Babesiosis

This article deals with human disease. For the disease of the same name in dogs see babesiosis of the dog .

Classification according to ICD-10
B60.0	Babesiosis
ICD-10 online (WHO version 2019)

As Babesiosis is called by Babesia (small intracellular parasites caused by tick bite are transmitted) caused infectious disease . The disease is similar to malaria in some aspects . In addition to humans, diseases caused by Babesia also occur in various other mammals, for example in dogs ( babesiosis of the dog ), cattle, sheep, goats and deer (see Babesia systematics ).

Pathogen, epidemiology, clinic

Life cycle of the babesiosis pathogen Babesia microti

Babesia within red blood cells in a blood smear

As Theobald Smith discovered, the pathogens of the disease are small protozoa of the Babesia genus . The pathogens occur worldwide and are transmitted to various vertebrates (e.g. mice, dogs, horses, cattle) and humans by ticks of the Ixodidae family . In Europe, infections by Babesia divergens dominate in humans , in the United States by Babesia microti (on the east coast and in the Midwest) and Babesia duncani (on the northwest coast). Babesia microti is transmitted by the same type of tick, Ixodes scapularis , that also transmits the borreliosis and ehrlichiosis pathogens . Babesia divergens is transmitted by the common wood tick ( Ixodes ricinus ).

Because babesia infects the erythrocytes, they can also be transmitted through blood transfusion. For this reason, people with babesiosis are excluded from donating blood. A congenital transmission of the Babesia is also possible.

The parasites attack the erythrocytes (red blood cells) and, depending on the parasite density, lead to a more or less pronounced hemolysis . The disease is rarely diagnosed in humans, which is in part certainly due to the fact that the infection is often clinically inapparent . In the US state of New York , only 136 cases of the disease were registered in the 20 years between 1970 and 1991, but in some regions of New England up to 7% of the population had antibodies against Babesia. Patients who have an immunodeficiency (e.g. with HIV infection or after splenectomy ) have a much more severe and possibly U. life-threatening course. Although Babesia was discovered as a pathogen in cattle as early as 1888 by the Romanian researcher Victor Babeș , the first scientifically described case of a human disease dates back to 1957.

Diagnosis

The diagnosis is made by direct microscopic detection of parasites (the “Maltese crosses”, which are rarely seen, however, are typical) or, in the case of a lower parasite density, by detecting the parasite genome by means of polymerase chain reaction (PCR).

Chronic babesiosis are known in veterinary medicine, as is the difficulty of being able to detect the pathogen. Changes in the blood count could give the first indications of babesiosis, but in human medicine it must be borne in mind that other pathogens can also show such changes in the blood count.

1. Blood count, clinical chemistry: The blood count may show decreased red blood cells, possibly also leukopenia (too few white blood cells). Clinical chemistry shows increased bilirubin (dark colored urine) in acute babesiosis .
2. Protein electrophoresis
3. Babesiosis- IFAT : Antibodies against babesia can be detected no earlier than 10 days after infection. In chronic babesiosis, the appearance of antibodies is often the only indication of a previous infection.
4. Microscopic detection of pathogens: Since babesia antibodies are only formed from the 10th day after infection, if babesiosis is suspected, a blood smear can be examined under the microscope for babesia in the red blood cells. Babesia, however, are only briefly detectable in the red blood cells.
5. PCR : PCR is a direct detection of pathogens, the search for existing pathogen genetic material. With the help of the PCR analysis, however, the babesia can only be detected in certain stages of the disease.

Due to the known difficulties in detecting pathogens in veterinary medicine, it should be borne in mind that the pathogen detection in humans is just as difficult, especially since very little is known about the chronic course of the disease in humans. The chronic course has been known in veterinary medicine for years; further research is urgently needed. Over a hundred different species of Babesia are currently known, some of which, such as Babesia canis, are considered exclusively host-specific. It is known from veterinary medicine that babesia can be transmitted from an infected mother to the unborn child via the placenta .

treatment

Babesiosis in humans is treated with antiparasitic drugs . The following schemes are recommended:

Antimicrobial treatment of babesiosis
Treatment regimen	Antiparasitic drugs	Dosage in adults (daily, po )	Duration of treatment
1st Choice:	Clindamycin + quinine	3 x 600 mg 3 x 650 mg	7-10 days each
Alternative:	Atovaquone + azithromycin	2 × 750 mg 1 × 250 mg (500 mg on the first day)	7-10 days each

An exchange transfusion can also be used if there is a high density of parasites in the blood or if the immune system is weak .

Web links

• Babesiosis. In: Orphanet (Rare Disease Database).

Individual evidence

1. ^ Paul de Kruif : Theobald Smith. Ticks and Texas fever. In: Paul de Kruif: Microbe hunters. (Original edition: Microbe Hunters. Harcourt, Brace & Co., New York 1926) Orell Füssli Verlag, Zurich / Leipzig 1927; 8th edition ibid 1940, pp. 224–241.
2. ↑ ^{a b c} E. Vannier, PJ Krause: Human babesiosis. The New England Journal of Medicine. 2012; 366, pp. 2397-2407, PMID 22716978
3. ↑ ^{a b c} M. J. Homer, I. Aguilar-Delfin, SR Telford, PJ Krause PJ, DH Persing: Babesiosis. In: Clin Microbiol Rev. 2000; 13, pp. 451-469. PMID 10885987 full text pdf
4. ↑ ^{a b} Thomas Löscher, Gerd D. Burchard (Ed.): Tropical medicine in clinic and practice: with travel and migration medicine. Georg Thieme, Stuttgart 2010, ISBN 978-3-13-785804-1 , p. 597.
5. ↑ Volker Kiefel: Transfusion Medicine And Transfusion Medicine And Immunohematology: Basics: Therapy: Methodology. Springer, Berlin 2011, ISBN 978-3-642-12764-9 , p. 225.
6. ↑ ^{a b c d e} C. P. Stowell, JA Gelfand, JA Shepard, A. Kratz: Case records of the Massachusetts General Hospital. Case 17-2007. A 25-year-old woman with relapsing fevers and recent onset of dyspnea. In: N Engl J Med. 2007; 356, pp. 2313-9, PMID 17538091
7. ^ V. Babes: Sur l'hemoglobinurie bactérienne du boeuf. In: CR Acad. Sci. Ser. III Sci. Vie 1888; 107, pp. 692-694.
8. ↑ Z.Skrabalo, Z. Deanovic: Piroplasmosis in one: report of a case. In: Doc Med Geogr Trop. 1957; 9, pp. 11-16.
9. ↑ Burke A Cunha, Barbara Barnett: Babesiosis

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !