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Spoorenberg N, Köhler CF, Vermeulen E, Jurriaans S, Cornelissen M, Persson KEM, van Doorn I, Sprong H, Hovius JW, Zonneveld R. Autochthonous Human Babesiosis Caused by Babesia venatorum, the Netherlands. Emerg Infect Dis 2024; 30:1934-1938. [PMID: 39174031 PMCID: PMC11347003 DOI: 10.3201/eid3009.240556] [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] [Indexed: 08/24/2024] Open
Abstract
Severe babesiosis with 9.8% parasitemia was diagnosed in a patient in the Netherlands who had previously undergone splenectomy. We confirmed Babesia venatorum using PCR and sequencing. B. venatorum was also the most prevalent species in Ixodes ricinus ticks collected around the patient's home. Our findings warrant awareness for severe babesiosis in similar patients.
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Barbiero A, Gabrielli S, Dani L, Spinicci M, Lagi F, Basile G, Nacci F, Mantella A, Kiros ST, Pieri A, Delama A, Piubelli C, Scarso S, Angheben A, Feasi M, Granozzi B, Comai G, Varani S, Zammarchi L, Bartoloni A. Babesiosis in the immunocompromised population: Results from a multicentric cohort study conducted in Italy. Parasite Epidemiol Control 2024; 26:e00372. [PMID: 39188966 PMCID: PMC11347065 DOI: 10.1016/j.parepi.2024.e00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/09/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Human babesiosis is an emerging zoonotic disease; diffused especially in some regions of the United States, it has been less frequently observed in other continents, including Europe. Serological surveys suggest that babesiosis could be more frequent than expected in European countries, representing an emerging health-issue and a possible harm, especially in immunocompromised populations. Only one case of human babesiosis has been reported in Italy and data about the diffusion of the pathogen in this country are scant. We conducted a multicentric serological survey in 5 centers of North-Eastern Italy, aimed to detect the seroprevalence of Babesia spp. antibodies in 3 groups of immunocompromised patients: people living with HIV (PLHIV), rheumatologic patients undergoing immunosuppressive therapies and patients undergoing renal transplant. Among the 433 enrolled patients, 3 (0.7%) tested positive for Babesia spp. serology. All positive patients belonged to the PLHIV group, with a seroprevalence of 1.7% (3/180) in this population; the three serologically positive patients were all asymptomatic. They were all enrolled in the provinces of Bolzano and Trento, where seroprevalences of 3.1% and 3.6% were recorded, respectively. Our results suggest that further research is needed on this field, awareness should be raised toward the human disease in Europe, especially in immunocompromised patients, and this emerging health issue should be analyzed in a One-Health perspective to be fully understood.
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Affiliation(s)
- Anna Barbiero
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza Università di Roma, 00185 Roma, Italy
| | - Lapo Dani
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
| | - Michele Spinicci
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
- Regional Referral Center for Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Filippo Lagi
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Gregorio Basile
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
| | - Francesca Nacci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50125 Florence, Italy
| | - Antonia Mantella
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
- Regional Referral Center for Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Seble Tekle Kiros
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
| | - Angela Pieri
- Department of Infectious Diseases, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Bolzano, Italy
| | - Andrea Delama
- Infectious Diseases Unit, Trento Hospital, 38122 Trento, Italy
| | - Chiara Piubelli
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, (VR), Italy
| | - Salvatore Scarso
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, (VR), Italy
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, 37024 Negrar di Valpolicella, (VR), Italy
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, 16128 Genova, Italy
| | - Bianca Granozzi
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giorgia Comai
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefania Varani
- Unit of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Lorenzo Zammarchi
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
- Regional Referral Center for Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
| | - Alessandro Bartoloni
- Department of Clinical and Experimental Medicine, Università degli Studi di Firenze, 50134 Firenze, Italy
- Department of Infectious and Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
- Regional Referral Center for Tropical Diseases, Azienda Ospedaliero Universitaria Careggi, 50134 Firenze, Italy
