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Jaenson TGT, Gray JS, Lindgren PE, Wilhelmsson P. Coinfection of Babesia and Borrelia in the Tick Ixodes ricinus-A Neglected Public Health Issue in Europe? Pathogens 2024; 13:81. [PMID: 38251388 PMCID: PMC10818971 DOI: 10.3390/pathogens13010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
Ixodes ricinus nymphs and adults removed from humans, and larvae and nymphs from birds, have been analysed for infection with Babesia species and Borrelia species previously in separately published studies. Here, we use the same data set to explore the coinfection pattern of Babesia and Borrelia species in the ticks. We also provide an overview of the ecology and potential public health importance in Sweden of I. ricinus infected both with zoonotic Babesia and Borrelia species. Among 1952 nymphs and adult ticks removed from humans, 3.1% were PCR-positive for Babesia spp. Of these Babesia-positive ticks, 43% were simultaneously Borrelia-positive. Among 1046 immatures of I. ricinus removed from birds, 2.5% were Babesia-positive, of which 38% were coinfected with Borrelia species. This study shows that in I. ricinus infesting humans or birds in Sweden, potentially zoonotic Babesia protozoa sometimes co-occur with human-pathogenic Borrelia spp. Diagnostic tests for Babesia spp. infection are rarely performed in Europe, and the medical significance of this pathogen in Europe could be underestimated.
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Affiliation(s)
- Thomas G. T. Jaenson
- Evolutionary Biology Centre, Department of Organismal Biology, Uppsala University, Norbyvägen 18d, SE-752 36 Uppsala, Sweden;
| | - Jeremy S. Gray
- UCD School of Biology and Environmental Science, University College Dublin, D04 N2E5 Dublin, Ireland;
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Department of Clinical Microbiology, Region Jönköping County, SE-551 11 Jönköping, Sweden
| | - Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Department of Clinical Microbiology, Region Jönköping County, SE-551 11 Jönköping, Sweden
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2
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Sawczyn-Domańska A, Zwoliński J, Kloc A, Wójcik-Fatla A. Prevalence of Borrelia, Neoehrlichia mikurensis and Babesia in ticks collected from vegetation in eastern Poland. EXPERIMENTAL & APPLIED ACAROLOGY 2023; 90:409-428. [PMID: 37389691 PMCID: PMC10406691 DOI: 10.1007/s10493-023-00818-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
In Poland, tick-borne diseases constitute the majority of diseases related to exposure to biological agents with a predominance of Lyme borreliosis; therefore, research on ticks as a reservoir of various pathogens remains crucial in the epidemiology of human diseases after tick bites. This study aimed to identify the occurrence of Borrelia burgdorferi sensu lato, Borrelia miyamotoi, Neoehrlichia mikurensis, and Babesia spp. in ticks collected from vegetation in eastern Poland. Additionally, the prevalence of co-infections in the adult Ixodes ricinus ticks was determined. Among I. ricinus ticks the predominantly detected pathogen was B. burgdorferi s.l. (23%) with B. burgdorferi sensu stricto as the most frequently identified species, followed by B. garinii. In 2013, the double or triple infections of B. burgdorferi s.s., B. afzelii, and B. garinii species did not exceed 9% in adult ticks, whereas in 2016, the prevalence of mixed infections reached 29%. The prevalence of N. mikurensis and B. miyamotoi in I. ricinus was determined at the same level of 2.8%. Four Babesia species were identified in the examined I. ricinus population: B. microti (1.5%), B. venatorum (1.2%), B. divergens (0.2%), and B. capreoli (0.1%). Co-infections were detected in 10.1% of all infected ticks with the highest prevalence of co-infections with B. burgdorferi s.l. and Babesia species. The changes in the prevalence and the distribution of particular pathogens within tick populations indicate the need for monitoring the current situation related to tick-borne pathogens from the aspect of risk to human health.
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Affiliation(s)
- Anna Sawczyn-Domańska
- Department of Health Biohazards and Parasitology, Institute of Rural Health, Jaczewskiego 2, 20-090, Lublin, Poland.
| | - Jacek Zwoliński
- Department of Health Biohazards and Parasitology, Institute of Rural Health, Jaczewskiego 2, 20-090, Lublin, Poland
| | - Anna Kloc
- Department of Health Biohazards and Parasitology, Institute of Rural Health, Jaczewskiego 2, 20-090, Lublin, Poland
| | - Angelina Wójcik-Fatla
- Department of Health Biohazards and Parasitology, Institute of Rural Health, Jaczewskiego 2, 20-090, Lublin, Poland
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3
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Kumar A, Kabra A, Igarashi I, Krause PJ. Animal models of the immunology and pathogenesis of human babesiosis. Trends Parasitol 2023; 39:38-52. [PMID: 36470781 DOI: 10.1016/j.pt.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
Animal models of human babesiosis have provided a basic understanding of the immunological mechanisms that clear, or occasionally exacerbate, Babesia infection and those pathological processes that cause disease complications. Human Babesia infection can cause asymptomatic infection, mild to moderate disease, or severe disease resulting in organ dysfunction and death. More than 100 Babesia species infect a wide array of wild and domestic animals, and many of the immunologic and pathologic responses to Babesia infection are similar in animals and humans. In this review, we summarize the knowledge gained from animal studies, their limitations, and how animal models or alternative approaches can be further leveraged to improve our understanding of human babesiosis.
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Affiliation(s)
- Abhinav Kumar
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Aditya Kabra
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
| | - Ikuo Igarashi
- National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido, Japan
| | - Peter J Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; Department of Infectious Diseases, Yale School of Medicine, New Haven, CT 06510, USA.
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Espinosa-Muñoz DY, López-López L, Ríos-Osorio LA, Gutiérrez-Builes LA. Detection of Babesia and the associated factors in cattle and humans from Magdalena Medio region, Colombia. Comp Immunol Microbiol Infect Dis 2022; 90-91:101900. [DOI: 10.1016/j.cimid.2022.101900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/08/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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Sands B, Lihou K, Lait P, Wall R. Prevalence of Babesia spp. pathogens in the ticks Dermacentor reticulatus and Ixodes ricinus in the UK. Acta Trop 2022; 236:106692. [PMID: 36115381 DOI: 10.1016/j.actatropica.2022.106692] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/26/2022] [Accepted: 09/13/2022] [Indexed: 11/01/2022]
Abstract
The emergence of Babesia pathogens novel to the UK is of growing concern; these include Babesia canis and Babesia caballi. However, a better understanding of changes in the prevalence of endemic Babesia species such as Babesia venatorum and Babesia divergens is also of importance. Here, the prevalence of Babesia pathogens in both Dermacentor reticulatus and Ixodes ricinus ticks was assessed. Dermacentor reticulatus were collected from six sites known to harbour populations of this species in west Wales and southern England. DNA was extracted from 879 individual ticks and subjected to PCR and sequence analysis. Seven Babesia species were detected in 7.5% of the ticks, including B. caballi (0.68%), B. bovis (1.7%), B. microti (1.02%), B. bigemina (0.34%), B. capreoli (0.34%), and one isolate of B. canis (0.34%). Two of the field sites with grazing equines present had ticks that were positive for B. caballi. For I. ricinus, up to 200 nymphs were collected from each of 24 cattle farms in south-west England. Nymphs were divided into 6 pools of 30 from each farm for DNA extraction, PCR, and sequencing. Samples from seven out of the 24 farms tested positive for Babesia, and most were positive for more than one species. Babesia divergens was identified from five farms, and three of these farms had two pooled samples positive for B. divergens, which given the low overall prevalence rate suggests that B. divergens may be highly clustered within the tick population. Most of the remaining positive samples were Babesia venatorum, demonstrating that this zoonotic pathogen is widespread in livestock habitats. The data suggest that B. canis is not yet widely prevalent in established D. reticulatus populations in the UK, but that there is a need to raise awareness of the risk of equine piroplasmosis in areas with endemic D. reticulatus foci, since B. caballi appears more widely established.
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Affiliation(s)
- Bryony Sands
- School of Biological Sciences, University of Bristol, Bristol, UK.
| | - Katie Lihou
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - Philippa Lait
- Molecular Diagnostic Unit, Langford Vets and School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - Richard Wall
- School of Biological Sciences, University of Bristol, Bristol, UK
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Kukina IV, Zelya OP. Extraordinary high level of propagation of Babesia divergens in severe human babesiosis. Parasitology 2022; 149:1160-1163. [PMID: 35591780 PMCID: PMC11010513 DOI: 10.1017/s0031182022000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/18/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
Babesias are obligate apicomplexan parasites that affect the red blood cells (RBCs) of animals. Humans can serve as accidental hosts for them. Asexual reproduction of a parasite occurs in a vertebrate host through asynchronous binary fission, yielding a complex pleomorphic population of intraerythrocytic forms. In natural hosts (Bos taurus), paired pyriforms (‘figure 8’) of Babesia divergens are usual, but tetrads (‘Maltese Cross’) are very rare (only in 0.02% infected erythrocytes); in humans, however, up to 5% of infected erythrocytes show tetrads. The current study shows that B. divergens proliferating in an accidental human host can promote extraordinarily high level of fission. This phenomenon is expressed as the simultaneous division of the parasite into 6 and possibly a greater number of merozoites, forming a ‘daisy head’ (vs the usual 2, less often 4 merozoites). Reproduction is possible without egressing merozoites from the erythrocyte, which results in multi-occupancy of an RBC (≥5 parasites per RBC). An unusually high polyparasitism – up to 14 parasites developed in the affected erythrocytes – was observed. This phenomenon is rare in natural hosts (usually ≤5), but when B. divergens is cultured in vitro it can be 10–12.
