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Jajosky RP, O’Bryan J, Spichler-Moffarah A, Jajosky PG, Krause PJ, Tonnetti L. The impact of ABO and RhD blood types on Babesia microti infection. PLoS Negl Trop Dis 2023; 17:e0011060. [PMID: 36696414 PMCID: PMC9901808 DOI: 10.1371/journal.pntd.0011060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/06/2023] [Accepted: 12/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Babesiosis is an emerging infectious disease caused by intraerythrocytic Babesia parasites that can cause severe disease and death. While blood type is known to affect the mortality of Plasmodium falciparum malaria patients, associations between red blood cell (RBC) antigens and Babesia microti infection and disease severity are lacking. METHODS We evaluated RhD and ABO blood types of Babesia-infected (18S rRNA reactive) blood donors in 10 endemic states in the Northeastern and northern Midwestern United States. We also assessed possible associations between RhD and ABO blood types and disease severity among hospitalized babesiosis patients in Connecticut. RESULTS A total of 768 Babesia-infected blood donors were analyzed, of which 750 (97.7%) had detectable B. microti-specific antibodies. B. microti-infected blood donors were more likely to be RhD- (OR of 1.22, p-value 0.024) than RhD+ donors. Hospitalized RhD- babesiosis patients were more likely than RhD+ patients to have high peak parasitemia (p-value 0.017), which is a marker for disease severity. No differences in RhD+ blood type were noted between residents of the Northeast (OR of 0.82, p-value 0.033) and the Midwest (OR of 0.74, p-value 0.23). Overall, ABO blood type was not associated with blood donor B. microti infection, however, B. microti-infected donors in Maine and New Jersey were more likely to be blood type B compared to non-type B (OR 2.49 [p = 0.008] and 2.07 [p = 0.009], respectively), while infected donors from Pennsylvania were less likely to be type B compared to non-type B (OR 0.32 [p = 0.02]). CONCLUSIONS People expressing RhD antigen may have a decreased risk of B. microti infection and babesiosis severity. The association of B antigen with B. microti infection is less clear because the antigen appeared to be less prevalent in infected Pennsylvania blood donors but more prevalent in Maine and New Jersey infected donors. Future studies should quantify associations between B. microti genotypes, RBC antigens, and the frequency and severity of B. microti infection to increase our understanding of human Babesia pathogenesis and improve antibody, vaccine, and RBC exchange transfusion strategies.
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Affiliation(s)
- Ryan Philip Jajosky
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Biconcavity Inc., Lilburn, Georgia, United States of America
- * E-mail:
| | - Jane O’Bryan
- Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, United States of America
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, United States of America
| | - Anne Spichler-Moffarah
- Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, United States of America
| | | | - Peter J. Krause
- Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Laura Tonnetti
- American Red Cross, Rockville, Maryland, United States of America
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Mazigo E, Jun H, Oh J, Malik W, Louis JM, Kim TS, Lee SJ, Na S, Chun W, Park WS, Park YK, Han ET, Kim MJ, Han JH. Ring stage classification of Babesia microti and Plasmodium falciparum using optical diffraction 3D tomographic technique. Parasit Vectors 2022; 15:434. [DOI: 10.1186/s13071-022-05569-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Babesia is an intraerythrocytic parasite often misdiagnosed as a malaria parasite, leading to inappropriate treatment of the disease especially in co-endemic areas. In recent years, optical diffraction tomography (ODT) has shown great potential in the field of pathogen detection by quantification of three-dimensional (3D) imaging tomograms. The 3D imaging of biological cells is crucial to investigate and provide valuable information about the mechanisms behind the pathophysiology of cells and tissues.
Methods
The early ring stage of P. falciparum were obtained from stored stock of infected RBCs and of B. microti were obtained from infected patients during diagnosis. The ODT technique was applied to analyze and characterize detailed differences between P. falciparum and B. microti ring stage at the single cell level. Based on 3D quantitative information, accurate measurement was performed of morphological, biochemical, and biophysical parameters.
Results
Accurate measurements of morphological parameters indicated that the host cell surface area at the ring stage in B. microti was significantly smaller (140.2 ± 17.1 µm2) than that in P. falciparum (159.0 ± 15.2 µm2), and sphericities showed higher levels in B. microti-parasitized cells (0.66 ± 0.05) than in P. falciparum (0.60 ± 0.04). Based on biochemical parameters, host cell hemoglobin level was significantly higher and membrane fluctuations were respectively more active in P. falciparum-infected cells (30.25 ± 2.96 pg; 141.3 ± 24.68 nm) than in B. microti (27.28 ± 3.52 pg; 110.1 ± 38.83 nm). The result indicates that P. falciparum more actively altered host RBCs than B. microti.
Conclusion
Although P. falciparum and B. microti often show confusable characteristics under the microscope, and the actual three-dimensional properties are different. These differences could be used in differential clinical diagnosis of erythrocytes infected with B. microti and P. falciparum.
Graphical Abstract
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Al-Nazal H, Low L, Kumar S, Good MF, Stanisic DI. A vaccine for human babesiosis: prospects and feasibility. Trends Parasitol 2022; 38:904-918. [PMID: 35933301 DOI: 10.1016/j.pt.2022.07.005] [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: 03/10/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
Babesiosis is a tick-borne disease caused by intraerythrocytic Babesia parasites. It is a well-known illness in companion animals and livestock, resulting in substantial economic losses in the cattle industry. Babesiosis is also recognized as an emerging zoonosis of humans in many countries worldwide. There is no vaccine against human babesiosis. Currently, preventive measures are focused on vector avoidance. Although not always effective, treatment includes antimicrobial therapy and exchange transfusion. In this review, we discuss the host's immune response to the parasite, vaccines being used to prevent babesiosis in animals, and lessons from malaria vaccine development efforts to inform the development of a human babesiosis vaccine. An effective human vaccine would be a significant advance towards curtailing this rapidly emerging disease.
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Affiliation(s)
- Hanan Al-Nazal
- Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Leanne Low
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, USA
| | - Sanjai Kumar
- Division of Emerging and Transfusion Transmitted Diseases, Office of Blood Research and Review, Centre for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Michael F Good
- Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Danielle I Stanisic
- Institute for Glycomics, Griffith University, Gold Coast Campus, Queensland, Australia.
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Rabah H, Chukkalore D, El-Charabaty E, Mobarakai N. Babesiosis and the human immune system. IDCases 2022; 27:e01368. [PMID: 34993053 PMCID: PMC8713127 DOI: 10.1016/j.idcr.2021.e01368] [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: 11/23/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/21/2022] Open
Abstract
Immunological phenomena have been described in infections such as infective endocarditis. However, none has been reported in the context of Babesiosis. Babesiosis is a tick-borne illness caused by the protozoa of the genus Babesia and causes infections that range from asymptomatic to severe and sometimes are fatal. This report presents the first case of ANCA/ANA positive severe babesiosis in an asplenic patient treated with repeated red blood cell exchange transfusion.
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Affiliation(s)
- Hussein Rabah
- Staten Island University Hospital, Department of Medicine, New York, USA
| | - Divya Chukkalore
- Staten Island University Hospital, Department of Medicine, New York, USA
| | - Elie El-Charabaty
- Staten Island University Hospital, Department of Medicine, New York, USA
| | - Neville Mobarakai
- Staten Island University Hospital, Department of Medicine, New York, USA
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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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