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Jevtic D, da Silva MD, Haylock AB, Nordstrom CW, Oluic S, Pantic N, Nikolajevic M, Nikolajevic N, Kotseva M, Dumic I. Hemophagocytic Lymphohistiocytosis (HLH) in Patients with Tick-Borne Illness: A Scoping Review of 98 Cases. Infect Dis Rep 2024; 16:154-169. [PMID: 38525759 PMCID: PMC10961790 DOI: 10.3390/idr16020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) secondary to tick-borne infections is a rare but potentially life-threatening syndrome. We performed a scoping review according to PRISMA guidelines to systematically analyze the existing literature on the topic. A total of 98 patients were included, with a mean age of 43.7 years, of which 64% were men. Most cases, 31%, were reported from the USA. Immunosuppression was present in 21.4%, with the most common cause being previous solid organ transplantation. Constitutional symptoms were the most common, observed in 83.7% of the patients, while fever was reported in 70.4% of cases. Sepsis was present in 27.6%. The most common laboratory abnormalities in this cohort were thrombocytopenia in 81.6% of patients, while anemia, leukopenia, and leukocytosis were observed in 75.5%, 55.1%, and 10.2%, respectively. Liver enzyme elevation was noted in 63.3% of cases. The H-score was analyzed in 64 patients, with the mean value being 209, and bone marrow analysis was performed in 61.2% of patients. Ehrlichia spp. was the main isolated agent associated with HLH in 45.9%, followed by Rickettsia spp. in 14.3% and Anaplasma phagocytophilum in 12.2%. Notably, no patient with Powassan virus infection or Lyme borreliosis developed HLH. The most common complications were acute kidney injury (AKI) in 35.7% of patients, shock with multiple organ dysfunction in 22.5%, encephalopathy/seizure in 20.4%, respiratory failure in 16.3%, and cardiac complications in 7.1% of patients. Treatment included antibiotic therapy alone in 43.9%, while 5.1% of patients were treated with immunosuppressants alone. Treatment with both antibiotics and immunosuppressants was used in 51% of patients. Appropriate empiric antibiotics were used in 62.2%. In 43.9% of cases of HLH due to tick-borne disease, patients received only antimicrobial therapy, and 88.4% of those recovered completely without the need for immunosuppressive therapy. The mortality rate in our review was 16.3%, and patients who received inappropriate or delayed empiric therapy had a worse outcome. Hence, we suggest empiric antibiotic treatment in patients who are suspected of having HLH due to tick-borne disease or in whom diagnostic uncertainty persists due to diagnostic delay in order to minimize mortality.
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Affiliation(s)
- Dorde Jevtic
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.J.); (A.B.H.)
- Department of Medicine, NYC Health + Hospitals/Elmhurst, New York, NY 11373, USA
| | | | - Alberto Busmail Haylock
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.J.); (A.B.H.)
- Department of Medicine, NYC Health + Hospitals/Elmhurst, New York, NY 11373, USA
| | - Charles W. Nordstrom
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA;
- Mayo Clinic College of Medicine and Science, Rochester, MN 55902, USA
| | - Stevan Oluic
- Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA;
| | - Nikola Pantic
- Clinic of Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Milan Nikolajevic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.N.); (N.N.)
| | - Nikola Nikolajevic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.N.); (N.N.)
| | - Magdalena Kotseva
- Internal Medicine Residency, Franciscan Health, Olympia Fields, Chicago, IL 60461, USA;
| | - Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA;
- Mayo Clinic College of Medicine and Science, Rochester, MN 55902, USA
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Tijani MK, Svensson J, Adlerborn P, Danielsson L, Teleka A, Lövmar ML, Lindgren PE, Forsberg P, Persson KEM. How to Detect Antibodies Against Babesia divergens in Human Blood Samples. Open Forum Infect Dis 2024; 11:ofae028. [PMID: 38328497 PMCID: PMC10849114 DOI: 10.1093/ofid/ofae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
Background Today only indirect fluorescent antibody assays (IFAs) are commercially available to detect antibodies against Babesia divergens in humans. IFA is subjective and requires highly experienced staff. We have therefore developed an enzyme-linked immunosorbent assay (ELISA)-based method for measuring anti-B. divergens immunoglobulin G antibodies in human blood samples. Methods Crude merozoite extract from in vitro cultures of a new B. divergens isolate was used in ELISA to detect antibodies in different sets of samples: Borrelia burgdorferi-positive samples, healthy individuals, tick-bitten individuals including follow-up samples 3 months later, positive control samples from patients with an active Babesia infection, and samples from malaria-endemic regions. As a reference, IFA was used to detect antibodies in the tick-bitten samples. Western blot was used to evaluate reactions against specific bands in extracts with/without parasites. Results Using IFA as the reference method, the sensitivity and specificity of the ELISA were 86% (12/14) and 100% (52/52). There was a very high correlation (r = -0.84; P = .0004) between IFA dilution factors and ELISA absorbances among the samples classified as positive. Five percent of the B. burgdorferi-positive samples were judged as weakly positive and 5% as strongly positive in our ELISA. Western blot showed that the immunodominant antigens (∼120 kDa) were from merozoites and not from erythrocytes. Conclusions This ELISA can detect antibodies directed against B. divergens, and it can be a useful and easy assay to handle compared with IFA. The ELISA can also measure high and low levels of antibodies, which could give insight into the recency of a B. divergens infection.