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Affiliation(s)
- Irina V. Kukina
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, Sechenov University, Moscow, Russia
| | - Olga P. Zelya
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, Sechenov University, Moscow, Russia
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Schötta AM, Stelzer T, Stanek G, Stockinger H, Wijnveld M. Bacteria and protozoa with pathogenic potential in Ixodes ricinus ticks in Viennese recreational areas. Wien Klin Wochenschr 2022; 135:177-184. [PMID: 35689113 PMCID: PMC9187151 DOI: 10.1007/s00508-022-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/15/2022] [Indexed: 11/09/2022]
Abstract
Ixodes ricinus is the most relevant vector for tick-borne diseases in Austria and responsible for the transmission of Borrelia burgdorferi sensu lato (s. l.), which causes Lyme borreliosis in humans; however, also other bacteria and protozoa can be found in ticks and have the potential of infecting people and animals. In this study we collected ticks in popular recreational areas in the city of Vienna in the years 2019 and 2020 and analyzed them for the presence of such putative pathogenic microorganisms. By using reverse line blot (RLB) hybridization we detected DNA of B. burgdorferi s. l., Rickettsia spp., Babesia spp., Candidatus Neoehrlichia mikurensis (CNM) and Anaplasma phagocytophilum. Moreover, we also screened them for the relapsing fever spirochete Borrelia miyamotoi employing real-time PCR. The most frequently detected pathogens were B. burgdorferi s. l. in 28.6% of the ticks in 2019 and 21.3% of the ticks in 2020. The genus Rickettsia was detected in 13.8% of the ticks from 2019 and only in 4.6% from 2020. Babesia spp. were detected in 5.7% in 2019 and 4.2% in 2020. Furthermore, we detected CNM in 4.0% (2019) and 5.6% (2020), A. phagocytophilum in 0.5% (2019) and 1.3% (2020) and finally B. miyamotoi in 3.3% (2019) and 1.7% (2020). Collectively, we show that various microorganisms are prevalent in ticks collected in Vienna and identify hotspots for B. miyamotoi, which we have detected for the first time in the city.
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Affiliation(s)
- Anna-Margarita Schötta
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Theresa Stelzer
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Gerold Stanek
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Hannes Stockinger
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
| | - Michiel Wijnveld
- Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
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Babesiosis in Southeastern, Central and Northeastern Europe: An Emerging and Re-Emerging Tick-Borne Disease of Humans and Animals. Microorganisms 2022; 10:microorganisms10050945. [PMID: 35630388 PMCID: PMC9146636 DOI: 10.3390/microorganisms10050945] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/19/2022] [Accepted: 04/26/2022] [Indexed: 12/10/2022] Open
Abstract
There is now considerable evidence that in Europe, babesiosis is an emerging infectious disease, with some of the causative species spreading as a consequence of the increasing range of their tick vector hosts. In this review, we summarize both the historic records and recent findings on the occurrence and incidence of babesiosis in 20 European countries located in southeastern Europe (Bosnia and Herzegovina, Croatia, and Serbia), central Europe (Austria, the Czech Republic, Germany, Hungary, Luxembourg, Poland, Slovakia, Slovenia, and Switzerland), and northern and northeastern Europe (Lithuania, Latvia, Estonia, Iceland, Denmark, Finland, Sweden, and Norway), identified in humans and selected species of domesticated animals (cats, dogs, horses, and cattle). Recorded cases of human babesiosis are still rare, but their number is expected to rise in the coming years. This is because of the widespread and longer seasonal activity of Ixodes ricinus as a result of climate change and because of the more extensive use of better molecular diagnostic methods. Bovine babesiosis has a re-emerging potential because of the likely loss of herd immunity, while canine babesiosis is rapidly expanding in central and northeastern Europe, its occurrence correlating with the rapid, successful expansion of the ornate dog tick (Dermacentor reticulatus) populations in Europe. Taken together, our analysis of the available reports shows clear evidence of an increasing annual incidence of babesiosis across Europe in both humans and animals that is changing in line with similar increases in the incidence of other tick-borne diseases. This situation is of major concern, and we recommend more extensive and frequent, standardized monitoring using a “One Health” approach.
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The Global Emergence of Human Babesiosis. Pathogens 2021; 10:pathogens10111447. [PMID: 34832603 PMCID: PMC8623124 DOI: 10.3390/pathogens10111447] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/05/2022] Open
Abstract
Babesiosis is an emerging tick-borne disease caused by intraerythrocytic protozoa that are primarily transmitted by hard-bodied (ixodid) ticks and rarely through blood transfusion, perinatally, and organ transplantation. More than 100 Babesia species infect a wide spectrum of wild and domestic animals worldwide and six have been identified as human pathogens. Babesia microti is the predominant species that infects humans, is found throughout the world, and causes endemic disease in the United States and China. Babesia venatorum and Babesia crassa-like agent also cause endemic disease in China. Babesia divergens is the predominant species in Europe where fulminant cases have been reported sporadically. The number of B. microti infections has been increasing globally in recent decades. In the United States, more than 2000 cases are reported each year, although the actual number is thought to be much higher. In this review of the epidemiology of human babesiosis, we discuss epidemiologic tools used to monitor disease location and frequency; demographics and modes of transmission; the location of human babesiosis; the causative Babesia species in the Americas, Europe, Asia, Africa, and Australia; the primary clinical characteristics associated with each of these infections; and the increasing global health burden of this disease.
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Bonsergent C, de Carné MC, de la Cotte N, Moussel F, Perronne V, Malandrin L. The New Human Babesia sp. FR1 Is a European Member of the Babesia sp. MO1 Clade. Pathogens 2021; 10:pathogens10111433. [PMID: 34832590 PMCID: PMC8618789 DOI: 10.3390/pathogens10111433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
In Europe, Babesia divergens is responsible for most of the severe cases of human babesiosis. In the present study, we describe a case of babesiosis in a splenectomized patient in France and report a detailed molecular characterization of the etiological agent, named Babesia sp. FR1, as well as of closely related Babesia divergens, Babesia capreoli and Babesia sp. MO1-like parasites. The analysis of the conserved 18S rRNA gene was supplemented with the analysis of more discriminant markers involved in the red blood cell invasion process: rap-1a (rhoptry-associated-protein 1) and ama-1 (apical-membrane-antigen 1). The rap-1a and ama-1 phylogenetic analyses were congruent, placing Babesia sp. FR1, the new European etiological agent, in the American cluster of Babesia sp. MO1-like parasites. Based on two additional markers, our analysis confirms the clear separation of B. divergens and B. capreoli. Babesia sp. MO1-like parasites should also be considered as a separate species, with the rabbit as its natural host, differing from those of B. divergens (cattle) and B. capreoli (roe deer). The natural host of Babesia sp. FR1 remains to be discovered.
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Affiliation(s)
- Claire Bonsergent
- BIOEPAR, INRAE, Oniris, 44300 Nantes, France;
- Correspondence: (C.B.); (L.M.)
| | - Marie-Charlotte de Carné
- Service de Maladies Infectieuses et Tropicales, Hôpital F. Quesnay, 78200 Mantes-la Jolie, France; (M.-C.d.C.); (V.P.)
| | | | - François Moussel
- Laboratoire de Biologie Médicale, Hôpital F. Quesnay, 78200 Mantes-la-Jolie, France;
| | - Véronique Perronne
- Service de Maladies Infectieuses et Tropicales, Hôpital F. Quesnay, 78200 Mantes-la Jolie, France; (M.-C.d.C.); (V.P.)
| | - Laurence Malandrin
- BIOEPAR, INRAE, Oniris, 44300 Nantes, France;
- Correspondence: (C.B.); (L.M.)
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Hildebrandt A, Zintl A, Montero E, Hunfeld KP, Gray J. Human Babesiosis in Europe. Pathogens 2021; 10:1165. [PMID: 34578196 PMCID: PMC8468516 DOI: 10.3390/pathogens10091165] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022] Open
Abstract
Babesiosis is attracting increasing attention as a worldwide emerging zoonosis. The first case of human babesiosis in Europe was described in the late 1950s and since then more than 60 cases have been reported in Europe. While the disease is relatively rare in Europe, it is significant because the majority of cases present as life-threatening fulminant infections, mainly in immunocompromised patients. Although appearing clinically similar to human babesiosis elsewhere, particularly in the USA, most European forms of the disease are distinct entities, especially concerning epidemiology, human susceptibility to infection and clinical management. This paper describes the history of the disease and reviews all published cases that have occurred in Europe with regard to the identity and genetic characteristics of the etiological agents, pathogenesis, aspects of epidemiology including the eco-epidemiology of the vectors, the clinical courses of infection, diagnostic tools and clinical management and treatment.
