NEW JERSEY LYME DISEASE, BABESIA, ERLICHIA AND BARTONELLA AND TREATMENT
PART THREE
A REVIEW OF MAJOR STUDIES
Recently a troubled and agitated New Jersey pseudo expert in Lyme disease seemed to report no interest in treating Babesia, and since her old protocols were questionable anyway, I suppose it was just as well. Others are treating her failures. She had one tool and one way to treat. In 2008 this is 1990's medicine. I believe one must read very widely, and just because past IV treatment has helped some patients does not mean one tool is the only option in the tool box.
So let's look at a small sample of the PUBLISHED DATA on New Jersey. But as real researchers and seasoned clinicians know, the best information is not even published yet. This is one reason to have expert clinicians and researchers to be close and talking back and forth. I recall one article I wrote for the Journal of the American Medical Association which was accepted and yet was not published for a year. In tick and flea-infection science at this time, a year is 10 years.
Here are some sample material relating only to New Jersey Lyme Disease
- 1: Wiad Parazytol. 2008;54(2):109-15.
[Dogs babesiosis--still actually problem]
[Article in Polish]
Adaszek , Winiarczyk S.
Katedra Epizootiologii i Klinika Chorb Zakaznych, Wydzial Medycyny Weterynaryjnej, Akademia Rolnicza, ul. Gleboka 30, 20-612 Lublin. ukaszek0@wp.pl
Babesiosis (piroplasmosis) is a tick-borne disease with a symptoms of hemolytic anemia. For the first time babesiosis was described in dogs in United States in 1934. The etiological factor of this disease in Poland is protozoa Babesia canis, and its vector--Dermacentor-tick. The most common symptoms of babesiosis are: icterus, hemoglobinuria, occasionally vomits and diarrhea. The biochemical examination of blood serum from sick animals can reveal the increase of activity of AST, ALT, the increase of total bilirubine, urea and creatynine concentrations. The results of hematological examinations can show anemia, leucopenia and thrombocytopenia. The diagnosis of babesiosis bases on anamnesis, clinical examinations of dogs, microscopical examinations of blood smears from sick animals; IF-assay and PCR can also be helpful for the diagnosis of babesiosis. Till now does not exist the effective immunoprophylaxis against this disease. Babesiosis is well-known disease, however there are still problems with therapy of infected animals. Most effective drug in therapy of dog piroplasmosis is imidocarb, but sometimes can be observed side effects after it application. It is possible that the genetically differences which are detected in subspecies may have an influence on the severity of disease and the effectiveness of therapy.
Publication Types:
PMID: 18702315 [PubMed - in process]
- 2: Parasite Immunol. 2008 Jun-Jul;30(6-7):365-70.
C3 contributes to the cross-protective immunity induced by Babesia gibsoni phosphoriboprotein P0 against a lethal B. rodhaini infection.
Terkawi MA, Zhang G, Jia H, Aboge G, Goo YK, Nishikawa Y, Yokoyama N, Igarashi I, Kawazu SI, Fujisaki K, Xuan X.
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555, Japan.
We have studied the impact of complement component 3 (C3) deficiency on the progression of lethal Babesia rodhaini infection in immune mice. A B. gibsoni ribosomal phosphoprotein P0 (BgP0) previously reported to be a cross-protective antigen against Babesia infection was used to immunize C57BL/6 wild-type (WT) and C3-deficient (C3-/-) mice. Test mice were immunized intraperitoneally (i.p.) with recombinant BgP0 (rBgP0), while controls either were immunized with PBS or did not receive any immunization. Following the immunization regime, test WT mice induced a specifically strong humoral response consisting of mixed immunoglobulins IgG1 and IgG2 associated with high production of IFN-gamma in the supernatant of splenocytes. While test C3-/- mice had significantly decreased total IgG, IgG1 and IgG2b responses, the secretions of IL-12 and IFN-gamma tended to be lower than those in WT mice. Furthermore, partial protection was only observed in rBgP0-immunized WT mice but not in C3-/- mice or controls. Indeed, rBgP0-immunized WT mice showed significant reductions in the initiation of parasitaemia correlated with delayed mortalities and considerable survival rates. Taken together, our results indicate that cross-protection was impaired in C3-/- mice in view of the decrease in the antibody responses and cytokine production and the high susceptibility to infection.
Publication Types:
PMID: 18533933 [PubMed - indexed for MEDLINE]
- 3: J S Afr Vet Assoc. 2007 Dec;78(4):215-20.
The response of the pituitary-adrenal and pituitary-thyroidal axes to the plasma glucose perturbations in Babesia canis rossi babesiosis.
Schoeman JP, Herrtage ME.
Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, 0110 South Africa. johanp.schoeman@up.ac.za
This prospective, cross-sectional, interventional study was designed to determine the association between the hormones of the pituitary-adrenal and pituitary-thyroid axes and other clinical parameters with the blood glucose perturbations in dogs with naturally occurring Babesia canis rossi babesiosis. Thirty-six dogs with canine babesiosis were studied. Blood samples were obtained from the jugular vein in each dog prior to treatment at admission to hospital and serum endogenous adrenocorticotrophic hormone (ACTH), pre-ACTH cortisol, thyroxine, free thyroxine and TSH concentrations were measured. Immediately thereafter each dog was injected intravenously with 5 microg/kg of ACTH (tetracosactrin). A 2nd blood sample was taken 1 hour later for serum post-ACTH cortisol measurement. Three patient groups were recruited: hypoglycaemic dogs (glucose < 3.3 mmol/l, n = 12); normoglycaemic dogs (glucose 3.3-5.5 mmol/l, n = 12); hyperglycaemic dogs (glucose > 5.5 mmol/l, n = 12). Basal and post-ACTH serum cortisol concentrations were significantly higher in hypoglycaemic dogs, whereas body temperature, serum thyroxine and free thyroxine were significantly lower in hypoglycaemic dogs. Haematocrit was significantly lower in both hypo-and hyperglycaemic dogs compared with normoglycaemic dogs. Low blood glucose concentrations were significantly associated with high basal and post-ACTH cortisol concentrations and with low serum thyroxine and free thyroxine concentrations in dogs suffering from B. canis rossi babesiosis.