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Affiliation(s)
| | - Joel Svensson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
- Laboratory Medicine, Unilabs, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Paula Adlerborn
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Lena Danielsson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Alexandra Teleka
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Matilda Ljungqvist Lövmar
- Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per-Eric Lindgren
- Department of Clinical Microbiology, Region Jönköping County, Jönköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pia Forsberg
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kristina E M Persson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, Lund, Sweden
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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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6
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Tijani MK, Danielsson L, Storry JR, Olsson ML, Persson KEM. Babesia divergens Shows Equal Predilection for Human ABO Blood Types in an In Vitro Erythrocyte Preference Assay. Pathogens 2023; 12:803. [PMID: 37375493 DOI: 10.3390/pathogens12060803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Babesia is spread to humans via ticks or blood transfusions. Severity of Plasmodium falciparum malaria is strongly correlated to the ABO blood group of the patient. Babesia divergens is an intraerythrocytic parasite with many similarities to malaria, but the impact of ABO on the susceptibility to and progression of the infection in humans is unknown. We have now cultured B. divergens in human group A, B and O erythrocytes in vitro and measured rates of multiplication. The predilection for the different erythrocyte types was also determined using an in vitro erythrocyte preference assay when the parasites were grown in group A, B or O erythrocytes over time and then offered to invade differently stained erythrocytes of all the blood types at the same time. The results showed no difference in multiplication rates for the different blood types, and the parasite exhibited no obvious morphological differences in the different blood types. When cultured first in one blood type and then offered to grow in the others, the preference assay showed that there was no difference between the A, B or O blood groups. In conclusion, this indicates that individuals of the different ABO blood types are likely to be equally susceptible to B. divergens infections.
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Affiliation(s)
- Muyideen K Tijani
- Cellular Parasitology Programme, Cell Biology and Genetics Unit, Department of Zoology, University of Ibadan, Ibadan 200132, Nigeria
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden
| | - Lena Danielsson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, 22185 Lund, Sweden
| | - Jill R Storry
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, 22185 Lund, Sweden
| | - Martin L Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, 22185 Lund, Sweden
| | - Kristina E M Persson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, 22185 Lund, Sweden
- Clinical Chemistry and Pharmacology, Laboratory Medicine, Office for Medical Services, Region Skåne, 22185 Lund, Sweden
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Conte HA, Biondi MC, Janket SJ, Ackerson LK, Diamandis EP. Babesia microti-induced fulminant sepsis in an immunocompromised host: A case report and the case-specific literature review. Open Life Sci 2022; 17:1200-1207. [PMID: 36185407 PMCID: PMC9483830 DOI: 10.1515/biol-2022-0448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
Babesia microti is an obligate intra-erythrocytic parasite transmitted by infected ticks. B. microti is a eukaryote much larger than prokaryotic microbes and more similar to human hosts in their biochemistry and metabolism. Moreover, Babesia spp. possess various immune evasion mechanisms leading to persistent and sometimes life-threatening diseases in immunocompromised hosts. Chronic lymphocytic leukemia (CLL) is the most prevalent adult B-cell malignancy, and a small percentage of CLL transforms into aggressive lymphomas. CLL also causes immune dysfunction due to the over-expansion of immature and ineffective B-cells. When our patient with indolent CLL presented with anemia, pancytopenia, and splenomegaly, all his healthcare providers presumptively assumed a malignant transformation of CLL. However, these are also the signs and symptoms of babesiosis. Herein, we report a case where B. microti infection was presumed as a malignant transformation of CLL and narrowly avoided a devastating outcome. Although the patient developed fulminant sepsis, he finally received the correct diagnosis and treatment. Unfortunately, the disease recrudesced twice. Each time, it became more difficult to control the infection. We describe the clinical course of the case and discuss the case-specific literature review. This report highlights the importance of differential diagnoses ruling out infections which include babesiosis, prior to initiating the treatment of B-cell malignancy.
