Archive for the ‘Babesia’ Category

Case Report: Delayed Onset Babesia

https://danielcameronmd.com/case-report-delayed-onset-babesia/

CASE REPORT: DELAYED ONSET BABESIA

delayed-onset-babesia

Hello, and welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this podcast, I will be discussing an unusual case of delayed onset Babesia.

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Podcast:  https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS83NzIx

The case, involving a 19-year-old Hispanic man, was published in the Italian Journal of Pediatrics.1

Ten weeks after travelling to New York, the patient was diagnosed with the tick-borne illness Babesia. Initially, he presented with a 4-day history of fever, generalized weakness, and flu-like symptoms.

His fever was 104.8 F. His hemoglobin dropped from 9.3g/dL to 6.7g/dL within 5 hours. He was diagnosed with hemolysis and transfused with 2 units of packed red blood cells. A peripheral blood smear revealed a Maltese cross typically seen in Babesia.

Babesia is more likely to be symptomatic in individuals with a history of a splenectomy. This young man had a history of a splenectomy for hereditary spherocytosis when he was 3 years old.

Early in the disease, Babesia is more likely to be diagnosed with a thick blood smear under the microscope. But later in the course of the disease, a polymerase chain reaction (PCR) or antibody test can confirm the infection.

Babesia is more likely to be contracted in the Northeastern region of the United States. This young man had returned from a trip to New York. The disease is less likely to be contracted in Florida where the young man presented to an emergency room.

The patient was prescribed Quinine, but it was stopped due to headache, tinnitus, and blurred vision. Instead, he was successfully treated with Atovaquone, clindamycin, and azithromycin.

Two newborns with delayed onset Babesia 

During their third trimester, two mothers were treated for Lyme disease with amoxicillin. Both babies were born and discharged home. But several weeks later, the babies became ill with Babesia.²

The following questions are addressed in this Inside Lyme Podcast.

  1. What is Babesia and where are you more likely to contract the disease?
  2. How is Babesia diagnosed and treated?
  3. Can Babesia be transmitted through blood transfusions?
  4. What are the most common symptoms of Babesia?
  5. Is treatment different from Lyme disease?
  6. How frequently does Babesia co-occur with Lyme disease?
  7. Do patients with Babesia and Lyme disease present differently?
  8. Could Babesia explain why some Lyme disease patients relapse after initially improving with treatment?
  9. What is a Maltese cross?
  10. What is the importance of a splenectomy?
  11. Why is delayed onset Babesia important?

Editor’s note:  Delayed onset Babesia in two newborns is discussed in another Inside Lyme podcast.

    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website @DanielCameronMD.com. As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

References:
  1. Patel JK, Tirumalasetty K, Zeidan B, Jr., Desai P, Frunzi J. A Case Report of Babesiosis Seen Outside of its Endemic Area and Incubation Period. Cureus. Dec 5 2020;12(12):e11926. doi:10.7759/cureus.11926
  2. Saetre K, Godhwani N, Maria M, et al. Congenital Babesiosis After Maternal Infection With Borrelia burgdorferi and Babesia microti. J Pediatric Infect Dis Soc. Feb 19 2018;7(1):e1-e5. doi:10.1093/jpids/pix074

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For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

https://madisonarealymesupportgroup.com/2020/07/31/cipro-derivatives-show-promise-against-babesia-in-vitro/

https://madisonarealymesupportgroup.com/2020/07/21/babesia-in-dogs-implications-for-people/

https://madisonarealymesupportgroup.com/2021/01/08/rising-geriatric-babesia-cases-may-require-longer-treatment/

Category:

Babesia, research, Treatment

Stealth Infections & Their Detection

Dr.-Schwarzbach-Stealth-Infections-and-their-Detection (1)  pdf here

iu-105

Armin Schwarzbach PhD

Medical doctor and Specialist for Laboratory Medicine

Augsburg, Germany

AONM Annual Conference London, November 19th 2017

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**Comment**

Excellent presentation on the following stealth pathogens:

