Risk Factors for Severe Infection, Hospitalization, and Prolonged Antimicrobial Therapy in Patients with Babesiosis

Mareedu, Neeharik; Schotthoefer, Anna M.; Tompkins, Jason; Hall, Matthew C.; Fritsche, Thomas R.; Frost, Holly M.

doi:10.4269/ajtmh.17-0146

Cited by 43 publications

(42 citation statements)

References 33 publications

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“…Long term antibiotic therapy of at least six weeks, rather than the standard 7 to 10 days, was required to resolve infection in these severely immunocompromised patients [12]. Severe and persistent B. microti infection also has been associated with advanced age in a mouse model and in humans [1,36,37].…”

Section: Persistent Babesia Microti Infection In Immunocompetent Amentioning

confidence: 99%

Persistence of Babesia microti Infection in Humans

2019

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Persistent infection is a characteristic feature of babesiosis, a worldwide, emerging tick-borne disease caused by members of the genus Babesia. Persistence of Babesia infection in reservoir hosts increases the probability of survival and transmission of these pathogens. Laboratory tools to detect Babesia in red blood cells include microscopic detection using peripheral blood smears, nucleic acid detection (polymerase chain reaction and transcription mediated amplification), antigen detection, and antibody detection. Babesia microti, the major cause of human babesiosis, can asymptomatically infect immunocompetent individuals for up to two years. Chronically infected blood donors may transmit the pathogen to another person through blood transfusion. Transfusion-transmitted babesiosis causes severe complications and death in about a fifth of cases. Immunocompromised patients, including those with asplenia, HIV/AIDS, malignancy, or on immunosuppressive drugs, often experience severe disease that may relapse up to two years later despite anti-Babesia therapy. Persistent Babesia infection is promoted by Babesia immune evasive strategies and impaired host immune mechanisms. The health burden of persistent and recrudescent babesiosis can be minimized by development of novel therapeutic measures, such as new anti-parasitic drugs or drug combinations, improved anti-parasitic drug duration strategies, or immunoglobulin preparations; and novel preventive approaches, including early detection methods, tick-avoidance, and blood donor screening.

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Section: Persistent Babesia Microti Infection In Immunocompetent Amentioning

confidence: 99%

Persistence of Babesia microti Infection in Humans

2019

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“…Patients were identified as having severe babesiosis if they had parasitemia >10% or if they had intensive care unit (ICU) care, exchange transfusion requirement, intubation, acute respiratory distress syndrome, shock, or dialysis ( 4 , 6 , 13 ). Six of the 8 patients were classified as having severe infection.…”

Section: The Patientsmentioning

confidence: 99%

“…Infection with Babesia parasites can cause a range of symptoms, including fever, myalgias, and fatigue. Although many patients are asymptomatic, the infection can be severe in some persons, especially those who are >50 years of age, immunosuppressed, or asplenic ( 1 , 5 , 6 ).…”

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confidence: 99%

Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018

Ingram¹,

Crook²

2020

Emerg. Infect. Dis.

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B abesiosis, a tickborne infection caused by protozoan parasites that infect erythrocytes, has been identified as an emerging infection of concern in the state of Pennsylvania, USA (1-4). Infection with Babesia parasites can cause a range of symptoms, including fever, myalgias, and fatigue. Although many patients are asymptomatic, the infection can be severe in some persons, especially those who are >50 years of age, immunosuppressed, or asplenic (1,5,6). The most common species known to cause human infection in the United States is Babesia microti, which is transmitted by the Ixodes scapularis tick (blacklegged tick). Transmission can also occur through blood transfusion; B. microti is currently the most common pathogen transmitted through the blood supply in the United States (7,8). The highest incidence of human infection has been reported in the Northeast and upper Midwest states (9). Until fairly recently, few cases of B. microti infection have occurred in Pennsylvania. However, new data suggest not only increased prevalence of ticks harboring B. microti within the state (10) but also a rise in the number of cases seen in clinical practice (2-4). Babesiosis is not a mandatory reportable infection in Pennsylvania; however, the Pennsylvania Department of Health does receive reports of cases of babesiosis from healthcare providers that elect to do so. Among these recounted cases, the department has seen a 20-fold increase in the past 12 years (E. Negrón, Pennsylvania Department of Health, pers. comm., 2018 Aug 1). A similar trend was documented in a recent study from February 2019 involving a 4-hospital system in southeastern Pennsylvania, where clinicians saw an increase in cases from <7 cases annually during 2008-2014 to 26 cases in 2015 (4). We have suspected a similar increase in the number of cases at our institution, Penn State Milton S. Hershey Medical Center (Hershey, PA, USA), which is a tertiary academic center located in central Pennsylvania. We performed a retrospective review of all of the confirmed cases of babesiosis at our institution for the period 2005-2018 to determine whether we were truly seeing an increased number of cases and to highlight the demographic and clinical characteristics of these patients. Methods We obtained a list of all patients who had International Classification of Diseases, 9th Revision (ICD-9) (088.82), and International Classification of Diseases, 10th Revision (ICD-10) (B60.0), diagnostic codes for babesiosis as well as patients that had Babesia serologic tests ordered at Hershey Medical Center during 2005-2018. The list consisted of 352 patient encounters, some of which were duplicates. We retrospectively chart reviewed each patient encounter to identify confirmed cases of babesiosis. Only patients who met Centers for Disease Control and Prevention criteria for confirmed cases of babesiosis were included in our study (Table 1): patients who had confirmatory laboratory results (i.e., parasite seen on peripheral smear, positive PCR from blood, or both) and met >1 of t...

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“…Recommendations for treatment of severe babesiosis include the use of clindamycin and quinine combination therapy [15, 144], which is not recommended for treatment of mild to moderate illness due to the risk of adverse reactions [14]. A number of risk factors have been associated with severe Babesia infections which may require long or repeated antibiotic therapy [2, 145, 146] and B . divergens has been associated with severe cases that require adjunct therapies such as red blood cell exchange [147, 148].…”

Section: Discussionmentioning

confidence: 99%

Zoonotic Babesia: A scoping review of the global evidence

et al. 2019

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BackgroundBabesiosis 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.MethodsA 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.ResultsThis 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.ConclusionKnowledge 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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Risk Factors for Severe Infection, Hospitalization, and Prolonged Antimicrobial Therapy in Patients with Babesiosis

Cited by 43 publications

References 33 publications

Persistence of Babesia microti Infection in Humans

Persistence of Babesia microti Infection in Humans

Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018

Zoonotic Babesia: A scoping review of the global evidence

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