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Affiliation(s)
- Harry A Conte
- Department of Infectious Diseases, Saint Francis Hospital, Hartford, CT, USA.,Department of Infectious Diseases, Johnson Memorial Hospital, Stafford Springs, CT, USA
| | - Michael C Biondi
- Department of Radiology, Saint Francis Hospital, Hartford, CT, USA
| | - Sok-Ja Janket
- Center for Clinical and Translational Research, The Forsyth Institute, Cambridge, MA, USA
| | - Leland K Ackerson
- Department of Public Health, University of Massachusetts at Lowell, Lowell, MA, USA
| | - Eleftherios P Diamandis
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 60 Murray St. Box 32, Floor 6, Rm L6-201. Toronto, ON, M5T 3L9, Canada
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Bajer A, Beck A, Beck R, Behnke JM, Dwużnik-Szarek D, Eichenberger RM, Farkas R, Fuehrer HP, Heddergott M, Jokelainen P, Leschnik M, Oborina V, Paulauskas A, Radzijevskaja J, Ranka R, Schnyder M, Springer A, Strube C, Tolkacz K, Walochnik J. Babesiosis in Southeastern, Central and Northeastern Europe: An Emerging and Re-Emerging Tick-Borne Disease of Humans and Animals. Microorganisms 2022; 10:945. [PMID: 35630388 PMCID: PMC9146636 DOI: 10.3390/microorganisms10050945] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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Affiliation(s)
- Anna Bajer
- Department of Eco-Epidemiology of Parasitic Diseases, Faculty of Biology, Institute of Developmental Biology and Biomedical Sciences, University of Warsaw, Miecznikowa 1, 02-096 Warsaw, Poland; (D.D.-S.); (K.T.)
| | - Ana Beck
- Ribnjak 8, 10 000 Zagreb, Croatia;
| | - Relja Beck
- Department for Bacteriology and Parasitology, Croatian Veterinary Institute, Savska Cesta 143, 10 000 Zagreb, Croatia;
| | - Jerzy M. Behnke
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK;
| | - Dorota Dwużnik-Szarek
- Department of Eco-Epidemiology of Parasitic Diseases, Faculty of Biology, Institute of Developmental Biology and Biomedical Sciences, University of Warsaw, Miecznikowa 1, 02-096 Warsaw, Poland; (D.D.-S.); (K.T.)
| | - Ramon M. Eichenberger
- Vetsuisse Faculty, Institute of Parasitology, University of Zurich, 8057 Zürich, Switzerland; (R.M.E.); (M.S.)
| | - Róbert Farkas
- Department of Parasitology and Zoology, University of Veterinary Medicine, 1078 Budapest, Hungary;
| | - Hans-Peter Fuehrer
- Department of Pathobiology, Institute of Parasitology, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Vienna, Austria;
| | - Mike Heddergott
- Department of Zoology, Musée National d’Historire Naturelle, 25, Rue Münster, 2160 Luxembourg, Luxembourg;
| | - Pikka Jokelainen
- Infectious Disease Prepardness, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark;
| | - Michael Leschnik
- Clinical Unit of Internal Medicine Small Animals, Department/Universitätsklinik für Kleintiere und Pferde, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Wien, Austria;
| | - Valentina Oborina
- Small Animal Clinic of Estonian University of Life Sciences, Kreutzwaldi 62, 51014 Tartu, Estonia;
| | - Algimantas Paulauskas
- Faculty of Natural Sciences, Vytautas Magnus University, K. Donelaičio str. 58, LT-44248 Kaunas, Lithuania; (A.P.); (J.R.)
| | - Jana Radzijevskaja
- Faculty of Natural Sciences, Vytautas Magnus University, K. Donelaičio str. 58, LT-44248 Kaunas, Lithuania; (A.P.); (J.R.)