Publication Types:
PMID: 18507221 [PubMed - indexed for MEDLINE]
- 4: Transfusion. 2008 May 22. [Epub ahead of print]
-
Photochemical inactivation with amotosalen and long-wavelength ultraviolet light of Plasmodium and Babesia in platelet and plasma components.
Grellier P, Benach J, Labaied M, Charneau S, Gil H, Monsalve G, Alfonso R, Sawyer L, Lin L, Steiert M, Dupuis K.
Biologie Fonctionnelle des Protozoaires, Musum National d'Histoire Naturelle, Paris, France.
BACKGROUND: Transfusion-transmitted cases of malaria and babesiosis have been well documented. Current efforts to screen out contaminated blood products result in component wastage due to the lack of specific detection methods while donor deferral does not always guarantee safe blood products. This study evaluated the efficacy of a photochemical treatment (PCT) method with amotosalen and long-wavelength ultraviolet light (UVA) to inactivate these agents in red blood cells (RBCs) contaminating platelet (PLT) and plasma components. STUDY DESIGN AND METHODS: Plasmodium falciparum- and Babesia microti-contaminated RBCs seeded into PLT and plasma components were treated with 150 micromol per L amotosalen and 3 J per cm(2) UVA. The viability of both pathogens before and after treatment was measured with infectivity assays. Treatment with 150 micromol per L amotosalen and 1 J per cm(2) UVA was used to assess the robustness of the PCT system. RESULTS: No viable B. microti was detected in PLTs or plasma after treatment with 150 mol per L amotosalen and 3 J per cm(2) UVA, demonstrating a mean inactivation of greater than 5.3 log in PLTs and greater than 5.3 log in plasma. After the same treatment, viable P. falciparum was either absent or below the limit of quantification in three of four replicate experiments both in PLTs and in plasma demonstrating a mean inactivation of at least 6.0 log in PLTs and at least 6.9 log in plasma. Reducing UVA dose to 1 J per cm(2) did not significantly affect the level of inactivation. CONCLUSION: P. falciparum and B. microti were highly sensitive to inactivation by PCT. Pathogen inactivation approaches could reduce the risk of transfusion-transmitted parasitic infections and avoid unnecessary donor exclusions.
PMID: 18503613 [PubMed - as supplied by publisher]
- 5: Curr Pharm Des. 2008;14(9):855-71.
The plastid-like organelle of apicomplexan parasites as drug target.
Wiesner J, Reichenberg A, Heinrich S, Schlitzer M, Jomaa H.
Institut fr Klinische Chemie und Pathobiochemie, Justus-Liebig-Universitt Giessen, Giessen, Germany.
Apicomplexan parasites infectious to humans include Plasmodium spp., Babesia spp., Toxoplasma gondii, Cryptosporidium spp., Isospora belli and Cyclospora cayetanensis. With exception of Cryptosporidium spp., these parasites possess a non-photosynthetic plastid-like organelle called apicoplast. The apicoplast possesses a small circular genome and harbours prokaryotic-type biochemical pathways. As the most important metabolic functions, the mevalonate independent 1-deoxy-D-xylulose 5-phosphate pathway of isoprenoid synthesis and the type II fatty acid synthesis system are operative inside the apicoplast. Classical antibacterial drugs such as ciprofloxacin, tetracycline, doxycycline, clindamycin and spiramycin inhibit the apicoplast-located gyrase and translation machinery, respectively, and are currently used in the clinic for the treatment of infections with apicomplexan parasites. As an inhibitor of isoprenoid synthesis, fosmidomycin was proven to be effective against acute P. falciparum malaria in clinical phase II studies. Triclosan, an inhibitor of fatty acid synthesis, was active in a malaria mouse model. In vitro antimalarial activity was shown for inhibitors of peptide deformylase and the import of apicoplast-targeted proteins. Work on various other inhibitors of apicoplast-located biochemical processes is ongoing.
Publication Types:
PMID: 18473835 [PubMed - indexed for MEDLINE]
- 6: Vet Parasitol. 2008 Jul 4;154(3-4):205-13. Epub 2008 Apr 7.
Adrenal response to the low dose ACTH stimulation test and the cortisol-to-adrenocorticotrophic hormone ratio in canine babesiosis.
Schoeman JP, Herrtage ME.
Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, South Africa. johanp.schoeman@up.ac.za <johanp.schoeman@up.ac.za>
This prospective, interventional, case-controlled study sought to determine the association between adrenocortical function and mortality in dogs with naturally occurring Babesia rossi babesiosis. Sixty-eight dogs with canine babesiosis were studied and fifteen normal dogs were used as controls. Blood samples were obtained from the jugular vein in each dog prior to treatment, at admission to hospital, for the measurement of basal plasma ACTH (adrenocorticotrophic hormone) and serum cortisol concentrations. Immediately thereafter, each dog was injected intravenously with 5 microg/kg of ACTH (tetracosactrin). A second blood sample was taken 1h later for serum ACTH-stimulated cortisol measurement and the resultant calculation of delta cortisol by subtracting basal from ACTH-stimulated cortisol. Diagnosis of babesiosis was confirmed by polymerase chain reaction (PCR) and reverse line blot (RLB). Three outcomes were defined: hospitalization with subsequent death (n=4); hospitalization followed by recovery (n=48); and treatment as an outpatient (n=16). Basal cortisol, but not ACTH-stimulated cortisol, was significantly higher in patients compared to control dogs. Basal- and ACTH-stimulated serum cortisol concentrations were significantly higher in the dogs that died, compared to hospitalized dogs that survived and compared to dogs treated as outpatients. There was no significant difference in delta cortisol concentrations or cortisol to ACTH ratios across outcome groups in dogs suffering from B. rossi babesiosis However, dogs with delta cortisol concentrations below 83 nmol/l had significantly higher cortisol to ACTH ratios compared to dogs with delta cortisol concentrations above 83 nmol/l. These findings of increased basal- and ACTH-stimulated cortisol and increased cortisol to ACTH ratios confirm the absence of adrenal insufficiency and concur with those in human malaria.
Publication Types:
PMID: 18468798 [PubMed - in process]
- 7: Int J Parasitol. 2008 Sep;38(11):1219-37. Epub 2008 Mar 20.
-
Babesiosis: Recent insights into an ancient disease.
Hunfeld KP, Hildebrandt A, Gray JS.
Institute of Medical Microbiology & Infection Control, Hospital of the Johann Wolfgang Goethe-University Frankfurt am Main, Department of Serology and Molecular Diagnostics, Paul-Ehrlich-Str. 40, D-60596 Frankfurt/Main, Germany.
Ever since the discovery of parasitic inclusions in erythrocytes of cattle in Romania by Victor Babes at the end of the 19th century, newly recognised babesial pathogens continue to emerge around the world and the substantial public health impact of babesiosis on livestock and man is ongoing. Babesia are transmitted by ixodid ticks and infection of the host causes a host-mediated pathology and erythrocyte lysis, resulting in anemia, hyperbilirubinuria, hemoglobinuria, and possibly organ failure. Recently obtained molecular data, particularly for the 18S rRNA gene, has contributed significantly to a better understanding of the sometimes puzzling phylogenetic situation of the genus Babesia and new information has been added to help determine the taxonomic position of many species. Moreover, it seems that owing to higher medical awareness the number of reported cases in humans is rising steadily. Hitherto unknown zoonotic babesias are now being reported from geographical areas where babesiosis was not known to occur and the growing numbers of immunocompromised individuals suggest that the frequency of cases will continue to rise. This review covers recent insights into human babesiosis with regard to phylogeny, diagnostics and treatment in order to provide new information on well known as well as recently discovered parasites with zoonotic potential.
PMID: 18440005 [PubMed - in process]
- 8: Clin Infect Dis. 2008 May 1;46(9):e92-5.
Spontaneous splenic rupture caused by Babesia microti infection.
Kuwayama DP, Briones RJ.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21205, USA. david.kuwayama@jhu.edu
Babesiosis has not been previously associated with spontaneous splenic rupture. We describe an otherwise healthy 61-year-old man with symptomatic babesiosis whose spleen ruptured during hospitalization. Although this complication is rare, practitioners who commonly treat patients with babesiosis should be aware of its potential occurrence.
Publication Types:
PMID: 18419430 [PubMed - indexed for MEDLINE]
- 9: Can Vet J. 2008 Mar;49(3):283-6.
An unusual form of canine babesiosis.
Van de Maele I, Savary-Bataille K, Gielen I, Daminet S.
Faculty of Veterinary Medicine, Department of Medicine and Clinical Biology of Small Animals, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium. isabelvandemaele@hotmail.com
An Akita Inu, living in Belgium, was presented with unusual clinical manifestations of acute babesiosis that included neurological signs and pancytopenia. Diagnosis was made by identifying Babesia canis in the blood smear. Neurological signs resolved after treatment with imidocarb diproprionate. Normalization of hematological abnormalities was gradual over 5 months.
Publication Types:
PMID: 18390102 [PubMed - indexed for MEDLINE]PMCID: PMC2249724
- 10: Jpn J Vet Res. 2008 Feb;55(4):129-36.
Flow cytometry to evaluate the level of Babesia gibsoni parasitemia in vivo and in vitro by using the fluorescent nucleic acid stain SYTO16.
Yamasaki M, Hwang SJ, Ohta H, Yamato O, Maede Y, Takiguchi M.
Laboratory of Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan. masayama@vetmed.hokudai.ac.jp
In the present study, we employed flow cytometry to evaluate the level of parasitemia of Babesia gibsoni infecting canine erythrocytes in vivo and in vitro by using fluorescent nucleic acid staining. Peripheral blood samples from a B. gibsoni-infected dog and cultured B. gibsoni parasitizing in canine erythrocytes were stained with a membrane-permeable fluorescent nucleic acid stain, SYTO16. In this study, we utilized normal canine erythrocytes (LK erythrocytes) and canine erythrocytes containing high concentrations of potassium, reduced glutathione, and some free amino acids (HK erythrocytes) as host cells for culture. Parasitized cells in vive were discriminated completely from unparasitized cells and a correlation (r = 0.998) between the percentage of SYTO16-positive cells and parasitemia in vivo was observed. On the other hand, erythrocytes in vitro could not be divided clearly into parasitized and unparasitized cells. However, when LK erythrocytes were used as host cells, the percentage of SYTO16-positive cells was almost the same as, and was well correlated (r = 0.932) with, the level of parasitemia. When HK erythrocytes were used as host cells, the percentage of SYTO16-positive cells was almost half of, but was correlated (r = 0.982) with, the level of parasitemia. Therefore, we attempted to observe the changes in the percentage of parasitized cells after treatment with antiprotozoal drug or mitochondria inhibitors by using flow cytometry. The changes in the percentage of SYTO16-positive cells corresponded well with the changes of the level of parasitemia when the parasites in HK erythrocytes were cultured with each compound. The present results suggest that flow cytometric detection using SYTO16 is a rapid and reliable method for monitoring parasitemia both in vive and in vitro.
