Babesia microti, an intraerythrocytic parasite, is tickborne in nature. In contrast to transmission by blood transfusion, which has been well documented, transmission associated with solid organ transplantation has not been reported. We describe parasitologically confirmed cases of babesiosis diagnosed ~8 weeks posttrasnplantation in 2 recipients of renal allografts from an organ donor who was multiply transfused on the day he died from traumatic injuries. The organ donor and recipients had no identified risk factors for tick borne infection. Antibodies against B. microti parasites were not detected by serologic testing of archived pre transplant specimens; however, 1 of the donor’s blood donors was seropositive when tested post donation and had risk factors for tick exposure. The organ donor probably served as a conduit of Babesia parasites from the seropositive blood donor to both kidney recipients. Babesiosis should be included in the differential diagnosis of unexplained fever and hemolytic anemia after blood transfusion or organ transplantation.
There’s a number of interesting points about this abstract.
Firstly, they state transmission from organ transplantation has not been reported. Not reported does not mean it doesn’t happen. As in the case of the refusal to treat two children in Arkansas due to the fact there hadn’t been any reported cases of Lyme Disease, even though they have ticks infected with LD,
https://madisonarealymesupportgroup.com/2016/09/24/arkansas-kids-denied-lyme-treatment/, at least now infection of Babesiosis by transplantation has been “officially” reported on so the next poor sucker that gets it doesn’t have to be left to suffer.
Secondly, it states that the donor and recipients had no identified risk factors for tick borne infection. If you live in Wisconsin – that’s your risk factor right there. Period. You can walk outside, sniff the air and get infected. Entomologists are finding ticks in short grass here – like in soccer fields.
Thirdly, it states that Babesiosis should be included in the differential diagnosis of unexplained fever and hemolytic anemia after blood transfusion or organ transplantation. Again, I’m glad this is “official” now but there are some nuances about Babesia regular doctors need to learn from Lyme Literate Doctors (LLMD’s) who are in the trenches with extremely ill folks.
It’s important to know that folks who are given immunosuppressant drugs if they have Babesia could get much worse, and since Babesia itself suppresses the immune system, the two together are a one, two punch. Folks receiving organ transplants all receive immunosuppressant drugs. The challenge is that donors might have subclinical Babesia and not know it. They have zero to mild symptoms they could easily brush off as menopause (who doesn’t have night sweats?) or age (who doesn’t have some fatigue?). Also, testing for Babesia takes a trained eye and there may not be enough organisms present in the blood sample to identify. According to Dr. Horowitz, a knowledgable LLMD, doctors are taught that besides day and night sweats and chills, patients are supposed to get hemolytic anemia and their liver functions go up or their platelet count might go down (thrombocytopenia), but that only certain strains of Babesia do this. Also, they are taught that 10 days of an antimalarial will cure babesiosis when in fact it is one of the most dangerous and tenacious co-infections he deals with. Many LLMD’s recommend treating it for minimum of 4 months to a year, much longer than what standard doctors recommend, and what was used in the above abstract.
And to top it all off, various species produce offspring that have different exterior proteins or genotypes to evade the immune system, making it even harder to identify.
And fourthly, the article states that because the cases of babesiosis in the recipients could have been easily missed, it highlights the possibility that other transplantation-associated cases have occurred but were not diagnosed or investigated, and that at least one patient’s Babesiosis was diagnosed because of the serendipitous finding of parasites on a blood smear that was examined manually because of platelet clumping. Ok – so they found it by luck. That’s a bit frightening.
How many were missed because they weren’t so lucky?
On the bright side, I truly am glad this is all official now.