| | - Renate Ranka
- Latvian Biomedical Research and Study Centre, LV-1067 Riga, Latvia;
| | - Manuela Schnyder
- Vetsuisse Faculty, Institute of Parasitology, University of Zurich, 8057 Zürich, Switzerland; (R.M.E.); (M.S.)
| | - Andrea Springer
- Centre for Infection Medicine, Institute for Parasitology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (A.S.); (C.S.)
| | - Christina Strube
- Centre for Infection Medicine, Institute for Parasitology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; (A.S.); (C.S.)
| | - Katarzyna Tolkacz
- Department of Eco-Epidemiology of Parasitic Diseases, Faculty of Biology, Institute of Developmental Biology and Biomedical Sciences, University of Warsaw, Miecznikowa 1, 02-096 Warsaw, Poland; (D.D.-S.); (K.T.)
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 5A Pawińskiego Str, 02-106 Warsaw, Poland
| | - Julia Walochnik
- Institute for Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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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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10
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Henningsson AJ, Aase A, Bavelaar H, Flottorp S, Forsberg P, Kirkehei I, Lövmar M, Nilsson K, Nyman D, Ornstein K, Sjöwall J, Skogman BH, Tjernberg I, Aaberge I. Laboratory Methods for Detection of Infectious Agents and Serological Response in Humans With Tick-Borne Infections: A Systematic Review of Evaluations Based on Clinical Patient Samples. Front Public Health 2021; 9:580102. [PMID: 34616701 PMCID: PMC8488432 DOI: 10.3389/fpubh.2021.580102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background: For the most important and well-known infections spread by Ixodes ticks, Lyme borreliosis (LB) and tick-borne encephalitis (TBE), there are recommendations for diagnosis and management available from several health authorities and professional medical networks. However, other tick-borne microorganisms with potential to cause human disease are less known and clear recommendations on diagnosis and management are scarce. Therefore, we performed a systematic review of published studies and reviews focusing on evaluation of laboratory methods for clinical diagnosis of human tick-borne diseases (TBDs), other than acute LB and TBE. The specific aim was to evaluate the scientific support for laboratory diagnosis of human granulocytic anaplasmosis, rickettsiosis, neoehrlichiosis, babesiosis, hard tick relapsing fever, tularemia and bartonellosis, as well as tick-borne co-infections and persistent LB in spite of recommended standard antibiotic treatment. Methods: We performed a systematic literature search in 11 databases for research published from 2007 through 2017, and categorized potentially relevant references according to the predefined infections and study design. An expert group assessed the relevance and eligibility and reviewed the articles according to the QUADAS (diagnostic studies) or AMSTAR (systematic reviews) protocols, respectively. Clinical evaluations of one or several diagnostic tests and systematic reviews were included. Case reports, non-human studies and articles published in other languages than English were excluded. Results: A total of 48 studies fulfilled the inclusion criteria for evaluation. The majority of these studies were based on small sample sizes. There were no eligible studies for evaluation of tick-borne co-infections or for persistent LB after antibiotic treatment. Conclusions: Our findings highlight the need for larger evaluations of laboratory tests using clinical samples from well-defined cases taken at different time-points during the course of the diseases. Since the diseases occur at a relatively low frequency, single-center cross-sectional studies are practically not feasible, but multi-center case control studies could be a way forward.