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Affiliation(s)
- Anke Hildebrandt
- St. Vincenz Hospital Datteln, Department of Internal Medicine I, 45711 Datteln, Germany;
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany
| | - Annetta Zintl
- UCD School of Veterinary Sciences, University College Dublin, D04 W6F6 Dublin, Ireland;
| | - Estrella Montero
- Parasitology Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain;
| | - Klaus-Peter Hunfeld
- Institute of Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Center, Medical Faculty Goethe University Frankfurt, Steinbacher Hohl 2-26, 60488 Frankfurt am Main, Germany;
- Society for Promoting Quality Assurance in Medical Laboratories (INSTAND, e.v.), Ubierstraße 20, 40223 Düsseldorf, Germany
- ESGBOR Study Group of the European Society for Clinical Microbiology & Infectious Diseases (ESCMID), ESCMID Executive Office, P.O. Box 214, 4010 Basel, Switzerland
| | - Jeremy Gray
- UCD School of Biology and Environmental Science, University College Dublin, D04 N2E5 Dublin, Ireland
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Tannous T, Cheves TA, Sweeney JD. Red Cell Exchange as Adjunctive Therapy for Babesiosis: Is it Really Effective? Transfus Med Rev 2021; 35:16-21. [PMID: 34334285 DOI: 10.1016/j.tmrv.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Human babesiosis is a parasitic disease prevalent in the Northeastern and Midwestern United States (US). Treatment with antibiotics is the standard of care but red cell exchange (RCE) has been used as an adjunctive treatment in more severe disease. Data for the efficacy of RCE in the treatment of babesiosis has been based on case reports and case series. An English language literature search was conducted for cases of babesiosis treated with RCE since 1980 and relevant laboratory and clinical outcome data were extracted. Similar data were obtained on severe cases of babesiosis referred for RCE in our hospitals in the time period 2000 to 2020. Fifty reports including forty-one individual case reports and nine case series were retrieved. There were 108 patients that underwent RCE with an overall mortality rate of 20%. Some patients had more than one RCE. The patients varied in the level of anemia and evidence of compromise of renal or pulmonary function. The pre-RCE level of parasitemia varied between 1.7% to 85% with the vast majority >10%. The post-RCE level of parasitemia varied between 1% to 10%. Since 2000, 32 patients were referred for RCE in our hospitals and RCE was performed on 23 of 32. There were more patients treated with RCE in the second decade as compared to the first decade, 19 versus 4 respectively. The overall mortality was 22% similar to the national data. Comparing the cohort treated with RCE to the 9 patients who were treated only with antibiotics, there were similar levels of parasitemia and laboratory parameters. The overall number of days needed to achieve a parasite count <1% was similar between the two cohorts and mortality for the antibiotics only cohort was 0%. More than 40 years after the first reported case of RCE in severe babesiosis it cannot be concluded that this adjunctive therapy favorably influences the clinical outcome. Since there is largely equipoise, a registry of severe patients treated with or without RCE could identify a benefit or otherwise.
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Affiliation(s)
- Toufic Tannous
- Roger Williams Medical Center, Providence, RI, USA; Boston University School of Medicine, Boston, MA, USA
| | - Tracey A Cheves
- Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph D Sweeney
- Roger Williams Medical Center, Providence, RI, USA; Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
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A historical review of Babesia spp. associated with deer in Europe: Babesia divergens/Babesia divergens-like, Babesia capreoli, Babesia venatorum, Babesia cf. odocoilei. Vet Parasitol 2021; 294:109433. [PMID: 33930692 DOI: 10.1016/j.vetpar.2021.109433] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 04/10/2021] [Accepted: 04/17/2021] [Indexed: 01/17/2023]
Abstract
This review is intended to provide an overview of the occurrence and diversity of Babesia spp. in European deer. Babesiosis is an emerging vector-borne disease with negative implications on animal and public health. Cervidae are important hosts for Ixodidae ticks, playing a critical role in the epidemiology of the parasite. Deer are susceptible to different Babesia spp., some of them with zoonotic potential. The infection is usually asymptomatic with high prevalence rates, although some fatal cases due to B. capreoli and B. venatorum have been reported. In Europe, 3 main Babesia spp. have been described in deer: Babesia divergens/B. divergens-like, B. capreoli and B. venatorum. Additionally, close relatives of B. odocoilei, the Babesia species of the American white-tailed deer (Odocoileus virginianus), have been isolated in several European countries. The occurrence of B. divergens/B. divergens-like generated concerns about the role of cervidae in the life cycle of the parasite, and the potential threat for public health. Few human cases have been attributed to B. venatorum so far, including hunters. Although this species is strictly related to the presence of roe deer (Capreolus capreolus), it has been occasionally reported in moose (Alces alces) and captive reindeer (Rangifer tarandus). Over recent years, vector-borne diseases received increased attention from International Organizations. However, technical difficulties persist, affecting surveillance efficiency. Given the veterinary and zoonotic importance of babesiosis, the author advocates the need for an effective monitoring at wildlife-domestic animals-humans interface and the implementation of management plans to reduce the risk of Babesia spp. infection for both humans and domestic animals.
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Wilhelmsson P, Pawełczyk O, Jaenson TGT, Waldenström J, Olsen B, Forsberg P, Lindgren PE. Three Babesia species in Ixodes ricinus ticks from migratory birds in Sweden. Parasit Vectors 2021; 14:183. [PMID: 33794970 PMCID: PMC8017608 DOI: 10.1186/s13071-021-04684-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Migratory birds can cross geographical and environmental barriers and are thereby able to facilitate transmission of tick-borne pathogens both as carriers of infected ticks and as reservoirs of pathogenic microorganisms. Ixodes ricinus is one of the most abundant tick species in the Northern Hemisphere and a main vector of several Babesia species, some which pose a potential threat to human and animal health. At present only two cases of overt babesiosis in humans have so far been reported in Sweden. To better understand the potential role of birds as disseminators of zoonotic Babesia protozoan parasites, we investigated the presence of Babesia species in ticks removed from migratory birds. Methods Ticks were collected from birds captured at Ottenby Bird Observatory, south-eastern Sweden, from March to November 2009. Ticks were molecularly identified to species, and morphologically to developmental stage, and the presence of Babesia protozoan parasites was determined by real-time PCR. Results In total, 4601 migratory birds of 65 species were examined for tick infestation. Ticks removed from these birds have previously been investigated for the presence of Borrelia bacteria and the tick-borne encephalitis virus. In the present study, a total of 1102 ticks were available for molecular analysis of Babesia protozoan parasites. We found that 2.4% of the ticks examined, all I. ricinus, were positive for mammal-associated Babesia species. Out of all Babesia-positive samples, Babesia venatorum was the most prevalent (58%) species, followed by Babesia microti (38%) and Babesia capreoli (4.0%). B. venatorum and B. capreoli were detected in I. ricinus larvae, whereas B. microti was only present in I. ricinus nymphs. This supports the view that the two first-mentioned species are vertically (transovarially) transmitted in the tick population, in contrast to B. microti. The largest number of Babesia-infected ticks was removed from the common redstart (Phoenicurus phoenicurus) and European robin (Erithacus rubecula). Conclusions This study reveals that Babesia protozoan parasites are present in ticks infesting migratory birds in south-eastern Sweden, which could potentially lead to the dissemination of these tick-borne microorganisms into new areas, thus posing a threat to humans and other mammals. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04684-8.
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Affiliation(s)
- Peter Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.
| | - Olga Pawełczyk
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Parasitology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Thomas G T Jaenson
- Department of Organismal Biology, Evolutionary Biology Centre, Uppsala University, Uppsala, Sweden
| | - Jonas Waldenström
- Center for Ecology and Evolution in Microbial Model Systems, Linnaeus University, Kalmar, Sweden
| | - Björn Olsen
- Zoonosis Science Center, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per-Eric Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
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Circulation of Babesia Species and Their Exposure to Humans through Ixodes Ricinus. Pathogens 2021; 10:pathogens10040386. [PMID: 33804875 PMCID: PMC8063829 DOI: 10.3390/pathogens10040386] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Human babesiosis in Europe has been attributed to infection with Babesia divergens and, to a lesser extent, with Babesia venatorum and Babesia microti, which are all transmitted to humans through a bite of Ixodes ricinus. These Babesia species circulate in the Netherlands, but autochthonous human babesiosis cases have not been reported so far. To gain more insight into the natural sources of these Babesia species, their presence in reservoir hosts and in I. ricinus was examined. Moreover, part of the ticks were tested for co-infections with other tick borne pathogens. In a cross-sectional study, qPCR-detection was used to determine the presence of Babesia species in 4611 tissue samples from 27 mammalian species and 13 bird species. Reverse line blotting (RLB) and qPCR detection of Babesia species were used to test 25,849 questing I. ricinus. Fragments of the 18S rDNA and cytochrome c oxidase subunit I (COI) gene from PCR-positive isolates were sequenced for confirmation and species identification and species-specific PCR reactions were performed on samples with suspected mixed infections. Babesia microti was found in two widespread rodent species: Myodes glareolus and Apodemus sylvaticus, whereas B. divergens was detected in the geographically restricted Cervus elaphus and Bison bonasus, and occasionally in free-ranging Ovis aries. B. venatorum was detected in the ubiquitous Capreolus capreolus, and occasionally in free-ranging O. aries. Species-specific PCR revealed co-infections in C. capreolus and C. elaphus, resulting in higher prevalence of B. venatorum and B. divergens than disclosed by qPCR detection, followed by 18S rDNA and COI sequencing. The non-zoonotic Babesia species found were Babesia capreoli, Babesia vulpes, Babesia sp. deer clade, and badger-associated Babesia species. The infection rate of zoonotic Babesia species in questing I. ricinus ticks was higher for Babesia clade I (2.6%) than Babesia clade X (1.9%). Co-infection of B. microti with Borrelia burgdorferi sensu lato and Neoehrlichia mikurensis in questing nymphs occurred more than expected, which reflects their mutual reservoir hosts, and suggests the possibility of co-transmission of these three pathogens to humans during a tick bite. The ubiquitous spread and abundance of B. microti and B. venatorum in their reservoir hosts and questing ticks imply some level of human exposure through tick bites. The restricted distribution of the wild reservoir hosts for B. divergens and its low infection rate in ticks might contribute to the absence of reported autochthonous cases of human babesiosis in the Netherlands.