Publication Types:
PMID: 18380154 [PubMed - indexed for MEDLINE]
- 11: Exp Parasitol. 2008 Jun;119(2):238-45. Epub 2008 Feb 13.
-
Babesia divergens: identification and characterization of BdHSP-20, a small heat shock protein.
Montero E, Rodriguez M, Gonzalez LM, Lobo CA.
Department of Blood-Borne Parasites, Lindsley Kimball Research Institute, The New York Blood Center, 310 E. 67th Street, New York, NY 10021, USA.
This study describes the identification and characterization of the Babesia divergens alpha-crystallin/small heat shock protein 20 (BdHSP-20). BdHSP-20 was recognized by the DG7 monoclonal antibody (DG7 mAb) originally produced by Precigout et al. [Precigout, E., Valentin, A., Carcy, B., Gorenflot, A., Nakamura, K., Aikawa, M., Schrevel, J. 1993. Babesia divergens: characterization of a 17-kDa merozoite membrane protein. Experimental Parasitology 77, 425-434] against B. divergens merozoites. We used DG7 mAb to immunoscreen a B. divergens cDNA library to clone the gene encoding the small heat shock protein. Bdhsp-20 is a single copy gene interrupted by one intron. The deduced gene product (BdHSP-20) clearly belongs to the alpha-crystallin family and shows significant homology to Babesia bovis, Plasmodium falciparum and Toxoplasma gondii sHSPs, with the highest degree of sequence identity around the catalytic domain. Nutritient stress (serum depletion) treatment of the parasites induced the upregulation of BdHSP-20 gene expression observed by semi-quantitative PCR and immunoprecipitation. This regulation pattern suggests that BdHSP-20 could probably be of importance for parasite survival in the case of environmental stress. BdHSP-20 has previously been shown to be highly conserved among different strains and antibodies against the protein drastically reduce parasitemia in vitro.
Publication Types:
PMID: 18346739 [PubMed - indexed for MEDLINE]
- 12: Vet Parasitol. 2008 Apr 15;152(3-4):173-85. Epub 2008 Jan 3.
-
The brown dog tick, Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae): from taxonomy to control.
Dantas-Torres F.
Departamento de Imunologia, Centro de Pesquisas Aggeu Magalhes, Fundao Oswaldo Cruz, Caixa Postal 7472, Avenida Professor Moraes Rego s/n, Campus UFPE, Recife, Pernambuco, Brazil. fdt@cpqam.fiocruz.br
Rhipicephalus sanguineus, commonly known as the brown dog tick, is a three-host tick that feeds primarily on dogs and occasionally on other hosts, including humans. R. sanguineus ticks are widely distributed around the world and they are known vectors of pathogens, such as Babesia canis, Ehrlichia canis, and Rickettsia conorii. The increasing number of cases of human parasitism by R. sanguineus ticks reported in the literature indicates that the interaction between humans and R. sanguineus ticks may be more common than it is actually recognized. The indiscriminate use of acaricides is an emerging problem worldwide and has led to the selection of acaricide resistant tick strains. In this article, the medical and veterinary importance, taxonomy, biology, and ecology of R. sanguineus ticks around the world are reviewed. It also discusses the current strategies for the control of R. sanguineus, highlighting the potential risks associated to the improper use of acaricides, such as environmental pollution and toxicity to humans and other non-target organisms (e.g., tick predators).
Publication Types:
PMID: 18280045 [PubMed - indexed for MEDLINE]
- 13: Acta Vet Hung. 2007 Dec;55(4):511-23.
Histological and ultrastructural studies of renal lesions in Babesia canis infected dogs treated with imidocarb.
Mth A, Dobos-Kovcs M, Vrs K.
Department and Clinic of Internal Medicine, Faculty of Veterinary Science, Szent Istvdn University, H-1078 Budapest, Istvin u. 2, Hungary. Mathe.Akos@aotk.szie.hu
Histological and electron microscopic examinations of the kidneys of 8 dogs suffering from fatal, naturally acquired Babesia canis infection and nephropathy are presented. Seven animals were treated with imidocarb dipropionate on average 4.5 days prior to death. Severe anaemia was present only in 2 cases. Degenerative histological changes observed mostly in the proximal convoluted tubules included vacuolar-hydropic degeneration, necrosis and detachment of renal tubular epithelial (RTE) cells from the basement membrane. Necrotic debris occasionally formed acidophilic casts within the tubules. In some cases, necrosis of the whole tubule was observed. Haemoglobin casts in the tubules and haemoglobin droplets in RTE cells seldom appeared. No significant histological changes were seen in the glomeruli. Ultrastructural lesions in RTE cells included nuclear membrane hyperchromatosis, karyopyknosis, karyolysis, swelling or collapse of mitochondria with fragmentation of cristae and vacuolar-hydropic degeneration in the endoplasmic reticulum and microvilli. Nuclear oedema was also observed. Many RTE cells exhibiting necrosis collapsed. Vacuolar-hydropic degeneration and necrosis were also observed in the glomerular and interstitial capillary endothelium. The severe acute tubular necrosis described in this study is probably the result of hypoxic renal injury. Systemic hypotension leading to vasoconstriction in the kidneys might be the most important cause of renal hypoxia in B. canis infections, but anaemia may also contribute to inadequate oxygenation. Imidocarb should be applied with caution in patients with possible renal involvement until further data become available on its potential nephrotoxicity in dogs.