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Affiliation(s)
- Anna J. Henningsson
- Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
- Division of Clinical Microbiology, Region Östergötland, Linköping, Sweden
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Audun Aase
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Herjan Bavelaar
- Division of Clinical Microbiology, Laboratory Medicine, Region Jönköping County, Jönköping, Sweden
| | - Signe Flottorp
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Pia Forsberg
- Division of Infectious Medicine, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Matilda Lövmar
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kenneth Nilsson
- Department of Medical Sciences, Section of Clinical Microbiology, Uppsala University, Uppsala, Sweden
| | - Dag Nyman
- The Åland Group for Borrelia Research, Mariehamn, Finland
| | | | - Johanna Sjöwall
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Region Östergötland, Norrköping, Sweden
| | - Barbro H. Skogman
- Department of Pediatrics and Center for Clinical Research, Dalarna-Uppsala University, Falun, Sweden
- Faculty of Medical and Health Sciences, Örebro University, Örebro, Sweden
| | - Ivar Tjernberg
- Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Chemistry and Transfusion Medicine, Region Kalmar County, Kalmar, Sweden
| | - Ingeborg Aaberge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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11
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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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12
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Sun Y, Jiang B, Zheng W, Wang H, Jiang R, Wang X, Jia N, Yang F, Chen H, Jiang J, Cao W. Isolation and in vitro cultivation of Babesia venatorum (Apicomplexa: Babesiidae), a zoonotic hemoprotozoan from Ixodes persulcatus ticks in China. BIOSAFETY AND HEALTH 2021. [DOI: 10.1016/j.bsheal.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Cafiso A, Olivieri E, Floriano AM, Chiappa G, Serra V, Sassera D, Bazzocchi C. Investigation of Tick-Borne Pathogens in Ixodes ricinus in a Peri-Urban Park in Lombardy (Italy) Reveals the Presence of Emerging Pathogens. Pathogens 2021; 10:pathogens10060732. [PMID: 34200825 PMCID: PMC8230559 DOI: 10.3390/pathogens10060732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022] Open
Abstract
Ticks are important vectors of a great range of pathogens of medical and veterinary importance. Lately, the spread of known tick-borne pathogens has been expanding, and novel ones have been identified as (re)emerging health threats. Updating the current knowledge on tick-borne pathogens in areas where humans and animals can be easily exposed to ticks represents a starting point for epidemiological studies and public awareness. A PCR screening for tick-borne pathogens was carried out in Ixodes ricinus ticks collected in a peri-urban recreational park in Ticino Valley, Italy. The presence of Rickettsia spp., Borrelia burgdorferi senso latu complex, Anaplasma spp. and Babesia spp. was evaluated in a total of 415 I. ricinus specimens. Rickettsia spp. (R monacensis and R. helvetica) were detected in 22.96% of the samples, while B. burgdorferi s.l. complex (B. afzelii and B. lusitaniae) were present in 10.94%. Neoehrlichia mikurensis (1.99%) and Babesia venatorum (0.73%) were reported in the area of study for the first time. This study confirmed the presence of endemic tick-borne pathogens and highlighted the presence of emerging pathogens that should be monitored especially in relation to fragile patients, the difficult diagnosis of tick-borne associated diseases and possible interactions with other tick-borne pathogens.
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Affiliation(s)
- Alessandra Cafiso
- Department of Veterinary Medicine, University of Milan, Via dell’Università 6, 26900 Lodi, Italy; (G.C.); (V.S.); (C.B.)
- Correspondence: ; Tel.: +39-0250334533
| | - Emanuela Olivieri
- Department of Biology and Biotechnology, University of Pavia, Via Ferrata 9, 27100 Pavia, Italy; (E.O.); (A.M.F.); (D.S.)
| | - Anna Maria Floriano
- Department of Biology and Biotechnology, University of Pavia, Via Ferrata 9, 27100 Pavia, Italy; (E.O.); (A.M.F.); (D.S.)
| | - Giulia Chiappa
- Department of Veterinary Medicine, University of Milan, Via dell’Università 6, 26900 Lodi, Italy; (G.C.); (V.S.); (C.B.)
| | - Valentina Serra
- Department of Veterinary Medicine, University of Milan, Via dell’Università 6, 26900 Lodi, Italy; (G.C.); (V.S.); (C.B.)
| | - Davide Sassera
- Department of Biology and Biotechnology, University of Pavia, Via Ferrata 9, 27100 Pavia, Italy; (E.O.); (A.M.F.); (D.S.)
| | - Chiara Bazzocchi
- Department of Veterinary Medicine, University of Milan, Via dell’Università 6, 26900 Lodi, Italy; (G.C.); (V.S.); (C.B.)