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Emerging Human Babesiosis with "Ground Zero" in North America. Microorganisms 2021; 9:microorganisms9020440. [PMID: 33672522 PMCID: PMC7923768 DOI: 10.3390/microorganisms9020440] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
The first case of human babesiosis was reported in the literature in 1957. The clinical disease has sporadically occurred as rare case reports in North America and Europe in the subsequent decades. Since the new millennium, especially in the last decade, many more cases have apparently appeared not only in these regions but also in Asia, South America, and Africa. More than 20,000 cases of human babesiosis have been reported in North America alone. In several cross-sectional surveys, exposure to Babesia spp. has been demonstrated within urban and rural human populations with clinical babesiosis reported in both immunocompromised and immunocompetent humans. This review serves to highlight the widespread distribution of these tick-borne pathogens in humans, their tick vectors in readily accessible environments such as parks and recreational areas, and their phylogenetic relationships.
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Kjær LJ, Klitgaard K, Soleng A, Edgar KS, Lindstedt HEH, Paulsen KM, Andreassen ÅK, Korslund L, Kjelland V, Slettan A, Stuen S, Kjellander P, Christensson M, Teräväinen M, Baum A, Jensen LM, Bødker R. Spatial patterns of pathogen prevalence in questing Ixodes ricinus nymphs in southern Scandinavia, 2016. Sci Rep 2020; 10:19376. [PMID: 33168841 PMCID: PMC7652892 DOI: 10.1038/s41598-020-76334-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Tick-borne pathogens cause diseases in animals and humans, and tick-borne disease incidence is increasing in many parts of the world. There is a need to assess the distribution of tick-borne pathogens and identify potential risk areas. We collected 29,440 tick nymphs from 50 sites in Scandinavia from August to September, 2016. We tested ticks in a real-time PCR chip, screening for 19 vector-associated pathogens. We analysed spatial patterns, mapped the prevalence of each pathogen and used machine learning algorithms and environmental variables to develop predictive prevalence models. All 50 sites had a pool prevalence of at least 33% for one or more pathogens, the most prevalent being Borrelia afzelii, B. garinii, Rickettsia helvetica, Anaplasma phagocytophilum, and Neoehrlichia mikurensis. There were large differences in pathogen prevalence between sites, but we identified only limited geographical clustering. The prevalence models performed poorly, with only models for R. helvetica and N. mikurensis having moderate predictive power (normalized RMSE from 0.74-0.75, R2 from 0.43-0.48). The poor performance of the majority of our prevalence models suggest that the used environmental and climatic variables alone do not explain pathogen prevalence patterns in Scandinavia, although previously the same variables successfully predicted spatial patterns of ticks in the same area.
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Affiliation(s)
- Lene Jung Kjær
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.
| | - Kirstine Klitgaard
- Department for Diagnostics and Scientific Advice, National Veterinary Institute, Technical University of Denmark, Lyngby, Denmark
| | - Arnulf Soleng
- Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Katrine M Paulsen
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Production Animal Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | | | - Lars Korslund
- Department of Natural Sciences, University of Agder, Kristiansand, Norway
| | - Vivian Kjelland
- Department of Natural Sciences, University of Agder, Kristiansand, Norway
- Research Unit, Sørlandet Hospital Health Enterprise, Kristiansand, Norway
| | - Audun Slettan
- Department of Natural Sciences, University of Agder, Kristiansand, Norway
| | - Snorre Stuen
- Department of Production Animal Clinical Sciences, Section of Small Ruminant Research, Norwegian University of Life Sciences, Sandnes, Norway
| | - Petter Kjellander
- Department of Ecology, Grimsö Wildlife Research Station, Swedish University of Agricultural Sciences, Riddarhyttan, Sweden
| | - Madeleine Christensson
- Department of Ecology, Grimsö Wildlife Research Station, Swedish University of Agricultural Sciences, Riddarhyttan, Sweden
| | - Malin Teräväinen
- Department of Ecology, Grimsö Wildlife Research Station, Swedish University of Agricultural Sciences, Riddarhyttan, Sweden
| | - Andreas Baum
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Laura Mark Jensen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - René Bødker
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Abstract
PURPOSE OF REVIEW As human babesiosis caused by apicomplexan parasites of the Babesia genus is associated with transfusion-transmitted illness and relapsing disease in immunosuppressed populations, it is important to report novel findings relating to parasite biology that may be responsible for such pathology. Blood screening tools recently licensed by the FDA are also described to allow understanding of their impact on keeping the blood supply well tolerated. RECENT FINDINGS Reports of tick-borne cases within new geographical regions such as the Pacific Northwest of the USA, through Eastern Europe and into China are also on the rise. Novel features of the parasite lifecycle that underlie the basis of parasite persistence have recently been characterized. These merit consideration in deployment of both detection, treatment and mitigation tools such as pathogen inactivation technology. The impact of new blood donor screening tests in reducing transfusion transmitted babesiosis is discussed. SUMMARY New Babesia species have been identified globally, suggesting that the epidemiology of this disease is rapidly changing, making it clear that human babesiosis is a serious public health concern that requires close monitoring and effective intervention measures. Unlike other erythrocytic parasites, Babesia exploits unconventional lifecycle strategies that permit host cycles of different lengths to ensure survival in hostile environments. With the licensure of new blood screening tests, incidence of transfusion transmission babesiosis has decreased.
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Affiliation(s)
- Cheryl A Lobo
- Department of Blood-Borne Parasites, Lindsley Kimball Research Institute, New York Blood Center, New York, New York, USA
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Wilhelmsson P, Lövmar M, Krogfelt KA, Nielsen HV, Forsberg P, Lindgren PE. Clinical/serological outcome in humans bitten by Babesia species positive Ixodes ricinus ticks in Sweden and on the Åland Islands. Ticks Tick Borne Dis 2020; 11:101455. [PMID: 32386909 DOI: 10.1016/j.ttbdis.2020.101455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
The risk of contracting babesiosis after a tick bite in Sweden and on the Åland Islands, Finland, is unknown. We investigated clinical and serological outcomes in people bitten by Ixodes ricinus ticks positive for Babesia species. Ticks, blood and questionnaires were obtained from study participants in Sweden and on the Åland Islands. Sixty-five of 2098 (3.1 %) ticks were positive by real-time PCR. Three Babesia species were detected, Babesia microti (n = 33), B. venatorum (n = 27) and B. capreoli (n = 5), the latter species not known to cause human infection. Half (46 %) of the Babesia PCR-positive ticks also contained Borrelia spp. Fifty-three participants bitten by a Babesia PCR-positive tick and a control group bitten by a Babesia PCR-negative tick were tested for B. microti IgG antibodies by IFA. The overall seroprevalence was 4.4 %, but there was no significant difference between the groups. None of the participants seroconverted and no participant with a Babesia PCR-positive tick sought medical care or reported symptoms suggestive of babesiosis. Given the prevalence of Babesia in I. ricinus ticks in southern Sweden and on the Åland Islands, babesiosis should be considered a possible diagnosis in symptomatic residents who seek medical care following tick exposure.
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Affiliation(s)
- P Wilhelmsson
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.
| | - M Lövmar
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - K A Krogfelt
- Department of Bacteria Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark; Department of Science and Environmental, Roskilde University, Denmark.
| | - H V Nielsen
- Department of Bacteria Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark.
| | - P Forsberg
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - P E Lindgren
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden.
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Thortveit ET, Aase A, Petersen LB, Lorentzen ÅR, Mygland Å, Ljøstad U. Human seroprevalence of antibodies to tick-borne microbes in southern Norway. Ticks Tick Borne Dis 2020; 11:101410. [PMID: 32156478 DOI: 10.1016/j.ttbdis.2020.101410] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/30/2020] [Accepted: 02/21/2020] [Indexed: 11/15/2022]
Abstract
The tick Ixodes ricinus is widespread along the coastline of southern Norway, but data on human exposure to tick-borne microbes are scarce. We aimed to assess the seroprevalence of IgG antibodies to various tick-borne microbes in the general adult population living in a Norwegian municipality where ticks are abundant. Søgne is a coastline municipality in the southernmost part of Norway, and has a high density of ticks. All individuals aged 18-69 years with residential address in Søgne municipality (n = 7424) were invited to give a blood sample and answer a questionnaire. Blood samples from 3568 individuals were available for analysis. All samples were analyzed for IgG antibodies to Borrelia burgdorferi sensu lato (Bbsl), and around 1500 samples for IgG antibodies to other tick-borne microbes. Serum IgG antibodies to Bbsl were present in 22.0% (785/3568) of the tested samples, tick-borne encephalitis virus (TBEV) in 3.1% (45/1453), Anaplasma phagocytophilum in 11.0% (159/1452), Babesia microti in 2.1% (33/1537), Bartonella henselae/B. quintana in 0.1% (2/1451) and Rickettsia helvetica/R. conorii in 4.2% (60/1445). Serum IgG antibodies to A. phagocytophilum and R. helvetica/R. conorii were significantly more prevalent (p = 0.010 and p = 0.016, respectively) among individuals with serum IgG antibodies to Bbsl than among individuals without. In conclusion, our study showed a high exposure to Bbsl in the general adult population living in a coastline municipality in the southernmost part of Norway. The population is also exposed to A. phagocytophilum, R. helvetica/R. conorii, B. microti and TBEV, but very rarely B. henselae/B. quintana.
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Affiliation(s)
| | - Audun Aase
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Lizette Balle Petersen
- Department of Infectious Disease Immunology, Norwegian Institute of Public Health, Oslo, Norway.
| | - Åslaug Rudjord Lorentzen
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; The Norwegian National Advisory Unit on Tick-Borne Diseases, Sørlandet Hospital Trust, Arendal, Norway.
| | - Åse Mygland
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Habilitation, Sørlandet Hospital Trust, Kristiansand, Norway.
| | - Unn Ljøstad
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Azagi T, Hoornstra D, Kremer K, Hovius JWR, Sprong H. Evaluation of Disease Causality of Rare Ixodes ricinus-Borne Infections in Europe. Pathogens 2020; 9:pathogens9020150. [PMID: 32102367 PMCID: PMC7168666 DOI: 10.3390/pathogens9020150] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/13/2022] Open
Abstract
In Europe, Ixodes ricinus ticks transmit pathogens such as Borrelia burgdorferi sensu lato and tick-borne encephalitis virus (TBEV). In addition, there is evidence for transmission to humans from I. ricinus of Anaplasma phagocytophilum, Babesia divergens, Babesia microti, Babesia venatorum, Borrelia miyamotoi, Neoehrlichia mikurensis, Rickettsia helvetica and Rickettsia monacensis. However, whether infection with these potential tick-borne pathogens results in human disease has not been fully demonstrated for all of these tick-borne microorganisms. To evaluate the available evidence for a causative relation between infection and disease, the current study analyses European case reports published from 2008 to 2018, supplemented with information derived from epidemiological and experimental studies. The evidence for human disease causality in Europe found in this review appeared to be strongest for A. phagocytophilum and B. divergens. Nonetheless, some knowledge gaps still exist. Importantly, comprehensive evidence for pathogenicity is lacking for the remaining tick-borne microorganisms. Such evidence could be gathered best through prospective studies, for example, studies enrolling patients with a fever after a tick bite, the development of specific new serological tools, isolation of these microorganisms from ticks and patients and propagation in vitro, and through experimental studies.
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Affiliation(s)
- Tal Azagi
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
- Correspondence:
| | - Dieuwertje Hoornstra
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; (D.H.); (J.W.R.H.)
| | - Kristin Kremer
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
| | - Joppe W. R. Hovius
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers Location Academic Medical Center, Amsterdam 1105 AZ, The Netherlands; (D.H.); (J.W.R.H.)
| | - Hein Sprong
- Centre for Infectious Diseases Research, National Institute for Public Health and the Environment, P.O. Box 1, Bilthoven 3720 BA, The Netherlands; (K.K.); (H.S.)
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Abstract
Increases in tick-borne disease prevalence and transmission are important public health issues. Efforts to control these emerging diseases are frustrated by the struggle to control tick populations and to detect and treat infections caused by the pathogens that they transmit. This review covers tick-borne infectious diseases of nonrickettsial bacterial, parasitic, and viral origins. While tick surveillance and tracking inform our understanding of the importance of the spread and ecology of ticks and help identify areas of risk for disease transmission, the vectors are not the focus of this document. Here, we emphasize the most significant pathogens that infect humans as well as the epidemiology, clinical features, diagnosis, and treatment of diseases that they cause. Although detection via molecular or immunological methods has improved, tick-borne diseases continue to remain underdiagnosed, making the scope of the problem difficult to assess. Our current understanding of the incidence of tick-borne diseases is discussed in this review. An awareness of the diseases that can be transmitted by ticks in specific locations is key to detection and selection of appropriate treatment. As tick-transmitted pathogens are discovered and emerge in new geographic regions, our ability to detect, describe, and understand the growing public health threat must also grow to meet the challenge.
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Young KM, Corrin T, Wilhelm B, Uhland C, Greig J, Mascarenhas M, Waddell LA. Zoonotic Babesia: A scoping review of the global evidence. PLoS One 2019; 14:e0226781. [PMID: 31887120 PMCID: PMC6936817 DOI: 10.1371/journal.pone.0226781] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Babesiosis is a parasitic vector-borne disease of increasing public health importance. Since the first human case was reported in 1957, zoonotic species have been reported on nearly every continent. Zoonotic Babesia is vectored by Ixodes ticks and is commonly transmitted in North America by Ixodes scapularis, the tick species responsible for transmitting the pathogens that also cause Lyme disease, Powassan virus, and anaplasmosis in humans. Predicted climate change is expected to impact the spread of vectors, which is likely to affect the distribution of vector-borne diseases including human babesiosis. METHODS A scoping review has been executed to characterize the global evidence on zoonotic babesiosis. Articles were compiled through a comprehensive search of relevant bibliographic databases and targeted government websites. Two reviewers screened titles and abstracts for relevance and characterized full-text articles using a relevance screening and data characterization tool developed a priori. RESULTS This review included 1394 articles relevant to human babesiosis and/or zoonotic Babesia species. The main zoonotic species were B. microti, B. divergens, B. duncani and B. venatorum. Articles described a variety of study designs used to study babesiosis in humans and/or zoonotic Babesia species in vectors, animal hosts, and in vitro cell cultures. Topics of study included: pathogenesis (680 articles), epidemiology (480), parasite characterization (243), diagnostic test accuracy (98), mitigation (94), treatment (65), transmission (54), surveillance (29), economic analysis (7), and societal knowledge (1). No articles reported predictive models investigating the impact of climate change on Babesia species. CONCLUSION Knowledge gaps in the current evidence include research on the economic burden associated with babesiosis, societal knowledge studies, surveillance of Babesia species in vectors and animal hosts, and predictive models on the impact of climate change. The scoping review results describe the current knowledge and knowledge gaps on zoonotic Babesia which can be used to inform future policy and decision making.
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Affiliation(s)
- Kaitlin M. Young
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Tricia Corrin
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | | | - Carl Uhland
- Independent Consultant, St-Hyacinthe, Quebec, Canada
| | - Judy Greig
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Mariola Mascarenhas
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Lisa A. Waddell
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
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Kukina IV, Zelya OP, Guzeeva TM, Karan LS, Perkovskaya IA, Tymoshenko NI, Guzeeva MV. Severe babesiosis caused by Babesia divergens in a host with intact spleen, Russia, 2018. Ticks Tick Borne Dis 2019; 10:101262. [DOI: 10.1016/j.ttbdis.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/17/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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Razanske I, Rosef O, Radzijevskaja J, Bratchikov M, Griciuviene L, Paulauskas A. Prevalence and co-infection with tick-borne Anaplasma phagocytophilum and Babesia spp. in red deer ( Cervus elaphus) and roe deer ( Capreolus capreolus) in Southern Norway. INTERNATIONAL JOURNAL FOR PARASITOLOGY-PARASITES AND WILDLIFE 2019; 8:127-134. [PMID: 30766793 PMCID: PMC6360459 DOI: 10.1016/j.ijppaw.2019.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 01/19/2023]
Abstract
Anaplasma phagocytophilum and Babesia spp. are causative agents of tick-borne infections that are increasingly considered as a threat to animal and public health. To assess the role of cervids in the maintenance of zoonotic pathogens in Norway, we investigated the prevalence of A. phagocytophilum and Babesia spp. in free-ranging roe deer and red deer. Initial screening of spleen samples of 104 animals by multiplex real-time PCR targeting the major surface protein (msp2) gene and 18S rRNA revealed the presence of A. phagocytophilum infection in 81.1% red deer (Cervus elaphus) and 88.1% roe deer (Capreolus capreolus), and Babesia spp. parasites in 64.9% red deer and 83.6% roe deer, respectively. Co-infections were found in 62.2% red deer and 79.9% roe deer. Nested PCR and sequence analysis of partial msp4 and 18S rRNA genes were performed for molecular characterization of A. phagocytophilum strains and Babesia species. A total of eleven A. phagocytophilum msp4 gene sequence variants were identified: five different variants were 100% identical to corresponding A. phagocytophilum sequences deposited in the GenBank database, while other six sequence variants had unique nucleotide polymorphisms. Sequence analysis of the 18S rRNA gene demonstrated the presence of multiple Babesia species, including Babesia capreoli, Babesia divergens, Babesia venatorum and Babesia odocoilei/Babesia cf. odocoilei. This study is the first report demonstrating the prevalence and molecular characterization of A. phagocytophilum strains and Babesia species in roe deer and red deer in Norway. The high infection and co-infection rates with A. phagocytophilum and Babesia spp. in red deer and roe deer suggest that these cervids may play an important role in the transmission of single and multiple pathogens.