PMID: 18277710 [PubMed - indexed for MEDLINE]
- 14: Parasitol Res. 2007 Sep;101 Suppl 2:S187-9.
Ticks of small ruminants in China.
Yin H, Luo J.
State Key Laboratory of Veterinary Etiological Biology, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu, PR China. yinhong@public.lz.gs.cn
The importance of ticks and tick-borne diseases of small ruminants in China is discussed. Of the 109 species of ticks identified to date in China, 45 species infest small ruminants. Five species have been proved to be involved, or possibly involved, in the transmission of tick-borne diseases. Anaplasma ovis, Babesia motasi, Babesia ovis and two unidentified species of Theileria, have been recorded in small ruminants in China. The diseases caused by these organisms are widespread in China, causing great economic losses, estimated at approximately 70 million USD per annum. Anaplasmosis occurs from September to March in Inner Mongolia and during spring in other areas. Babesiosis and theileriosis occur in March to June in northwestern China. The vectors of A. ovis are Dermacentor nuttalli, Hyalomma asiaticum and Rhipicephalus pumilio. These three species of ticks do not appear to transmit A. ovis transstadially or transovarially, but rather through movement of partially engorged, infected adult ticks from A. ovis carrier animals. The vector ticks of the two species of Babesia have not been very well documented, but at least two species of Haemaphysalis are thought to transmit them. Haemaphysalis qinghaiensis transmits the two as yet unidentified species of Theileria transstadially. Priorities for future research on these diseases are summarised.
Publication Types:
PMID: 17823826 [PubMed - indexed for MEDLINE]
- 15: Clin Infect Dis. 2007 Dec 15;45(12):1588-90.
-
Treatment of refractory Babesia microti infection with atovaquone-proguanil in an HIV-infected patient: case report.
Vyas JM, Telford SR, Robbins GK.
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. jvyas@partners.org
A patient with acquired immune deficiency syndrome presented with babesiosis 6 months after presumed tick exposure. Despite initial treatment with azithromycin and atovaquone, followed by quinine and clindamycin, he experienced an increasing parasite load. Finally, red blood cell exchange transfusion, anti-Babesia therapy, and the addition of atovaquone-proguanil to the treatment regimen led to symptomatic improvement and elimination of parasitemia. Low-level parasitemia recurred 20 weeks later and was eradicated by administration of atovaquone-proguanil monotherapy. Atovaquone-proguanil appears to have activity against babesiosis and should be studied as a potential therapy for patients with refractory babesiosis.
Publication Types:
PMID: 18190320 [PubMed - indexed for MEDLINE]
- 16: Clin Infect Dis. 2008 Feb 1;46(3):370-6.
-
Persistent and relapsing babesiosis in immunocompromised patients.
Krause PJ, Gewurz BE, Hill D, Marty FM, Vannier E, Foppa IM, Furman RR, Neuhaus E, Skowron G, Gupta S, McCalla C, Pesanti EL, Young M, Heiman D, Hsue G, Gelfand JA, Wormser GP, Dickason J, Bia FJ, Hartman B, Telford SR 3rd, Christianson D, Dardick K, Coleman M, Girotto JE, Spielman A.
Division of Infectious Diseases, Connecticut Children's Medical Center, and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut 06106, USA. PKrause@ccmckids.org
BACKGROUND: Human babesiosis is a tickborne malaria-like illness that generally resolves without complication after administration of atovaquone and azithromycin or clindamycin and quinine. Although patients experiencing babesiosis that is unresponsive to standard antimicrobial therapy have been described, the pathogenesis, clinical course, and optimal treatment regimen of such cases remain uncertain. METHODS: We compared the immunologic status, clinical course, and treatment of 14 case patients who experienced morbidity or death after persistence of Babesia microti infection, despite repeated courses of antibabesial treatment, with those of 46 control subjects whose infection resolved after a single course of standard therapy. This retrospective case-control study was performed in southern New England, New York, and Wisconsin. RESULTS: All case patients were immunosuppressed at the time of acute babesiosis, compared with <10% of the control subjects. Most case patients experienced B cell lymphoma and were asplenic or had received rituximab before babesial illness. The case patients were more likely than control subjects to experience complications, and 3 died. Resolution of persistent infection occurred in 11 patients after 2-10 courses of therapy, including administration of a final antimicrobial regimen for at least 2 weeks after babesia were no longer seen on blood smear. CONCLUSIONS: Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness. Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.
Publication Types:
PMID: 18181735 [PubMed - indexed for MEDLINE]
- 17: J Am Board Fam Med. 2008 Jan-Feb;21(1):75-7.
Complications of coinfection with Babesia and Lyme disease after splenectomy.
Abrams Y.
Department of Family and Community Medicine, University of Pittsburgh, PA 15217, USA. abramsym@upmc.edu
Publication Types:
PMID: 18178707 [PubMed - indexed for MEDLINE]
- 18: Exp Parasitol. 2008 Apr;118(4):543-8. Epub 2007 Nov 19.
-
Babesia: the protective effects of killed Propionibacterium acnes on the infections of two rodent Babesia parasites in mice.
Iseki H, Takabatake N, Ota N, Ishigame T, Yokoyama N, Igarashi I.
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Inada-cho, Obihiro, Hokkaido 080-8555, Japan.