- Coordinated Research Center “EpiSoMI”, University of Milan, 20133 Milan, Italy
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14
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Jiao J, Lu Z, Yu Y, Ou Y, Fu M, Zhao Y, Wu N, Zhao M, Liu Y, Sun Y, Wen B, Zhou D, Yuan Q, Xiong X. Identification of tick-borne pathogens by metagenomic next-generation sequencing in Dermacentor nuttalli and Ixodes persulcatus in Inner Mongolia, China. Parasit Vectors 2021; 14:287. [PMID: 34044867 PMCID: PMC8161991 DOI: 10.1186/s13071-021-04740-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Background Hard ticks act as arthropod vectors in the transmission of human and animal pathogens and are widely distributed in northern China. The aim of this study is to screen the important tick-borne pathogens (TBPs) carried by hard ticks in Inner Mongolia using metagenomic next-generation sequencing (mNGS) and to estimate the risk of human infection imposed by tick bites. Methods The adult Dermacentor nuttalli (n = 203) and Ixodes persulcatus (n = 36) ticks feeding on cattle were collected. The pooled DNA samples prepared from these ticks were sequenced as the templates for mNGS to survey the presence of TBPs at the genus level. Individual tick DNA samples were detected by genus--specific or group-specific nested polymerase chain reaction (PCR) of these TBPs and combined with DNA sequencing assay to confirm the results of mNGS. Results R. raoultii (45.32%, 92/203), Candidatus R. tarasevichiae (5.42%, 11/203), Anaplasma sp. Mongolia (26.60%, 54/203), Coxiella-like endosymbiont (CLE) (53.69%, 109/203), and Babesia venatorum (7.88%, 16/203) were detected in D. nuttalli, while R. raoultii (30.56%, 11/36), Anaplasma sp. Mongolia (27.80%, 10/36), and CLE (27.80%, 10/36) were detected in I. persulcatus. The double- and triple-pathogen/endosymbiont co-infections were detected in 40.39% of D. nuttalli and 13.89% of I. persulcatus, respectively. The dual co-infection with R. raoultii and CLE (14.29%, 29/203) and triple co-infection with R. raoultii, Anaplasma sp. Mongolia, and CLE (13.79%, 28/203) were most frequent in D. nuttalli. Conclusions This study provides insight into the microbial diversity of D. nuttalli and I. persulcatus in Inner Mongolia, China, reporting for the first time that Candidatus R. tarasevichiae had been found in D. nuttalli in China, and for the first time in the world that Anaplasma sp. Mongolia has been detected in I. persulcatus. This study proves that various vertically transmitted pathogens co-inhabit D. nuttalli and I. persulcatus, and indicates that cattle in Inner Mongolia are exposed to several TBPs. Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04740-3.
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Affiliation(s)
- Jun Jiao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Zhiyu Lu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yonghui Yu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yangxuan Ou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Mengjiao Fu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yuee Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Nier Wu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Mingliang Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yan Liu
- Department of Microbiology, School of Basic Medical Sciences, Anhui Provincial Laboratory of Microbiology and Parasitology, Anhui Key Laboratory of Zoonoses, Anhui Medical University, Hefei, PR China
| | - Yi Sun
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Bohai Wen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Qinghong Yuan
- Yunnan Institute of Endemic Disease Control and Prevention, Yunnan Provincial Key Laboratory of Natural Focal Disease Control and Prevention, Yunnan, PR China.
| | - Xiaolu Xiong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China.
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15
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Johnson N, Golding M, Phipps LP. Detection of Tick-Borne Pathogens in Red Deer ( Cervus elaphus), United Kingdom. Pathogens 2021; 10:pathogens10060640. [PMID: 34070977 PMCID: PMC8224737 DOI: 10.3390/pathogens10060640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Deer represent a major vertebrate host for all feeding stages of the hard tick Ixodes ricinus in the United Kingdom (UK), and could play a role in the persistence of tick-borne pathogens. However, there have been few studies reporting the presence of Babesia spp. and Anaplasma phagocytophilum in deer in the UK, and those that detected Babesia were unable to confirm the species. To address this, we have investigated blood samples from red deer (Cervus elaphus) for the presence of tick-borne pathogens. Total DNA was extracted from haemolysed blood that was removed from clotted blood sampled from culled, captive red deer. Babesia spp. were detected with a pan-piroplasm PCR that amplifies a fragment of the 18S rRNA gene. Species were identified based on identity with published sequences. Anaplasma phagocytophilum was detected with a probe-based PCR targeting the msp2 gene. In addition, residual serum samples from a subset of animals were tested for the presence of anti-flavivirus antibodies. Of 105 red deer samples tested from three locations in the United Kingdom, 5 were positive for piroplasm and 5 were positive for A. phagocytophilum. Co-infection with both pathogens was detected in two samples from one location. No evidence for antibodies against West Nile virus were detected. However, 12% of sera tested were positive for tick-borne encephalitis virus antibodies.
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16
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Krause PJ, Auwaerter PG, Bannuru RR, Branda JA, Falck-Ytter YT, Lantos PM, Lavergne V, Meissner HC, Osani MC, Rips JG, Sood SK, Vannier E, Vaysbrot EE, Wormser GP. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis 2021; 72:e49-e64. [PMID: 33252652 DOI: 10.1093/cid/ciaa1216] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 11/12/2022] Open
Abstract
The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesiosis. The diagnosis and treatment of co-infection with babesiosis and Lyme disease will be addressed in a separate Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guideline [1]. Recommendations for the diagnosis and treatment of human granulocytic anaplasmosis can be found in the recent rickettsial disease guideline developed by the Centers for Disease Control and Prevention [2]. The target audience for the babesiosis guideline includes primary care physicians and specialists caring for this condition, such as infectious diseases specialists, emergency physicians, intensivists, internists, pediatricians, hematologists, and transfusion medicine specialists.
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Affiliation(s)
- Peter J Krause
- Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Paul G Auwaerter
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
| | - John A Branda
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yngve T Falck-Ytter
- Case Western Reserve University and VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Paul M Lantos
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Valéry Lavergne
- Research Center CIUSSS NIM, University of Montreal, Quebec, Canada
| | - H Cody Meissner
- Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Mikala C Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Sunil K Sood
- Zucker School of Medicine and Cohen Children's Medical Center, Northwell Health, New York, USA
| | - Edouard Vannier
- Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elizaveta E Vaysbrot
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA
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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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Abstract
INTRODUCTION Human babesiosis is reported throughout the world and is endemic in the northeastern and northern Midwestern United States and northeastern China. Transmission is primarily through hard bodied ticks. Most cases of severe disease occur in immunocompromised individuals and may result in prolonged relapsing disease or death. AREAS COVERED We provide a summary of evidence supporting current treatment recommendations for immunocompetent and immunocompromised individuals experiencing babesiosis. EXPERT OPINION Most cases of human babesiosis are successfully treated with atovaquone and azithromycin or clindamycin and quinine. Severe disease may require prolonged treatment.
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Affiliation(s)
- Robert P Smith
- Division of Infectious Diseases, Maine Medical Center, Portland, Maine; Tufts University School of Medicine , Boston, MA, USA
| | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Medical Faculty, Goethe University , Frankfurt/Main, Germany
| | - Peter J Krause
- Yale School of Public Health and Yale School of Medicine , New Haven, CT, USA
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19
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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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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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21
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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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Svensson J, Hunfeld KP, Persson KEM. High seroprevalence of Babesia antibodies among Borrelia burgdorferi-infected humans in Sweden. Ticks Tick Borne Dis 2018; 10:186-190. [PMID: 30389326 DOI: 10.1016/j.ttbdis.2018.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/09/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
In northern Europe, tick-borne diseases such as Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are well known. The actual incidence of Babesia infections, however, has remained elusive. In this study, the prevalence of antibodies against two Babesia spp. was investigated in a cohort of patients that were seropositive for Borrelia (B.) burgdorferi sensu lato (s.l.). Data were compared to a control group of healthy individuals. Sera were collected from 283 individuals residing in the southernmost region of Sweden, Skåne County. Almost one third of the sera were from patients with a confirmed seropositive reaction against B. burgdorferi s.l. All sera samples were assessed for IgG antibodies against Babesia (Ba.) microti and Ba. divergens by indirect fluorescent antibody (IFA) assays. Seropositive IgG titers for at least one of the Babesia spp. was significantly more common (p < 0.05) in individuals seropositive for Borrelia (16.3%) compared to the healthy control group (2.5%). Our findings suggest that Babesia infections may indeed be quite common among individuals who have been exposed to tick bites. Furthermore, the results indicate that human babesiosis should be considered in patients that show relevant symptoms; particularly for splenectomized and other immunocompromised individuals. Finally, the data challenges current blood transfusion procedures and highlights the current lack of awareness of the parasite in northern Europe.
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Affiliation(s)
- Joel Svensson
- Department of Laboratory Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Kristina E M Persson
- Department of Laboratory Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
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