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Marcos LA, Vorkas CK, Mann I, Garry E, Lamba P, Pham SK, Spector R, Papamanoli A, Krivacsy S, Lum M, Zahra A, Hou W, Spitzer ED. Reduced Cholesterol Levels during Acute Human Babesiosis. Pathogens 2023; 12:pathogens12040613. [PMID: 37111499 PMCID: PMC10144092 DOI: 10.3390/pathogens12040613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Babesiosis, an intra-erythrocytic protozoan disease, is an emerging zoonotic parasitic disease worldwide. Cholesterol levels are correlated with severe infections, such as sepsis and COVID-19, and anecdotal reports suggest that high-density lipoprotein (HDL) cholesterol declines during acute babesiosis. Our aim was to describe the cholesterol levels in patients with acute babesiosis diagnosed in an endemic area in New York, hypothesizing that HDL levels correlate with the severity of infection. METHODS We reviewed the medical records of adult patients with babesiosis diagnosed by identification of Babesia parasites on a thin blood smear and confirmed by polymerase chain reaction from 2013 to 2018, who also had available a lipid profile drawn at the time of clinical presentation. Additional lipid profile levels were considered as "baseline" if they were drawn within 2 months before or after the infection as part of routine care. RESULTS A total of 39 patients with babesiosis had a lipid profile drawn on presentation. The patients were divided into two groups for comparison based on the treating physician's clinical decision: 33 patients who were admitted to the hospital and 8 patients who were evaluated as outpatients. A history of hypertension was more common in admitted patients (37% vs. 17%, p = 0.02). The median levels of low-density lipoprotein (LDL) and HDL were significantly reduced in admitted patients compared to non-admitted patients (46 vs. 76 mg/dL, p = 0.04; and 9 vs. 28.5 mg/dL, p = 0.03, respectively). In addition, LDL and HDL levels returned to baseline values following resolution of acute babesiosis. CONCLUSION LDL and HDL levels are significantly reduced during acute babesiosis, suggesting that cholesterol depletion may predict disease severity. Pathogen and host factors may contribute to a reduction in serum cholesterol levels during acute babesiosis.
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Affiliation(s)
- Luis A Marcos
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Charles Kyriakos Vorkas
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, NY 11794, USA
| | - Inderjit Mann
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Evan Garry
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Pooja Lamba
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sophia K Pham
- Stony Brook Southampton Hospital, Southampton, NY 11968, USA
| | - Rachel Spector
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sara Krivacsy
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Michael Lum
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Aleena Zahra
- Division of Infectious Diseases, Department of Internal Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Wei Hou
- Division of Epidemiology and Biostatistics, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Eric D Spitzer
- Department of Pathology, Stony Brook University, Stony Brook, NY 11794, USA
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Lum M, Gauvin C, Pham SK, Papamanoli A, Spitzer ED, Kalogeropoulos AP, Marcos LA. Procalcitonin as a Potential Biomarker in the Study of Babesiosis Caused by B. microti. Pathogens 2022; 11:pathogens11111222. [PMID: 36364974 PMCID: PMC9698394 DOI: 10.3390/pathogens11111222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022] Open
Abstract
Procalcitonin is gaining momentum in the study of protozoal sepsis, but its utility as a biomarker has yet to be fully discovered in human babesiosis. A total of 33 cases of acute babesiosis dating between 2012 and 2019 were retrospectively collected from Stony Brook University Hospital (SBUH) and Stony Brook South Hampton Hospital (SHH), both of which are located on Long Island, NY. Cases were cross-referenced for the need for ICU admission, and the procalcitonin levels were measured by the use of BRAHMS Elecsys assay at SBUH and BRAHMS Architect assay at SHH. Our study demonstrated that the log-transformed procalcitonin levels had a linear correlation with log-transformed maximum parasitemia, which suggests that procalcitonin directly correlates with parasitemia values. Furthermore, when comparing values that predict ICU admission, our ROC analysis of procalcitonin demonstrated similar AUC values to the percentage of parasitemia, suggesting that procalcitonin may assist in determining the severity of disease. We demonstrate that procalcitonin may directly correlate with the parasitemia percentage and have prognostic capabilities, which suggests that procalcitonin may have biomarker potential in human babesiosis.
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Affiliation(s)
- Michael Lum
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
- Correspondence:
| | - Caitlin Gauvin
- Division of General, Geriatric and Hospital Medicine, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sophia K. Pham
- Division of Internal Medicine, Department of Medicine, Stony Brook Southampton Hospital, Southampton, NY 11968, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Eric D. Spitzer
- Department of Pathology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Luis A. Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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