In the present study, we investigated the protective effects of killed Propionibacterium acnes on the infections of two rodent Babesia parasites in mice. Pre-treatment with "EqStim" (a commercially available immunostimulant containing killed P. acnes) showed significant resistance to both infections. To elucidate the immunological status in the mice, the concentrations of multiple cytokines were measured in serum collected from infected mice. After B. microti infection, the levels of interleukin (IL)-2, IL-4, IL-5, IL-10, IL-12p70, and tumor necrosis factor (TNF)-alpha in the treated group were significantly lower than in the control group. In contrast, after B. rodhaini infection, only IL-12p70 and TNF-alpha were detectable at significantly higher levels in the treated group than in the control group. The present findings indicated the protective effects of killed P. acnes on rodent babesiosis even with different immune responses between the B. microti and B. rodhaini infections. Killed P. acnes might be a powerful tool for the control of serious livestock babesiosis.
Publication Types:
PMID: 18164706 [PubMed - indexed for MEDLINE]
- 19: Vet Parasitol. 2008 Mar 25;152(1-2):60-6. Epub 2007 Nov 22.
-
Plasma insulin concentrations in hypoglycaemic dogs with Babesia canis rossi infection.
Rees P, Schoeman JP.
Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, Onderstepoort 0110, South Africa. phil.rees@up.ac.za
Hypoglycaemia has been identified as a life-threatening metabolic complication in almost 20% of severely ill dogs suffering from babesiosis due to Babesia canis rossi infection, and has been correlated with mortality. Hyperinsulinaemia as a result of inappropriate insulin secretion may precipitate hypoglycaemia, and has been suggested as a possible cause of hypoglycaemia in human and murine malaria. This prospective, cross-sectional, observational study, including 94 dogs with naturally occurring virulent babesiosis, sought to identify the presence of inappropriate insulin secretion in hypoglycaemic canine babesiosis. Pre-treatment jugular blood samples were collected for simultaneous determination of plasma glucose and insulin concentrations. Animals were retrospectively divided into three groups: hypoglycaemic (BG<3.3 mmol/L; n=16), normoglycaemic (BG 3.3-5.5 mmol/L; n=62), and hyperglycaemic (BG>5.5 mmol/L; n=16). The median insulin concentrations for the hypoglycaemic, normoglycaemic, and hyperglycaemic groups were 10.7 pmol/L, 10.7 pmol/L, and 21.7 pmol/L, respectively. Statistical analysis revealed no significant difference in insulin concentration between the three groups. Additionally, the median insulin concentration in the hypoglycaemic and normoglycaemic groups was below the detection limit of the assay, suggesting that insulin secretion was appropriately low (i.e. undetectable) in these cases. Only two dogs had inappropriately elevated insulin concentrations. One of these dogs was hypoglycaemic. We conclude that hyperinsulinaemia is an infrequent cause of hypoglycaemia in virulent canine babesiosis. Other causes of hypoglycaemia, such as increased glucose consumption, depletion of hepatic glycogen stores, and hepatic dysfunction with impaired gluconeogenesis, are speculated to play more important roles in the pathophysiology of hypoglycaemia in canine babesiosis.
Publication Types:
PMID: 18164550 [PubMed - indexed for MEDLINE]
- 20: Vet Parasitol. 2008 Feb 14;151(2-4):320-2. Epub 2007 Nov 17.
-
Repeated high dose imidocarb dipropionate treatment did not eliminate Babesia caballi from naturally infected horses as determined by PCR-reverse line blot hybridization.
Butler CM, Nijhof AM, van der Kolk JH, de Haseth OB, Taoufik A, Jongejan F, Houwers DJ.
Department of Equine Sciences, Medicine Section, Utrecht University, PO Box 80.153, 3508 TD Utrecht, The Netherlands. c.m.butler@uu.nl
Imidocarb treatment of horses infected with Babesia caballi is supposed to eliminate the infection, but data on the efficacy of this treatment is scarce. The study presented here concerns four Paso Fino horses, which were imported into the island of Curacao on the basis of a piroplasmosis negative complement fixation test (CFT). Upon re-testing with an indirect fluorescent antibody test immediately after arrival in Curacao, two horses appeared to have antibodies to B. caballi and all horses had antibodies to Theileria equi. Subsequent testing with polymerase chain reaction combined with a reverse line blot yielded positive results for both agents in all four horses. Treatment with five consecutive doses of imidocarb dipropionate (4.7 mg/kg BW im q 72 h), temporarily resulted in negative results, but B. caballi and T. equi were detected again in the samples taken at 6 and 18 weeks after completion of the treatment. These results confirm that the CFT is not a suitable test for pre-import testing and that even high dose treatment with imidocarb may not be capable of eliminating B. caballi and T. equi infections from healthy carriers.
Publication Types:
PMID: 18160222 [PubMed - in process]
- 21: Rev Bras Parasitol Vet. 2007 Jul-Sep;16(3):163-5.
[Natural infection by hemoparasites in calves submitted to chemoprophylaxis at 30 days of age]
[Article in Portuguese]
da Silva RA, Corra Fdo N, Botteon Rde C, Botteon Pde T.