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Affiliation(s)
- Irma Razanske
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania
| | - Olav Rosef
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania.,Rosef Field Research Station, Frolandsveien 2667, 4828, Mjåvatn, Norway
| | - Jana Radzijevskaja
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania
| | - Maksim Bratchikov
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania.,Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, M.K. Čiurlionio 21, LT-03101, Vilnius, Lithuania
| | - Loreta Griciuviene
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania
| | - Algimantas Paulauskas
- Department of Biology, Vytautas Magnus University, Vileikos 8, LT -444404, Kaunas, Lithuania
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Leiby DA, O'Brien SF, Wendel S, Nguyen ML, Delage G, Devare SG, Hardiman A, Nakhasi HL, Sauleda S, Bloch EM. International survey on the impact of parasitic infections: frequency of transmission and current mitigation strategies. Vox Sang 2018; 114:17-27. [PMID: 30523642 DOI: 10.1111/vox.12727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Globally, blood safety interventions have been successful in mitigating risk of the major transfusion-transmitted (TT) viruses. However, strategies that address risk from parasites are comparatively limited. TT parasites are often regional in nature, posing unique challenges; we sought to understand their impact on blood safety. MATERIALS AND METHODS An electronic questionnaire was distributed to transfusion medicine leaders in 100 countries. The survey focused on specific questions pertaining to four parasitic diseases: babesiosis, Chagas, leishmaniasis and malaria. Respondents provided data on historical TT cases, local epidemiology, policies to mitigate risk and an assessment of public health perceptions for each aetiologic agent. RESULTS Twenty-eight (28%) surveys were returned from countries in Europe (n = 13), the Americas (n = 6), Africa (n = 4), Asia (n = 3) and Oceana (n = 2). Historically, no cases of TT leishmaniasis were reported, TT babesiosis was exclusive to Canada and the USA, TT Chagas was limited to the Americas and Spain, while TT malaria was cosmopolitan. Mitigation efforts varied widely; malaria was the most frequently tested parasitic disease. The public's perception of risk for parasitic agents was low, while that of health authorities in endemic countries was higher. CONCLUSION The global impact of parasitic infections on blood safety and related mitigation efforts varied widely by parasite epidemiology, test availability, public health priorities and socioeconomic constraints. While parasites continue to pose a risk to blood safety, the successful mitigation of viral risk has elevated the prominence of TT parasites in many locations, thereby requiring consideration of mitigation efforts.
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Affiliation(s)
- David A Leiby
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, ON, USA
| | | | - Megan L Nguyen
- Transmissible Diseases Department, American Red Cross Holland Laboratory, Rockville, MD, USA
| | - Gilles Delage
- Medical Affairs, Microbiology, Héma-Quebec, Montreal, Quebec, Canada
| | | | | | - Hira L Nakhasi
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Silvia Sauleda
- Transfusion Safety Laboratory, Catalonian Blood Bank (Banc de Sang i Teixits de Catalunya), Barcelona, Spain
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Jajosky RP, Jajosky AN, Jajosky PG. Optimizing exchange transfusion for patients with severe Babesia divergens babesiosis: Therapeutically-Rational Exchange (T-REX) of M antigen-negative and/or S antigen-negative red blood cells should be evaluated now. Transfus Clin Biol 2018; 26:76-79. [PMID: 30447802 DOI: 10.1016/j.tracli.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
Babesia divergens is an intraerythrocytic parasite, which is the major cause of babesiosis in Europe. For years, clinicians have been publishing stunning case reports that describe how some - but not all - conventional red blood cell (RBC) exchange transfusions have saved the lives of severely ill babesiosis patients. Due to markedly different patient outcomes, clinicians agree that new treatments and additional studies are needed. Here we argue that we should evaluate "therapeutically-rational exchange" (T-REX) in which the RBCs used to replace Babesia-parasitized RBCs are special disease-resistant RBC genetic variants (instead of the nondescript, "standard issue" RBCs used in conventional exchanges). T-REX seems prudent because with conventional exchange only some units of "standard issue" RBCs may be disease-resistant, while other units may not protect or may even promote disease. The random selection of RBCs for conventional RBC exchange may explain why clinical outcomes can vary dramatically. Fortunately, researchers have found that M antigen-negative (M-) and S antigen-negative (S-) RBCs resist invasion by B. divergens. Thus, we recommend evaluating T-REX of RBC variants that are B. divergens invasion-resistant: RBCs that are (1) M-, (2) S-, or (3) both M- and S-. By using only Babesia-resistant RBCs, T-REX eliminates the risk of unintentionally infusing Babesia-susceptible RBCs that might increase the severity of babesiosis. Because the T-REX variation of the conventional RBC exchange procedure is feasible, safe, and biologically plausible, we feel T-REX of Babesia-resistant RBCs should now be evaluated.
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Affiliation(s)
- R P Jajosky
- Department of Pathology, Emory University, Atlanta, GA, USA; Biconcavity Inc., Lilburn, GA, USA.
| | - A N Jajosky
- Pathology Department, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - P G Jajosky
- Biconcavity Inc., Lilburn, GA, USA; Retired USPHS Commissioned Corps, Centers for Disease Control and Prevention, Atlanta, GA, USA
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28
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Jalovecka M, Hartmann D, Miyamoto Y, Eckmann L, Hajdusek O, O'Donoghue AJ, Sojka D. Validation of Babesia proteasome as a drug target. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2018; 8:394-402. [PMID: 30103207 PMCID: PMC6092455 DOI: 10.1016/j.ijpddr.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022]
Abstract
Babesiosis is a tick-transmitted zoonosis caused by apicomplexan parasites of the genus Babesia. Treatment of this emerging malaria-related disease has relied on antimalarial drugs and antibiotics. The proteasome of Plasmodium, the causative agent of malaria, has recently been validated as a target for anti-malarial drug development and therefore, in this study, we investigated the effect of epoxyketone (carfilzomib, ONX-0914 and epoxomicin) and boronic acid (bortezomib and ixazomib) proteasome inhibitors on the growth and survival of Babesia. Testing the compounds against Babesia divergens ex vivo revealed suppressive effects on parasite growth with activity that was higher than the cytotoxic effects on a non-transformed mouse macrophage cell line. Furthermore, we showed that the most-effective compound, carfilzomib, significantly reduces parasite multiplication in a Babesia microti infected mouse model without noticeable adverse effects. In addition, treatment with carfilzomib lead to an ex vivo and in vivo decrease in proteasome activity and accumulation of polyubiquitinated proteins compared to untreated control. Overall, our results demonstrate that the Babesia proteasome is a valid target for drug development and warrants the design of potent and selective B. divergens proteasome inhibitors for the treatment of babesiosis.
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Affiliation(s)
- Marie Jalovecka
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-370 05, Ceske Budejovice, Czech Republic; Faculty of Science, University of South Bohemia, CZ-370 05, Ceske Budejovice, Czech Republic
| | - David Hartmann
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-370 05, Ceske Budejovice, Czech Republic; Faculty of Science, University of South Bohemia, CZ-370 05, Ceske Budejovice, Czech Republic
| | - Yukiko Miyamoto
- Department of Medicine, University of California, San Diego, La Jolla, USA
| | - Lars Eckmann
- Department of Medicine, University of California, San Diego, La Jolla, USA
| | - Ondrej Hajdusek
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-370 05, Ceske Budejovice, Czech Republic
| | - Anthony J O'Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, USA.
| | - Daniel Sojka
- Institute of Parasitology, Biology Centre of the Czech Academy of Sciences, CZ-370 05, Ceske Budejovice, Czech Republic.
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29
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Sayama Y, Zamoto-Niikura A, Matsumoto C, Saijo M, Ishihara C, Matsubayashi K, Nagai T, Satake M. Analysis of antigen-antibody cross-reactivity among lineages and sublineages of Babesia microti parasites using human babesiosis specimens. Transfusion 2018. [PMID: 29524239 DOI: 10.1111/trf.14558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human babesiosis is caused mainly by Babesia microti and has recently become a public health concern due to an increase in transfusion-transmitted infection. Thus, the development of an antibody detection method with high specificity and sensitivity is a priority. Seroreactivity against B. microti has been reported to be highly specific not only to B. microti lineages but also to sublineages. This study aimed to elucidate the human antibody reactivity against various lineages, including US, Kobe, and Hobetsu, and sublineages (North America and East Asia) in the US lineage. STUDY DESIGN AND METHODS Twenty samples obtained from individuals infected with B. microti in the United States were tested for the presence of anti-B. microti antibodies using indirect immunofluorescence assay (IFA) and Western blotting (WB) to indicate antigens of each (sub-)lineage. RESULTS By IFA, 20 samples showed reactivity to the North America sublineage (titer range, 64-4096), 16 to the East Asia sublineage (64-512), 10 to the Kobe (64-128), and five to the Hobetsu (64). Antibody titers to the East Asia sublineage, Kobe, and Hobetsu were significantly lower than those to the North America sublineage (p < 0.01). By WB, in parallel with the IFA results, 18 samples showed strong reactions to the North America sublineage, weak reactions to the East Asia sublineage, and near-zero reactions to the Kobe and Hobetsu. CONCLUSION Human antibodies induced by B. microti infection are highly specific against B. microti lineages and sublineages with low cross-reactivity. Developing a precise antibody detection method may require specific antigens based on B. microti lineages and sublineages.
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Affiliation(s)
- Yusuke Sayama
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, National Institute of Infectious Diseases, Tokyo, Japan.,Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Aya Zamoto-Niikura
- Division of Experimental Animal Diseases, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chieko Matsumoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chiaki Ishihara
- School of Veterinary Medicine, Rakuno-Gakuen University, Ebetsu, Japan
| | - Keiji Matsubayashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tadashi Nagai
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, National Institute of Infectious Diseases, Tokyo, Japan
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30
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Neglected vector-borne zoonoses in Europe: Into the wild. Vet Parasitol 2017; 251:17-26. [PMID: 29426471 DOI: 10.1016/j.vetpar.2017.12.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/22/2022]
Abstract
Wild vertebrates are involved in the transmission cycles of numerous pathogens. Additionally, they can affect the abundance of arthropod vectors. Urbanization, landscape and climate changes, and the adaptation of vectors and wildlife to human habitats represent complex and evolving scenarios, which affect the interface of vector, wildlife and human populations, frequently with a consequent increase in zoonotic risk. While considerable attention has focused on these interrelations with regard to certain major vector-borne pathogens such as Borrelia burgdorferi s.l. and tick-borne encephalitis virus, information regarding many other zoonotic pathogens is more dispersed. In this review, we discuss the possible role of wildlife in the maintenance and spread of some of these neglected zoonoses in Europe. We present case studies on the role of rodents in the cycles of Bartonella spp., of wild ungulates in the cycle of Babesia spp., and of various wildlife species in the life cycle of Leishmania infantum, Anaplasma phagocytophilum and Rickettsia spp. These examples highlight the usefulness of surveillance strategies focused on neglected zoonotic agents in wildlife as a source of valuable information for health professionals, nature managers and (local) decision-makers. These benefits could be further enhanced by increased collaboration between researchers and stakeholders across Europe and a more harmonised and coordinated approach for data collection.
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31
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Quarsten H, Grankvist A, Høyvoll L, Myre IB, Skarpaas T, Kjelland V, Wenneras C, Noraas S. Candidatus Neoehrlichia mikurensis and Borrelia burgdorferi sensu lato detected in the blood of Norwegian patients with erythema migrans. Ticks Tick Borne Dis 2017; 8:715-720. [PMID: 28539197 DOI: 10.1016/j.ttbdis.2017.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/21/2022]
Abstract
The most common tick-borne human disease in Norway is Lyme borreliosis. Ticks in Norway also harbour less known disease-causing agents such as Candidatus Neoehrlichia mikurensis, Borrelia miyamotoi and Rickettsia helvetica. However, human infections caused by these pathogens have never been described in Norway. The main aims of the study were to evaluate the contribution of several tick-borne bacterial agents, other than Borrelia burgdorferi sensu lato, to zoonotic diseases in Norway and to determine their clinical pictures. Blood samples from 70 symptomatic tick-bitten adults from the Agder counties in southern Norway were screened for seven tick-borne pathogens by using a commercial multiplex PCR-based method and by singleplex real-time PCR protocols. Most patients (65/70) presented with a rash clinically diagnosed as erythema migrans (EM). The most frequently detected pathogen DNA was from Ca. N. mikurensis and was found in the blood of 10% (7/70) of the patients. The Ca. N. mikurensis-infected patients presented with an EM-like rash as the only symptom. B. burgdorferi s.l. DNA was present in the blood of 4% (3/70) of the study participants. None had detectable Anaplasma phagocytophilum, B. miyamotoi, Rickettsia typhus group or spotted fever group, Francisella tularensis, Coxiella burnetii or Bartonella spp. DNA in the blood. The commercially available multiplex PCR bacteria flow chip system failed to identify half of the infected patients detected by corresponding real-time PCR protocols. The recovery of Ca. N. mikurensis DNA was higher in the pellet/plasma fraction of blood than from whole blood. To conclude, Ca. N. mikurensis appeared to be the etiological agent in patients with EM in a surprisingly large fraction of tick-bitten persons in the southern part of Norway.
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Affiliation(s)
- H Quarsten
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, Egsveien 100, PO-Box 416, NO-4604, Kristiansand, Norway.
| | - A Grankvist
- University of Gothenburg, Department of Infectious Diseases, Guldhedsgatan 10, 413 46 Göteborg, Sweden
| | - L Høyvoll
- Sørlandet Hospital Health Enterprise, Medical Department, Egsveien 100, PO-Box 416, NO-4604 Kristiansand, Norway
| | - I B Myre
- University of Agder, Faculty of Engineering and Science, Department of Natural Sciences, Gimlemoen 25, PO-Box 422, NO-4604 Kristiansand, Norway
| | - T Skarpaas
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, Egsveien 100, PO-Box 416, NO-4604, Kristiansand, Norway
| | - V Kjelland
- University of Agder, Faculty of Engineering and Science, Department of Natural Sciences, Gimlemoen 25, PO-Box 422, NO-4604 Kristiansand, Norway; Sørlandet Hospital Health Enterprise, Research Unit, Egsveien 100, PO-Box 416, NO-4604 Kristiansand, Norway
| | - C Wenneras
- University of Gothenburg, Department of Infectious Diseases, Guldhedsgatan 10, 413 46 Göteborg, Sweden
| | - S Noraas
- Sørlandet Hospital Health Enterprise, Department of Medical Microbiology, Egsveien 100, PO-Box 416, NO-4604, Kristiansand, Norway
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32
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O'Connell S, Lyons C, Abdou M, Patowary R, Aslam S, Kinsella N, Zintl A, Hunfeld KP, Wormser GP, Gray J, Merry C, Alizadeh H. Splenic dysfunction from celiac disease resulting in severe babesiosis. Ticks Tick Borne Dis 2017; 8:537-539. [PMID: 28286145 DOI: 10.1016/j.ttbdis.2017.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 02/26/2017] [Accepted: 02/27/2017] [Indexed: 11/26/2022]
Abstract
We describe a 79-year-old Irish man who, because he had hyposplenism and splenic atrophy due to adult celiac disease, became critically ill from a severe Babesia divergens infection. Greater awareness of the possible consequences of splenic dysfunction from adult celiac disease, such as serious pneumococcal infections and babesiosis, is warranted.
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Affiliation(s)
- Sarah O'Connell
- Department of Infectious Diseases, St. James's Hospital, Dublin 8, Ireland.
| | - Craig Lyons
- Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland
| | - Moustafa Abdou
- Department of Haematology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Rittick Patowary
- Department of Haematology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Salman Aslam
- Department of Haematology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Nora Kinsella
- Department of Haematology, St. James's Hospital, Dublin, Ireland
| | - Annetta Zintl
- School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Academic Teaching Hospital, Goethe-University, Frankfurt, Germany
| | - Gary P Wormser
- Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jeremy Gray
- UCD School of Biology and Environmental Science, University College Dublin, Dublin 4, Ireland
| | - Concepta Merry
- Department of Infectious Diseases, St. James's Hospital, Dublin 8, Ireland; Northwestern Memorial University Chicago, USA; Makerere University Uganda, Uganda
| | - Hussain Alizadeh
- Department of Haematology, Letterkenny University Hospital, Letterkenny, Ireland; Pecs University, Faculty of General Medicine, Pecs, Hungary
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33
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Zintl A, Moutailler S, Stuart P, Paredis L, Dutraive J, Gonzalez E, O'Connor J, Devillers E, Good B, OMuireagain C, De Waal T, Morris F, Gray J. Ticks and Tick-borne diseases in Ireland. Ir Vet J 2017; 70:4. [PMID: 28163889 PMCID: PMC5282849 DOI: 10.1186/s13620-017-0084-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/19/2017] [Indexed: 11/12/2022] Open
Abstract
Throughout Europe interest in tick-borne agents is increasing, particularly with regard to those that can cause human disease. The reason for this is the apparent rise in the incidence of many tick-borne diseases (TBD’s). While there has never been a national survey of ticks or TBD’s in Ireland, the trend here appears to be the reverse with a decline in the incidence of some agents seemingly associated with decreasing tick numbers particularly on agricultural land. In the absence of robust baseline data, however, this development cannot be confirmed. This review collates the limited information available from several dated published records on tick species and a small number of studies focused on certain TBD’s. Some pilot data on tick density and TBD agents collected in 2016 are also presented. The aim is to explore the particular situation in Ireland with regard to ticks and TBD’s and to provide a reference for future workers in the field.
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Affiliation(s)
- Annetta Zintl
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Ireland
| | - Sara Moutailler
- UMR BIPAR, ANSES, INRA, ENVA, Animal Health Laboratory, 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - Peter Stuart
- Department of Zoology, Trinity College Dublin, Dublin 2, Ireland
| | - Linda Paredis
- Department of Zoology, Trinity College Dublin, Dublin 2, Ireland
| | | | | | | | - Elodie Devillers
- UMR BIPAR, ANSES, INRA, ENVA, Animal Health Laboratory, 14 rue Pierre et Marie Curie, 94700 Maisons-Alfort, France
| | - Barbara Good
- Animal & Grassland Research and Innovation Centre, Teagasc, Athenry, Co. Galway Ireland
| | - Colm OMuireagain
- Department of Agriculture, Food and the Marine, Sligo Regional Veterinary Laboratory, Sligo, Ireland
| | - Theo De Waal
- UCD School of Veterinary Medicine, University College Dublin, Belfield, Ireland
| | | | - Jeremy Gray
- School of Biology and Environmental Science (Emeritus Professor), University College Dublin, Belfield, Ireland
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34
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Hamšíková Z, Kazimírová M, Haruštiaková D, Mahríková L, Slovák M, Berthová L, Kocianová E, Schnittger L. Babesia spp. in ticks and wildlife in different habitat types of Slovakia. Parasit Vectors 2016; 9:292. [PMID: 27207099 PMCID: PMC4874003 DOI: 10.1186/s13071-016-1560-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Babesiosis is an emerging and potentially zoonotic disease caused by tick-borne piroplasmids of the Babesia genus. New genetic variants of piroplasmids with unknown associations to vectors and hosts are recognized. Data on the occurrence of Babesia spp. in ticks and wildlife widen the knowledge on the geographical distribution and circulation of piroplasmids in natural foci. Questing and rodent-attached ticks, rodents, and birds were screened for the presence of Babesia-specific DNA using molecular methods. Spatial and temporal differences of Babesia spp. prevalence in ticks and rodents from two contrasting habitats of Slovakia with sympatric occurrence of Ixodes ricinus and Haemaphysalis concinna ticks and co-infections of Candidatus N. mikurensis and Anaplasma phagocytophilum were investigated. RESULTS Babesia spp. were detected in 1.5 % and 6.6 % of questing I. ricinus and H. concinna, respectively. Prevalence of Babesia-infected I. ricinus was higher in a natural than an urban/suburban habitat. Phylogenetic analysis showed that Babesia spp. from I. ricinus clustered with Babesia microti, Babesia venatorum, Babesia canis, Babesia capreoli/Babesia divergens, and Babesia odocoilei. Babesia spp. amplified from H. concinna segregated into two monophyletic clades, designated Babesia sp. 1 (Eurasia) and Babesia sp. 2 (Eurasia), each of which represents a yet undescribed novel species. The prevalence of infection in rodents (with Apodemus flavicollis and Myodes glareolus prevailing) with B. microti was 1.3 % in an urban/suburban and 4.2 % in a natural habitat. The majority of infected rodents (81.3 %) were positive for spleen and blood and the remaining for lungs and/or skin. Rodent-attached I. ricinus (accounting for 96.3 %) and H. concinna were infected with B. microti, B. venatorum, B. capreoli/B. divergens, Babesia sp. 1 (Eurasia), and Babesia sp. 2 (Eurasia). All B. microti and B. venatorum isolates were identical to known zoonotic strains from Europe. Less than 1.0 % of Babesia-positive ticks and rodents carried Candidatus N. mikurensis or A. phagocytophilum. CONCLUSION Our findings suggest that I. ricinus and rodents play important roles in the epidemiology of zoonotic Babesia spp. in south-western Slovakia. Associations with vertebrate hosts and the pathogenicity of Babesia spp. infecting H. concinna ticks need to be further explored.