  • Mycoplasma
  • Bartonella
  • Babesia
  • Ehrlichia/Anaplasma
  • Chlamydia pneumoniae
  • Yersinia
  • Coxsackie viruses (B1, A7, A16) and many others 
  • Borrelia burgdorferi , in all its forms

While Dr. Schwarzbach wants to blame “ecosystem disruption” for the mess we are in, I think it more likely to be due to laboratory experimentation/manipulation (bioweaponization), dropping ticks from airplanes, and migratory birds and animals transporting ticks far and wide:

https://madisonarealymesupportgroup.com/2020/09/25/why-should-we-care-about-lyme-disease-a-colorful-tale-of-government-conflicts-of-interest-probable-bioweaponization-and-pathogen-complexity/

Category:

Anaplasmosis, Babesia, Bartonella, Ehrlichiosis, Lyme, Mycoplasma, Testing, Viruses

Rising Geriatric Babesia Cases May Require Longer Treatment

https://danielcameronmd.com/geriatric-babesia-rising-longer-treatment/

GERIATRIC BABESIA CASES ARE RISING AND MAY REQUIRE LONGER TREATMENT

woman with geriatric babesia receiving medication from nurse

The number of Babesia cases among the elderly in the U.S. appears to be growing. According to a study by Menis and colleagues, published in the journal Open Forum Infectious Diseases, 19,469 Medicare beneficiaries had a Babesia diagnosis recorded between 2006 – 2017, with the highest rates occurring in babesiosis-endemic states. [1]

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Overall, the number of individuals contracting Babesia is rising, as well. The annual number of cases per year climbed from 4 per 100,000 to 9 per 100,000 in the U.S. between 2006 and 2017. The annual number of cases of Babesia per year for individuals over the age of 85 was 4 out of 100,000. In comparison, the number of Lyme disease cases among the elderly was 15.98 per 100,000.

Most of the cases of Babesia occurred in the Lyme-endemic states of Massachusetts, Rhode Island, Connecticut, New York, and New Jersey, according to the authors. Other states recording Babesia cases included Florida, Pennsylvania, California, Maryland, and Virginia. Some cases of Babesia were also reported in New Hampshire, Maine, Vermont, Minnesota, Wisconsin, Texas, North Carolina, and Illinois.

The most common test used to diagnose Babesia was a blood smear in the institutional setting, wrote Menis in a related paper. [2] The intracellular parasite in the red blood cell clears after a few days. The most common tests used in a physician’s office involved antibody or PCR testing. [2]

Co-infections can be deadly

A Babesia infection can be serious for patients.

“Patients co-infected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n=10) experiencing babesial infection alone,” wrote Krause and colleagues [3]. In another paper, the authors explain, “Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness.” [4]

For some patients, including the elderly, a Babesia infection can be more serious. “Babesiosis can be life threatening, particularly for persons who are asplenic, immunocompromised, or elderly,” wrote Krause et al. [4]

85-year-old dies from Babesia and Ehrlichia

Javed and colleagues describe the case of an 85-year-old man who died of a concurrent Babesiosis and Ehrlichiosis infection. [5]

He was an avid gardener and golfer in good health except for hypertension. He did not have a tick bite or rash. The man was hospitalized with weakness and jaundice. He had mild anemia, a very low platelet count, a mildly elevated bilirubin, and mildly reduced renal function.

The doctors diagnosed Babesia based on a bone marrow biopsy revealing intraerythrocytic inclusions (tetrads), typical of babesiosis. In retrospective, his admitting bloods from admission revealed parasitemia in 8% of the red blood cells. The Babesia antibody IgM and IgG were positive for Babesia.

READ MORE: Elderly Lyme disease patients more likely to have unfavorable treatment outcomes

The elderly man was treated with IV clindamycin and IV quinine. His anemia worsened despite transfusion of two units of blood and he was transferred to a tertiary hospital for possible exchange transfusion. The doctor added azithromycin but not Atovaquone.

His condition worsened. His oxygen saturation dropped to 84% and he subsequently developed bilateral pneumonia, renal failure, hepatic failure, and a coma. He was too ill to tolerate exchange transfusion.

He died within 60 hours of admission to the tertiary care center.

Post-mortem tests were positive for Human Monocytic Ehrlichiosis, the cause of Ehrlichia. He was never treated with doxycycline, the most commonly prescribed medication for Ehrlichia.

Treatment of Babesia

Krause and colleagues reported that a 10-day course of Mepron and Zithromax would be as effective as clindamycin and quinine and have less side effects. [3] The Medicare beneficiaries were far more likely to be prescribed Mepron with Zithromax than clindamycin and quinine. [1]

Some patients with Babesia require longer treatment. Krause and colleagues reported immunocompromised and elderly patients were more likely to need longer term therapy.” [4]

In another paper, the authors point out that,

“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.” [4]

More than one-third of elderly Babesia patients were not treated with anti-Babesia treatment during their evaluation. The study was not designed to determine if the elderly were subsequently treated.

IDSA position

The 2020 Infectious Diseases Society of America (IDSA) guidelines for Babesia highlighted concerns regarding severe Babesia in the elderly.

“Numerous immunodeficiencies and comorbidities have been associated with severe babesiosis, including asplenia and hyposplenism, cancer, congestive heart failure, HIV infection, immunosuppressive drugs, and advanced age.” [6]

For immunocompromised patients, we suggest monitoring Babesia parasitemia using peripheral blood smears even after they become asymptomatic and until blood smears are negative. PCR testing should be considered if blood smears have become negative but symptoms persist (weak recommendation, moderate-quality evidence).

In addition, the IDSA guidelines advised longer treatment for immunocompromised Babesia patients.

“A subgroup of highly immunocompromised patients reported in a case control study required at least 6 consecutive weeks of antibiotic therapy, including 2 final weeks during which parasites were no longer detected on peripheral blood smear.” [6]

However, some patients can relapse.

“A few cases of relapse despite at least 6 consecutive weeks of atovaquone plus azithromycin demonstrate that resistance to atovaquone and/or azithromycin can emerge in highly immunocompromised patients during an extended course of this antibiotic combination,” wrote Krause et al. [6]

Editor’s note: I share the same concerns regarding Babesia in the elderly, and I base the length of antibiotics on the patient’s response to treatment.

Related Articles:

Tick bite causes 3 diseases in elderly woman

Lyme disease mimics autoimmune disorder in elderly woman

Podcast: Confusion in elderly woman with anaplasmosis and babesia infection

References:
  1. Menis M, Whitaker BI, Wernecke M, et al. Babesiosis Occurrence among the U.S. Medicare Beneficiaries Ages 65 and Older, During 2006-2017: Overall, and by State and County of Residence. Open Forum Infectious Diseases. 2020
  2. Menis M, Forshee RA, Kumar S, McKean S, Warnock R, Izurieta HS, Gondalia R, Johnson C, Mintz PD, Walderhaug MO, Worrall CM, Kelman JA, Anderson SA. Babesiosis Occurrence among the Elderly in the United States, as Recorded in Large Medicare Databases during 2006-2013. PLoS One. 2015 Oct 15;10(10)
  3. Krause PJ, Telford SR, 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. Jun 5 1996;275(21):1657-60.
  4. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. Feb 1 2008;46(3):370-6. doi:10.1086/525852
  5. Javed MZ, Srivastava M, Zhang S, Kandathil M. Concurrent babesiosis and ehrlichiosis in an elderly host. Mayo Clin Proc. May 2001;76(5):563-5. doi:10.4065/76.5.563
  6. Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis. Nov 30 2020;doi:10.1093/cid/ciaa1216

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For more:  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/

Mainstream medicine still does not believe the seriousness of this complex illness that thousands upon thousands are suffering from.  The interaction of confections make cases extremely difficult to treat.  Do not mess around with this, get to a Lyme literate doctor asap:  https://madisonarealymesupportgroup.com/2020/11/25/what-makes-a-doctor-lyme-literate/  These doctors typically layer treatment to reduce any potential of resistance to treatment.  We often took 4 things simultaneously.