Empresa de Pesquisa Agropecuria de Minas Gerais, Instituto Tcnicoem Agropecuria e Cooperativismo, Pitangui, MG 35650-00, Brasil. rosangelarural@yahoo.com.br
The tick-borne disease (TBD) brings great damages to cattle breeding. The most important etiologic agents are Babesia bigemina, B. bovis and Anaplasma marginale, being the tick Boophilus microplus the main vector. This work reports the occurrence of natural infection by hemoparasites of TBD in 36 calves with high ticks natural infestation submitted to chemoprophylaxis with 30 days year-old. The blood smears from animals of different ages were analized and were found B. bigemina (33.3%), B. bovis (11.1%) and A. marginale (13.9%). Six animals had clinical symptoms (16.7%) and one dead (2.8%). The number of clinical cases ocurred in consequence of an association of factors as high infestation of ticks and low passive immunity in period that calves had not developed enough active immunity.
Publication Types:
PMID: 18078605 [PubMed - indexed for MEDLINE]
- 22: Epidemiol Mikrobiol Imunol. 2007 Nov;56(4):176-80.
[Babesiosis, a little known zoonosis]
[Article in Czech]
Dvorakov HM, Dvorckov M.
Mikrobiologicky ustav LF MU a FN u sv. Anny v Brne. monika.heroldova@fnusa.cz
Babesiosis is an emerging tick borne zoonotic disease caused by intraerythrocytic parasites of the genus Babesia. Babesiosis is one of the most common infections of free-living animals worldwide but is perhaps most prevalent in rodents, carnivores, and cattle. This fact increases the concern about the emerging zoonosis. Like the malaria agent Plasmodium, the parasite Babesia attacks and damages the host's red cells. Babesia microti and Babesia divergens cause human infections. In the USA, an endemic region of this infection, most human cases are due to Babesia microti. In Europe, babesiosis is considerably rare and is caused by Babesia divergens, with splenectomized patients being at highest risk. The spectrum of disease is broad, ranging from an apparently silent infection to a fulminant, malaria-like disease. Symptoms include fever, chills and icterus. The treatment of choice is clindamycin and quinine. The laboratory diagnosis is based on direct detection of the parasite from blood smears. Due to increasing international travel, even relatively uncommon parasitic infections can be found in the Czech Republic and babesiosis is just one of them.
Publication Types:
PMID: 18072299 [PubMed - indexed for MEDLINE]
- 23: J Vet Med Sci. 2007 Oct;69(10):999-1004.
Involvement of a host erythrocyte sialic acid content in Babesia bovis infection.
Takabatake N, Okamura M, Yokoyama N, Okubo K, Ikehara Y, Igarashi I.
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan.
Host sialic acid (SA) has recently been suggested to play an important role in erythrocyte (RBC) infection by Babesia spp. The present study attempted to further determine the specific type of SAs important in the RBC invasion. Bovine RBC was found to bear abundant alpha2-3-linked SA residues but not alpha2-6-linked SA in nature, confirmed by flow cytometric analysis of the neuraminidase (Nm)-treated RBCs. Lectin-blot analyses revealed the removal of alpha2-3-linked SAs from the 97-, 33-, and 31-kDa bands by the Nm treatment. Addition of the Nm-treated RBCs into an in vitro culture of B. bovis resulted in a decreased population of the parasitized RBCs. The thin smear samples from the cultures were then observed under a confocal laser scanning microscope after staining with the alpha2-3-linked SA-specific lectin: a selective invasion of B. bovis was found only in the intact RBCs bearing the SAs, but not in the desialylated RBCs. Furthermore, a significant reduction of the parasitized RBCs was also observed in the culture supplemented with exogenous 3'-sialyllactose containing the alpha2-3-linked SAs. However, the complete inhibition of parasite proliferation was not achieved in the culture. These findings indicate that while the alpha2-3-linked SA-dependent pathway is needed for highly efficient invasion of host RBCs by B. bovis, there might also be other potential alternative pathways.
Publication Types:
PMID: 17984585 [PubMed - indexed for MEDLINE]
- 24: J S Afr Vet Assoc. 2007 Jun;78(2):63-5.
A field trial evaluation of the prophylactic efficacy of amitraz-impregnated collars against canine babesiosis (Babesia canis rossi) in South Africa.
Last RD, Hill JM, Matjila PT, Rme CA.
Vetdiagnostix-Veterinary Pathology Services, P.O. Box 13624, Cascades, 3202, South Africa. vetdiagnostix@futurenet.co.za
South African canine babesiosis caused by Babesia canis rossi is a common clinical disease in dogs in South Africa and remains a significant cause of domestic dog mortality. To determine whether tick-repellent, 9% amitraz-impregnated tick collars (Preventic-Virbac) could prevent tick-borne exposure to B. canis rossi, 50 dogs were assigned to two groups. Group 1 (20 dogs), polymerase chain reaction (PCR)--and reverse line blot (RLB)-negative for B. canis rossi, were fitted with amitraz collars and blood samples collected monthly, over a 6-month period, and analysed for B. canis rossi. Group 2 (30 dogs) included 5 dogs selected on a month-by-month basis from a population of dogs from the same geographical area as the group 1 dogs, but with no history of previous tick control, which were blood-sampled together with the treatment group and analysed for B. canis rossi by PCR and RLB, to serve as the control group. Eight of the 30 control dogs (26.6%) were PCR/RLB positive for B. canis rossi, indicating high pathogen exposure during the trial period. All twenty of the treatment group dogs remained negative for B. canis rossi throughout the 6 months of the trial. These results suggest that the use of amitraz-impregnated collars had a significant effect on reducing infection with B. canis rossi.
PMID: 17941596 [PubMed - indexed for MEDLINE]
- 25: Expert Opin Pharmacother. 2007 Oct;8(14):2401-44.
Update on clindamycin in the management of bacterial, fungal and protozoal infections.
Guay D.