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Affiliation(s)
- Zuzana Hamšíková
- Institute of Zoology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovakia
| | - Mária Kazimírová
- Institute of Zoology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovakia.
| | - Danka Haruštiaková
- Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University, Kamenice 3, 625 00, Brno, Czech Republic
| | - Lenka Mahríková
- Institute of Zoology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovakia
| | - Mirko Slovák
- Institute of Zoology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 06, Bratislava, Slovakia
| | - Lenka Berthová
- Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05, Bratislava, Slovakia
| | - Elena Kocianová
- Institute of Virology, Biomedical Research Center, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05, Bratislava, Slovakia
| | - Leonhard Schnittger
- Instituto de Patobiología, CICVyA, INTA-Castelar, 1686 Hurlingham, Prov. de Buenos Aires, Argentina.,CONICET (National Research Council of Argentina), C1033AAJ, Buenos Aires, Argentina
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Identification and Characterization of the Rhoptry Neck Protein 2 in Babesia divergens and B. microti. Infect Immun 2016; 84:1574-1584. [PMID: 26953328 DOI: 10.1128/iai.00107-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/01/2016] [Indexed: 01/07/2023] Open
Abstract
Apicomplexan parasites include those of the genera Plasmodium, Cryptosporidium, and Toxoplasma and those of the relatively understudied zoonotic genus Babesia In humans, babesiosis, particularly transfusion-transmitted babesiosis, has been emerging as a major threat to public health. Like malaria, the disease pathology is a consequence of the parasitemia which develops through cyclical replication of Babesia parasites in host erythrocytes. However, there are no exoerythrocytic stages in Babesia, so targeting of the blood stage and associated proteins to directly prevent parasite invasion is the most desirable option for effective disease control. Especially promising among such molecules are the rhoptry neck proteins (RONs), whose homologs have been identified in many apicomplexan parasites. RONs are involved in the formation of the moving junction, along with AMA1, but no RON has been identified and characterized in any Babesia spp. Here we identify the RON2 proteins of Babesia divergens (BdRON2) and B. microti (BmRON2) and show that they are localized apically and that anti-BdRON2 antibodies are significant inhibitors of parasite invasion in vitro Neither protein is immunodominant, as both proteins react only marginally with sera from infected animals. Further characterization of the direct role of both BdRON2 and BmRON2 in parasite invasion is required, but knowledge of the level of conformity of RON2 proteins within the apicomplexan phylum, particularly that of the AMA1-RON2 complex at the moving junction, along with the availability of an animal model for B. microti studies, provides a key to target this complex with a goal of preventing the erythrocytic invasion of these parasites and to further our understanding of the role of these conserved ligands in invasion.
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Puraite I, Rosef O, Radzijevskaja J, Lipatova I, Paulauskas A. The first detection of species of Babesia Starcovici, 1893 in moose, Alces alces (Linnaeus), in Norway. Folia Parasitol (Praha) 2016; 63. [DOI: 10.14411/fp.2016.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
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Aase A, Hajdusek O, Øines Ø, Quarsten H, Wilhelmsson P, Herstad TK, Kjelland V, Sima R, Jalovecka M, Lindgren PE, Aaberge IS. Validate or falsify: Lessons learned from a microscopy method claimed to be useful for detectingBorreliaandBabesiaorganisms in human blood. Infect Dis (Lond) 2016; 48:411-9. [DOI: 10.3109/23744235.2016.1144931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ord RL, Lobo CA. Human Babesiosis: Pathogens, Prevalence, Diagnosis and Treatment. CURRENT CLINICAL MICROBIOLOGY REPORTS 2015; 2:173-181. [PMID: 26594611 DOI: 10.1007/s40588-015-0025-z] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Human babesiosis is a zoonotic disease caused by protozoan parasites of the Babesia genus, primarily in the Northeastern and Midwest United States due to B. microti, and Western Europe due to B. divergens. Parasites are transmitted by the bite of the ixodid tick when the vector takes a blood meal from the vertebrate host, and the economic importance of bovine babesiosis is well understood. The pathology of human disease is a direct result of the parasite's ability to invade host's red blood cells. The current understanding of human babesiosis epidemiology is that many infections remain asymptomatic, especially in younger or immune competent individuals, and the burden of severe pathology resides within older or immunocompromised individuals. However, transfusion-transmitted babesiosis is an emerging threat to public health as asymptomatic carriers donate blood and there are as yet no licensed or regulated tests to screen blood products for this pathogen. Reports of tick-borne cases within new geographical regions such as the Pacific Northwest of the US, through Eastern Europe, and into China are also on the rise. Further, new Babesia spp. have been identified globally as agents of severe human babesiosis, suggesting that the epidemiology of this disease is rapidly changing, and it is clear that human babesiosis is a serious public health concern that requires close monitoring and effective intervention measure.
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Affiliation(s)
- Rosalynn Louise Ord
- Department of Blood-Borne Parasites, Lindsley Kimball Research Institute, New York Blood Center, New York, NY, 10065, USA
| | - Cheryl A Lobo
- Department of Blood-Borne Parasites, Lindsley Kimball Research Institute, New York Blood Center, New York, NY, 10065, USA
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Karlsson ME, Andersson MO. Babesia species in questing Ixodes ricinus, Sweden. Ticks Tick Borne Dis 2015; 7:10-12. [PMID: 26277447 DOI: 10.1016/j.ttbdis.2015.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/03/2015] [Accepted: 07/26/2015] [Indexed: 10/23/2022]
Abstract
Babesiosis is an emerging tick-transmitted zoonosis in large parts of the world. In Sweden, the occurrence and diversity of Babesia species is largely unknown. In order to estimate the exposure to Babesia from infected ticks, we collected questing Ixodes ricinus from several sites across southern Sweden during two consecutive field seasons and investigated the occurrence of Babesia species. We report for the first time the occurrence of the zoonotic species Babesia venatorum in Swedish ticks, with a prevalence of 1%. We also detected B. microti (prevalence 3.2%) and B. divergens (prevalence 0.2%). The incidence of Babesia in questing ticks is substantially lower than that of several other tick-borne diseases in Sweden. Nevertheless, babesiosis should not be neglected as a possible diagnosis following tick bites in humans and animals in Sweden.
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Affiliation(s)
- Maria E Karlsson
- Department of Plant Protection Biology, SLU, SE-230 53 Alnarp, Sweden
| | - Martin O Andersson
- Molecular Ecology and Evolution Lab, Department of Biology, Ecology Building, Lund University, SE-223 62 Lund, Sweden.
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Tanyel E, Guler N, Hokelek M, Ulger F, Sunbul M. A case of severe babesiosis treated successfully with exchange transfusion. Int J Infect Dis 2015; 38:83-5. [PMID: 26232090 DOI: 10.1016/j.ijid.2015.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/13/2015] [Accepted: 07/21/2015] [Indexed: 11/17/2022] Open
Abstract
Babesiosis is a zoonotic disease that may be asymptomatic or result in severe clinical conditions, with severe hemolysis, hepatic, and renal failure, in humans. Clinical symptoms depend on the species and immune status of the host. The disease is especially severe in those of advanced age, those with an immune deficiency, and the splenectomized. A severe case of babesiosis that developed in a splenectomy patient is presented here; the patient was admitted from a rural region with severe anemia and a deterioration in her general condition, with an initial diagnosis of malaria. In such situations, an exchange transfusion (ET), in addition to antimicrobial treatment, could be lifesaving.
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Affiliation(s)
- Esra Tanyel
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun 55139, Turkey.
| | - Nil Guler
- Department of Hematology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Hokelek
- Department of Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Ulger
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Mustafa Sunbul
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun 55139, Turkey
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