlichiaSpecies andCandidatusNeoehrlichia mikurensis in Wild Rodents from Shimane Prefecture, Japan

A significant number of patients are diagnosed with "fevers of unknown origin" (FUO) in Shimane Prefecture in Japan where tick-borne diseases are endemic. We conducted molecular surveys for Babesia microti, Ehrlichia species, and Candidatus Neoehrlichia mikurensis in 62 FUO cases and 62 wild rodents from Shimane Prefecture, Japan. PCR using primers specific for the Babesia 18S small-subunit rRNA (rDNA) gene and Anaplasmataceae groESL amplified products from 45% (28/62) and 25.8% (16/62) of captured mice, respectively. Of the 28 18S rDNA PCR positives, 23 and five samples were positive for Hobetsu- and Kobe-type B. microti, respectively. In contrast, of the 16 groESL PCR positives, eight, one and seven samples were positive for Ehrlichia muris, Ehrlichia sp. HF565 and Candidatus N. mikurensis, respectively. Inoculation of selected blood samples into Golden Syrian hamsters indicated the presence of Hobetsu- and Kobe-type B. microti in four and one sample, respectively. Isolation of the latter strain was considered important as previous studies suggested that the distribution of this type was so far confined to Awaji Island in Hyogo Prefecture, where the first case of transfusion-associated human babesiosis originated. DNA samples from 62 FUO human cases tested negative for B. microti 18S rDNA gene, Anaplasmataceae groESL gene, Rickettsia japonica 17K genus-common antigen gene and Orientia tsutsugamushi 56K antigen gene by PCRs. We also conducted seroepidemiological surveys on 62 human sera collected in Shimane Prefecture from the FUO patients who were suspected of carrying tick-borne diseases. However, indirect immunofluorescent antibody tests using B. microti- and E. muris-infected cells detected IgG against E. muris in only a single positive sample. This study demonstrates the presence of several potentially important tick-borne pathogens in Shimane Prefecture and suggests the need for further study on the causative agents of FUOs.

First Case of Human Babesiosis in Korea: Detection and Characterization of a Novel Type of Babesia sp. (KO1) Similar to Ovine Babesia

We report on the first case of human babesiosis in Korea. The intraerythrocytic parasite (KO1) in the patient's blood mainly appeared as paired pyriforms and ring forms; but Maltese cross forms were not seen, and the parasite showed morphological features consistent with those of the genus Babesia sensu stricto. The sequence of the 18S rRNA gene of KO1 was closely related to that of Babesia spp. isolated from sheep in China (similarity, 98%). The present study provides the first evidence of the presence of a hitherto unidentified, new type of Babesia parasite capable of infecting humans.

First case of human babesiosis in Germany – Clinical presentation and molecular characterisation of the pathogen

Babesiosis is a common infection of animals and is gaining increasing attention as an emerging tick-borne zoonosis of humans in Europe. Here we report on the first case of human babesiosis in Germany in a 63-year-old splenectomised German patient with a relapse of nodular lymphocyte-predominant Hodgkin's lymphoma. After treatment with a chimeric anti-CD20 antibody preparation (Rituximab), the patient was hospitalised because of anaemia and dark urine from haemoglobinuria. Presumptive diagnosis of babesiosis was made based on piriform parasitic erythrocytic inclusions in peripheral blood smears and confirmed by Babesia-specific 18S rDNA PCR. Sequence analysis revealed a >99% homology of the amplicon with the recently described EU1 organism clustering within the Babesia divergens/Babesia odocoilei complex. Despite treatment with quinine and clindamycin the patient relapsed and developed chronic parasitaemia requiring re-treatment and long-term maintenance therapy with atovaquone before he eventually seroconverted and the parasite was cleared. Our findings suggest that human babesiosis occurs in Germany and can take a chronic course in immunocompromised individuals.

A complicated case of concurrent canine babesiosis and canine ehrlichiosis

Canine babesiosis and canine ehrlichiosis are the major tick-borne diseases throughout the world. The concurrent infection between canine babesiosis and canine ehrlichiosis can occur in endemic regions. This report showed the clinical pathology and treatment outcome of concurrent infection in a dog admitted to a veterinary hospital. Based on the history, physical examination, and laboratory finding, the dog was diagnosed with neurological disorders induced by babesiosis and ehrlichiosis concurrent infection. The dog presented with moderate normocytic normochromic anemia, severe thrombocytopenia and moderately increased alkaline phosphatase. The symptoms were more complicated with high fever, seizure, and cardiopulmonary arrest. The condition was specifically treated with doxycycline and diminazene aceturate, but the dog died 2 days after admission. In conclusion, concurrent infection of canine babesiosis and canine ehrlichiosis can cause complicated clinical neurological compromise and result in mortality in dogs.