University of Minnesota, College of Pharmacy, Weaver-Densford Hall 7-148, 308 Harvard Street SE, Minneapolis, MN 55455, USA. guayx001@umn.edu
Lincomycin and clindamycin are the only members of the relatively small lincosamide antimicrobial class marketed for use in humans. This paper only reviews data regarding clindamycin, with an emphasis on data published over the last decade. Clindamycin exhibits a broad spectrum of antimicrobial activity, including Gram-positive aerobes/anaerobes, Gram-negative anaerobes and select protozoa (Toxoplasma gondii, Plasmodium falciparum, Babesia spp.) and fungi (Pneumocystis jiroveci). It still enjoys use in the therapy and prophylaxis of a large number of bacterial, protozoal and fungal infections, despite > 40 years of clinical use. However, the spectre of resistance by an increasing number of microorganisms is beginning to cast a shadow over the future use of this valuable agent. With the emergence and spread of infections due to community-acquired methicillin-resistant Staphylococci (for which clindamycin is a first-line agent), it is hoped that the issues of resistance can be mitigated and the use of clindamycin extended for at least the foreseeable future.
Publication Types:
PMID: 17927492 [PubMed - indexed for MEDLINE]
- 26: Vet J. 2007 Oct 5. [Epub ahead of print]
-
Molecular evaluation of the incidence of Ehrlichia canis, Anaplasma platys and Babesia spp. in dogs from Ribeiro Preto, Brazil.
Santos F, Coppede JS, Pereira AL, Oliveira LP, Roberto PG, Benedetti RB, Zucoloto LB, Lucas F, Sobreira L, Marins M.
Unidade de Biotecnologia, Universidade de Ribeiro Preto (UNAERP), Ribeiro Preto, SP, Brazil.
Canine monocytic ehrlichiosis caused by Ehrlichia canis is endemic in many regions of Brazil. Since thrombocytopenia is a common finding in infected dogs, many clinicians tend to use it as an indication for antibiotic treatment. Polymerase chain reaction (PCR) and nested PCR were used to study the presence of E. canis, Anaplasma platys and Babesia spp. in thrombocytopenic and non-thrombocytopenic dogs from Ribeiro Preto, Brazil. Despite the high prevalence of E. canis infection among thrombocytopenic dogs, 46.7% of the thrombocytopenic dogs studied were either infected with Babesia spp. or A. platys or not infected with any of the three pathogens. There was a high incidence (25.4%) of E. canis infection in non-thrombocytopenic dogs. Although infection with E. canis should be considered in thrombocytopenic dogs, the final diagnosis needs to be confirmed by complementary tests such as blood smears and PCR to avoid the unnecessary use of antibiotics.
PMID: 17920967 [PubMed - as supplied by publisher]
- 27: Vet Parasitol. 2007 Nov 30;150(1-2):54-64. Epub 2007 Oct 24.
-
Differential Bos taurus cattle response to Babesia bovis infection.
Benavides MV, Sacco AM.
South Embrapa Cattle & Sheep Research Centre, BR 153 km 595 P.O. Box 242, Bag, RS 96401-970, Brazil. magda@cppsul.embrapa.br
Bovine babesiosis is a tick-borne disease caused by Babesia spp. haemoprotozoans. The disease is of great importance at tick enzootic unstable areas and hampers cattle production in several developing countries. The available immunisation alternatives are pre-immunition and attenuated vaccines. Despite being efficient and protective, they are unsafe as they use cattle blood cells as inoculum and may potentially spread other diseases. Another alternative to help in babesiosis control would be the identification of genetically resistant cattle to Babesia bovis infection. The objective of this work was to phenotype cattle based on primary response against B. bovis infection. Two-hundred and forty half-sib Hereford and Aberdeen Angus heifers (120 animals from each breed), 12-18-month-old nave cattle, originated from a tick-free area in Southern Brazil, were used in the experiment. Animals were monitored following an inoculation with 1x10(7)B. bovis parasitised erythrocytes. Results showed three different phenotypes: 1-'susceptible', animals with babesiosis clinical signs that received treatment to avoid death; 2-'intermediate', animals with clinical signs: parasitaemia, >or=21.5% reduction in packed cell volume (PCV) and increase in body temperature when compared to their pre-challenge physiological parameters, no specific treatment was needed as animals self recovered from the disease, and 3-'resistant', animals without clinical signs that showed B. bovis presence in blood smears, <21.5% PCV reductions, with little or no increase in body temperature and no need for babesiosis treatment. The frequencies of each phenotype were: 45.4, 26.7, and 27.9%, respectively, demonstrating the existence of phenotypic variation for B. bovis in Bos taurus cattle.
Publication Types:
PMID: 17919816 [PubMed - indexed for MEDLINE]
- 28: Wiad Parazytol. 2007;53(2):73-9.
[Cattle babesiosis]
[Article in Polish]
Sawczuk M.
Katedra Genetyki, Uniwersytet Szczecinski, Al. Piastw 40B, Szczecin 71-045. sawczukm@univ.szczecin.pl
Babesia parasites are intraerytrocytic Protozoa that infect wide range of domestic and wild animals and occasionally man causing babesiosis (piroplasmosis). Babesiosis also known in cattle as tick fever or red water fever is most important arthropod-borne disease of bovinae ungulates worldwide with areas of Africa, Asia, South and Central America, Australia and finally Europe. Since Smith and Kilborne had first described potential role of ticks in spread of piroplasmosis within animals, only United States till end of 50 of XX century eradicated the disease from the continent. In other, especially African countries, the problem seems to be of great economic importance. In this review all species of Babesia known to date to be infective to cattle are described with emphasis on geographical distribution of piroplasmosis, tick vector and pathogenicity of particular species and strains.
Publication Types: