Severe babesiosis due to Babesia divergens acquired in the United Kingdom

Human Babesiosis in Europe

“…A few exceptions include reports of death in babesiosis patients with parasitemia <3% [ 116 ]. This latter observation has also been made in critically ill patients in Europe [ 76 ], but in most European cases, parasitemias in patients with complications ranged from 10% up to 80% in B. divergens infection [ 14 , 44 , 46 , 70 , 75 , 77 , 78 , 79 ], 4% to 30% in B. venatorum infection [ 4 , 5 ] and 3% to 20% in B. microti infection [ 90 , 91 , 92 , 93 ].…”

“…Some cases were not published but communicated personally, and not all of them were confirmed using molecular methods [ 1 , 46 , 47 , 64 , 65 , 66 , 67 , 68 ]. From 1998 until the present, at least 13 additional cases were published in France [ 69 , 70 , 71 , 72 ], Portugal [ 14 ], Norway [ 73 ], Spain [ 74 , 75 , 76 ], Turkey [ 77 ], Finland [ 44 ], Ireland [ 78 ] and the UK [ 79 ] ( Table 1 ). Overall, this amounts to more than 50 cases, with 35 attributed to B. divergens , 5 to B. venatorum and 11 to B. microti (excluding imported cases) ( Table 1 , Table 2 , Table 3 ).…”

“…Babesia divergens parasitemias in immunocompetent individuals are generally lower than in immunocompromised patients and are often difficult to detect [ 71 ]), but at least six cases of infection have been reported in normosplenic patients during the last 21 years [ 71 , 72 , 75 , 76 , 79 ]. The course of disease ranged from mild [ 71 ] to severe [ 75 , 79 ] and even lethal [ 76 ], and parasitemias ranged from 0.29% [ 71 ] to 20% [ 78 , 79 ]. Mild cases presented with fever, chills, headache, arthromyalgia, leukopenia and elevated liver enzymes [ 71 , 72 ].…”

“…Unfortunately, we have no information about the clinical course of the disease in this patient. Older age was the only known risk factor [ 79 ]. Old age was probably also a factor in a fatal B. divergens infection in an 87-year-old woman from Spain who was hospitalized after three months of low-grade fever, malaise, vomiting, decreased appetite, jaundice and hemoglobinuria.…”

High Resolution Melting (HRM) approach-based strategy for simultaneous differentiation of five Babesia species response for human babesiosis

“…Babesia crassa and B. venatorum have mainly been reported in Europe and China [15,16], whereas B. crassa infections have been reported in Slovenia and France in recent years [17,18]. B. divergens is mostly distributed in Europe, and Babesia motasi (KO-1) is found in Asia [9,[19][20][21]. B. duncani was rst reported in Washington, USA, but is now also prevalent in Canada [12,22,23].…”