BABESIOSIS: A RARE AND POTENTIALLY FATAL RISK OF BLOOD TRANSFUSION

INTRODUCTION: Babesiosis is a tick-borne disease caused by parasites of the genus Babesia resulting in an intraerythrocytic infection that ranges from an asymptomatic state to a life-threatening illness. Human disease in the United States is most commonly due to B. microti. Transmission usually occurs via a bite from the Ixodid tick. We present a rare case of transfusion-associated babesiosis.

Clinico-pathological findings and coagulation disorders in 45 cases of canine babesiosis in Spain

A retrospective study of clinical cases of babesiosis in dogs examined at the Veterinary Teaching Hospital, Rof Codina, from January 2003 to October 2004 is presented. The diagnosis was confirmed by direct observation of large piroplasms in stained blood smears. Dogs with concurrent diseases were excluded from the study. Clinical signs, complete blood count, serum biochemistry and hemostasis profiles were obtained. The observed clinical signs were due to hemolytic anemia and inflammatory responses but the most relevant clinico-pathological findings were related to alterations in hemostasis. All dogs presented with thrombocytopenia and 20% had disseminated intravascular coagulation syndrome. Anemia of variable severity was observed in most of the dogs.

Erythema figuratum in septic babesiosis

Babesiosis is a rare worldwide-distributed protozoal zoonosis caused by a haemoprotozoan of the genus Babesia, transmitted through bites of tick of the genus Ixodes. The first demonstrated case of human babesiosis in the world was discovered in Europe, in 1957. However, most of the cases were reported later in the north-east of the United States where Babesia microti has been the cause of over 300 cases of human babesiosis since 1969. In Europe, the most severe cases are observed in asplenic patients infected by a parasite of cattle, the Babesia divergens. Only two cases of babesiosis have been reported in Spain. We present a case of erythema figuratum associated to septic babesiosis in a non-splenectomized man, which is currently the third case of babesiosis in Spain.

Babesiosis masquerading as recurrent immune thrombocytopenic purpura in a splenectomized patient

Dear Editor, Splenectomy is a clinically effective therapeutic intervention against chronic immune thrombocytopenic purpura (ITP) [1]. Severe, potentially life-threatening infections are a major long-term complication of splenectomy [2]. Certain infections may present with thrombocytopenia, which, in the case of splenectomized patients with a history of ITP, may be mistaken for ITP recurrence. We report what is, to the best of our knowledge, the first case of babesiosis in a patient with stable chronic ITP who had previously undergone splenectomy. The patient was a 66-year-old woman from Nantucket Island, MA, USA, with a known diagnosis of ITP, who was treated with prednisone, intravenous immunoglobulin, and rituximab before eventually undergoing splenectomy. Her postsplenectomy platelet count remained stable in the 60,000–70,000 range, without treatment. Two years following splenectomy, she presented with fever (temperature 101°F), chills, myalgias, and arthralgias. She denied any bleeding or bruising. Physical examination was unremarkable. Complete blood count demonstrated a hematocrit of 45.5 vol%, a white blood cell count of 4,600 cells/μL, and a platelet count of 10,000 platelets/μL. Liver function tests were notable for a slightly elevated alanine transaminase of 64 and aspartate transaminase of 49. Peripheral smear showed characteristic Howell-Jolly bodies and rare intraerythrocytic parasite ring forms in normal-sized red blood cells (Fig. 1). Babesiosis was confirmed by extremely high IgG and IgM titers to Babesia of 1:1,024 and 1:1,280, respectively, and a positive polymerase chain reaction (PCR). Importantly, there were no detectable antibodies for Lyme disease and ehrlichiosis. The patient was started on azithromycin and atovaquone and on a tapering dose of prednisone. She received 4 weeks of antibiotic therapy and her platelet count increased to 325,000 platelets/μL. Four weeks after completing the course of antibiotics, the platelet count dropped again to 24,000 platelets/μL. She continued to have circulating intracellular parasites on peripheral smear, and Babesia PCR and serologies were still positive. Atovaquone, azithromycin, and prednisone treatments were restarted. Her platelet count steadily improved, and only after 4 months of antibiotic therapy did the PCR for Babesia normalize. Steroids were discontinued. Her platelet count returned to her baseline value of 60,000–70,000, off immunosuppressive and anti-infective therapies. The approach to thrombocytopenia should always include an accurate history, physical examination, and examination of the peripheral blood smear. Splenectomy predisposes to infections that may present with thrombocytopenia, including ehrlichiosis, Colorado tick fever, Rocky Mountain spotted fever, babesiosis, and malaria. While patients can have a recurrence of ITP, other causes of thrombocytopenia need to be excluded. Babesiosis is a worldwide tick-borne disease caused by the intraerythrocytic protozoan Babesia [3]. Humans are infected by various tick vectors (Ixodes scapularis and Ixodes ricinus) and rarely by transfusions. In the USA, endemic areas include the islands off the coasts of MA and NY [4]. Symptoms include fever, chills, weakness, and myalgias. Babesiosis may present with hemolytic anemia, lymphopenia, and thrombocytopenia. Splenectomized patients may develop a fulminant infection with massive intravascular hemolysis [5]. The peripheral blood smear reveals small coccoid and dumbbell-shaped organisms. The trophozoites are small rings similar to those of Plasmodium falciparum. The parasites can be pyriform (pear shaped). Babesia microti is associated with Maltese cross forms and ring forms. IgM or P. A. Konstantinopoulos . K. B. Miller . B. J. Dezube (*) Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA e-mail: bdezube@bidmc.harvard.edu Tel.: +1-617-6677082 Fax: +1-617-9758030

Identity of the causal agents of human babesiosis in Europe

Most cases of human babesiosis are caused either by Babesia divergens in Europe or Babesia microti in America. B. microti, once regarded as a single species, occurs as a world-wide species complex and although both phenotypic and genotypic features lend support to suggestions that zoonotic B. microti may occur in Europe, convincing medical evidence is lacking. Several B. divergens-like parasites have emerged in the last few years, but 18S rRNA gene analysis suggests that B. divergens ‘sensu stricto’ is restricted to European (and North African) cattle. Some of the B. divergens-like parasites only differ from the bovine type by a few bases, and it remains to be determined whether this is sufficient to accord them separate species status. Comparative biology should support genetic data in taxonomic studies of both B. divergens and B. microti.

Neonatal Babesiosis

A case of transfusion-associated neonatal babesiosis is presented. Jaundice, hepatosplenomegaly, anemia and conjugated hyperbilirubinemia developed in this preterm infant. The diagnosis was eventually made by blood smear, serology and polymerase chain reaction. The patient was treated with clindamycin and quinine and made a favorable recovery. Of neonatal babesiosis reported in the literature, 9 other cases are reviewed, including 6 that were transfusion-associated, 2 congenital and 2 tick transmitted.

クリンダマイシンによる&lt;I&gt;Babesia gibsoni&lt;/I&gt;感染犬の治療

The efficacy of intramuscular clindamycin administration was evaluated at a dose of 50mg/kg b. w. b.i. d. for seven days in combination with a hepatic therapy, against severe cases infected withBabesia gibsoni. In the treated group, anemia and parasitemia were improved compaved with those in the control group. In addition, side effects such as damage at the injection site and clinical abnormality were not observed in the treated group. Based on these findings, we conclude that this treatment is useful for severe canine babesiosis cases.

COMPARATIVE INFECTIVITY OF BABESIA DIVERGENS AND A ZOONOTIC BABESIA DIVERGENS–LIKE PARASITE IN CATTLE

Babesia divergens-like parasites identified in human babesiosis cases in Missouri and Kentucky and in eastern cottontail rabbits (Sylvilagus floridanus) on Nantucket Island, Massachusetts, share identical small subunit ribosomal RNA gene sequences. This sequence is 99.8% identical to that of Babesia divergens, suggesting that the U.S. parasite may be B. divergens, a causative agent of human and bovine babesiosis in Europe. Holstein-Friesian calves were inoculated with cultured Nantucket Island Babesia sp. (NR831) and B. divergens parasites and monitored by clinical signs, Giemsa-stained blood films, PCR, and culture. The NR831 recipients did not exhibit clinical signs of infection and remained negative for all assays. The B. divergens recipients developed clinical infections and became positive by all assays. NR831 recipients were fully susceptible upon challenge inoculation with B. divergens. This study confirms that the Nantucket Island Babesia sp. is not conspecific with B. divergens based on host specificity for cattle.