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Drews SJ, Kjemtrup AM, Krause PJ, Lambert G, Leiby DA, Lewin A, O'Brien SF, Renaud C, Tonnetti L, Bloch EM. Transfusion-transmitted Babesia spp.: a changing landscape of epidemiology, regulation, and risk mitigation. J Clin Microbiol 2023; 61:e0126822. [PMID: 37750699 PMCID: PMC10595070 DOI: 10.1128/jcm.01268-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Babesia spp. are tick-borne parasites with a global distribution and diversity of vertebrate hosts. Over the next several decades, climate change is expected to impact humans, vectors, and vertebrate hosts and change the epidemiology of Babesia. Although humans are dead-end hosts for tick-transmitted Babesia, human-to-human transmission of Babesia spp. from transfusion of red blood cells and whole blood-derived platelet concentrates has been reported. In most patients, transfusion-transmitted Babesia (TTB) results in a moderate-to-severe illness. Currently, in North America, most cases of TTB have been described in the United States. TTB cases outside North America are rare, but case numbers may change over time with increased recognition of babesiosis and as the epidemiology of Babesia is impacted by climate change. Therefore, TTB is a concern of microbiologists working in blood operator settings, as well as in clinical settings where transfusion occurs. Microbiologists play an important role in deploying blood donor screening assays in Babesia endemic regions, identifying changing risks for Babesia in non-endemic areas, investigating recipients of blood products for TTB, and drafting TTB policies and guidelines. In this review, we provide an overview of the clinical presentation and epidemiology of TTB. We identify approaches and technologies to reduce the risk of collecting blood products from Babesia-infected donors and describe how investigations of TTB are undertaken. We also describe how microbiologists in Babesia non-endemic regions can assess for changing risks of TTB and decide when to focus on laboratory-test-based approaches or pathogen reduction to reduce TTB risk.
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Affiliation(s)
- Steven J. Drews
- Microbiology, Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne M. Kjemtrup
- California Department of Public Health, Vector-Borne Disease Section, Sacramento, California, USA
| | - Peter J. Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - Grayson Lambert
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health and Yale School of Medicine, New Haven, Connecticut, USA
| | - David A. Leiby
- Department of Microbiology, Immunology, and Tropical Medicine, George Washington University, Washington, USA
| | - Antoine Lewin
- Epidemiology, Surveillance and Biological Risk Assessment, Medical Affairs and Innovation, Héma-Québec, Montréal, Quebec, Canada
- Département d'Obstétrique et de Gynécologie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sheila F. O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Donation Policy and Studies, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian Renaud
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Laura Tonnetti
- American Red Cross, Scientific Affairs, Holland Laboratories for the Biomedical Sciences, Rockville, Maryland, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Panahi E, Stanisic DI, Skinner EB, Faddy HM, Young MK, Herrero LJ. Detection of Leishmania (Mundinia) macropodum (Kinetoplastida: Trypanosomatidae) and heterologous Leishmania species antibodies among blood donors in a region of Australia with marsupial Leishmania endemicity. Int J Infect Dis 2022; 130:42-47. [PMID: 36241162 DOI: 10.1016/j.ijid.2022.10.006] [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: 06/20/2022] [Revised: 09/20/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The Australian Leishmania (Mundinia) macropodum parasite causes cutaneous leishmaniasis among marsupial species. Although cutaneous leishmaniasis is a major public health burden worldwide, it is not clear if humans are naturally exposed to the unique L. macropodum. To assess whether humans have an immunoglobulin (Ig) G response to L. macropodum, we examined anti-Leishmania antibodies among humans residing in a region of marsupial Leishmania endemicity in Australia. METHODS Using a serological enzyme-linked immunosorbent assay, we characterized Leishmania-specific IgG and IgG subclass responses to soluble Leishmania antigen from L. macropodum, and other Leishmania species (L. donovani, L. major, and L. mexicana) in 282 blood donor samples. RESULTS We found that 20.57% of individuals demonstrated a positive total IgG response to L. macropodum. For individuals with antibodies to soluble Leishmania antigen from one Leishmania species, there was no increased likelihood of recognition to other Leishmania species. For samples with detectable L. macropodum IgG, IgG1 and IgG2 were the prevalent subclasses detected. CONCLUSION It is not yet clear whether the IgG antibody detection in this study reflects exposure to Leishmania parasites or a cross-reactive immune response that was induced against an unrelated immunogen. Future studies should investigate whether L. macropodum can result in a viable infection in humans.
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Affiliation(s)
- Elina Panahi
- Institute for Glycomics, Griffith University, Southport, Australia
| | | | - Eloise B Skinner
- Department of Biology, Stanford University, Stanford, USA; Centre for Planetary Health and Food Security, Griffith University, Southport, Australia
| | - Helen M Faddy
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Australia; School of Health and Behavioural Sciences, University of the Sunshine Coast, Petrie, Australia
| | - Megan K Young
- School of Medicine, Griffith University, Southport, Australia
| | - Lara J Herrero
- Institute for Glycomics, Griffith University, Southport, Australia.
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The Global Emergence of Human Babesiosis. Pathogens 2021; 10:pathogens10111447. [PMID: 34832603 PMCID: PMC8623124 DOI: 10.3390/pathogens10111447] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/05/2022] Open
Abstract
Babesiosis is an emerging tick-borne disease caused by intraerythrocytic protozoa that are primarily transmitted by hard-bodied (ixodid) ticks and rarely through blood transfusion, perinatally, and organ transplantation. More than 100 Babesia species infect a wide spectrum of wild and domestic animals worldwide and six have been identified as human pathogens. Babesia microti is the predominant species that infects humans, is found throughout the world, and causes endemic disease in the United States and China. Babesia venatorum and Babesia crassa-like agent also cause endemic disease in China. Babesia divergens is the predominant species in Europe where fulminant cases have been reported sporadically. The number of B. microti infections has been increasing globally in recent decades. In the United States, more than 2000 cases are reported each year, although the actual number is thought to be much higher. In this review of the epidemiology of human babesiosis, we discuss epidemiologic tools used to monitor disease location and frequency; demographics and modes of transmission; the location of human babesiosis; the causative Babesia species in the Americas, Europe, Asia, Africa, and Australia; the primary clinical characteristics associated with each of these infections; and the increasing global health burden of this disease.
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Bloch EM, Krause PJ, Tonnetti L. Preventing Transfusion-Transmitted Babesiosis. Pathogens 2021; 10:pathogens10091176. [PMID: 34578209 PMCID: PMC8468711 DOI: 10.3390/pathogens10091176] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Babesia are tick-borne intra-erythrocytic parasites and the causative agents of babesiosis. Babesia, which are readily transfusion transmissible, gained recognition as a major risk to the blood supply, particularly in the United States (US), where Babesia microti is endemic. Many of those infected with Babesia remain asymptomatic and parasitemia may persist for months or even years following infection, such that seemingly healthy blood donors are unaware of their infection. By contrast, transfusion recipients are at high risk of severe babesiosis, accounting for the high morbidity and mortality (~19%) observed in transfusion-transmitted babesiosis (TTB). An increase in cases of tick-borne babesiosis and TTB prompted over a decade-long investment in blood donor surveillance, research, and assay development to quantify and contend with TTB. This culminated in the adoption of regional blood donor testing in the US. We describe the evolution of the response to TTB in the US and offer some insight into the risk of TTB in other countries. Not only has this response advanced blood safety, it has accelerated the development of novel serological and molecular assays that may be applied broadly, affording insight into the global epidemiology and immunopathogenesis of human babesiosis.
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Affiliation(s)
- Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD 21287, USA
- Correspondence: ; Tel.: +1-410-614-4246
| | - Peter J. Krause
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520, USA;
| | - Laura Tonnetti
- Scientific Affairs, American Red Cross, Holland Laboratories, Rockville, MD 21287, USA;
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Egan SL, Taylor CL, Austen JM, Banks PB, Northover AS, Ahlstrom LA, Ryan UM, Irwin PJ, Oskam CL. Haemoprotozoan surveillance in peri-urban native and introduced wildlife from Australia. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2021; 1:100052. [PMID: 35284862 PMCID: PMC8906138 DOI: 10.1016/j.crpvbd.2021.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023]
Affiliation(s)
- Siobhon L. Egan
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia, 6150, Australia
- Corresponding author.
| | - Casey L. Taylor
- School of Life and Environmental Sciences, Camperdown, The University of Sydney, New South Wales, 2006, Australia
| | - Jill M. Austen
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Peter B. Banks
- School of Life and Environmental Sciences, Camperdown, The University of Sydney, New South Wales, 2006, Australia
| | - Amy S. Northover
- College of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Liisa A. Ahlstrom
- Elanco Animal Health, Macquarie Park, New South Wales, 2113, Australia
| | - Una M. Ryan
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Peter J. Irwin
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia, 6150, Australia
- College of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Charlotte L. Oskam
- Harry Butler Institute, Murdoch University, Murdoch, Western Australia, 6150, Australia
- Corresponding author.
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Persistence of Babesia microti Infection in Humans. Pathogens 2019; 8:pathogens8030102. [PMID: 31319461 PMCID: PMC6789900 DOI: 10.3390/pathogens8030102] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 01/13/2023] Open
Abstract
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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