Category:

Babesia, research, Treatment

Tick Bite – Letter to the Editor

https://www.bmj.com/content/370/bmj.m3029/rr-3

Tick bite

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3029 (Published 13 August 2020)Cite this as: BMJ 2020;370:m3029

21 August 2020
Habib ur Rehman
Physician
Saskatchewan Health Authority
Suite 100, 2550 12th Ave, Regina, SK, S4P 3X1, Canada

Rapid Response:

Re: Tick bite

Dear Editor

Razai et al, in their consultation on tick bite, missed an important message to learners (1).

  • As the incidence of Lyme disease increases, there is also greater likelihood of co-transmission of other pathogens carried by I scapularis and I pacificus ticks.
  • Since symptoms of these co infections are non-specific and may overlap with Lyme’s disease, accurate diagnosis becomes more difficult. It is therefore important that a high level of suspicion is maintained for these co-infections so patients receive accurate diagnosis and adequate treatment.

The most common infectious agents transmitted by Ixodes species ticks in North America that have the potential for co-infection with B burgdorferi are Anaplasma phagocytophilum, Babesia species, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris–like agent (2).

A phagocytophilum is transmitted by the same Ixodes ticks as B burgdorferi in the United States and causes fever, chills, headache, myalgia, and fatigue arising 1 to 3 weeks following tick exposure. Most cases are mild and self-limited. However, severe manifestations may include respiratory failure, adult respiratory distress syndrome, peripheral neuropathy, rhabdomyolysis, acute renal failure, pancreatitis, and coagulopathies.

It has been found that in Wisconsin, approximately 3% of I scapularis ticks examined were co-infected with B burgdorferi and A phagocytophilum (3). A similar study in 11,000 ticks in public parks of New York State’s Hudson Valley Region found that co-infection rates of nymphs and adults were 0.5% and 6.3%, respectively (4).

The frequency of humans with Lyme disease simultaneously co-infected with A phagocytophilum from various studies ranges from 2% to 10% (5,6). Similirly, Babesiosis is transmitted through the bite of infected I scapularis and I pacificus ticks. Most patients are asymptomatic or have mild, self-limited disease but may be complicated by renal failure, acute respiratory distress, and shock.

In a study of patients with Lyme disease from southern New England, approximately 10% were co-infected with babesiosis (7).

Unlike Lyme disease and Anaplasmosis, doxycycline is not an effective treatment of babesiosis and requires atovaquone and azithromycin or combination of clindamycin with quinine, making it imperitive to consider this diagnosis in mind in patients with tick bite.

Of the 3 species of Ehrlichia in United States, only E muris–like (EML) agent is transmitted by I scapularis is the vector of this emerging pathogen(8).

Possible co-infections should be considered in any patients who are diagnosed with tick bite or Lyme disease, especially those who have unexplained leukopenia, thrombocytopenia, or anemia, or who fail to respond to treatment for Lyme’s disease.

References:
1- Razai MS, Doerholt K, Galiza E, Oakeshott P. Tick bite. BMJ 2020;370:m3029
2- Caulfield AJ, Pritt BS. Lyme disease Coinfections in the United States. Clin Lab Med 2015;35:827–846.
3- Lee, X, Coyle DR, Johnson DK, et al. Prevalence of Borrelia burgdorferi and Anaplasma phagocytophilum in Ixodes scapularis (Acari: Ixodidae) nymphs collected in managed red pine forests in Wisconsin. J Med Entomol 2014;51:694-701.
4- Prusinski MA, Kokas JE, Hukey KT, et al. Prevalence of Borrelia burgdorferi (Spoirochets: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley Region, New York State. J Med Entomol 2014;51:226-36.
5- Horowitz HW, Aguero-Rosenfeld ME, Holmgren D, et al. Lyme disease and human granulocytic anaplasmosis coinfection: impact of case definition on coinfection rates and illness severity. Clin Infect Dis 2013;56;93-9.
6- Steere AC, McHugh G, Suarez C, et al. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis 2003;36:1078-81.
7- Krause PJ, Telford SR, Spielman A, et al. Concurrent Lyme disease and babesiosis – evidence for increased severity and duration of illness. JAMA 1996;275:1657-60.
8- Pritt BS, McFadden JD, Stromdah E, et al. Emergence of a novel Ehrlichia sp. agent
pathogenic for humans in the Midwestern United States. 6th International Meeting
on Rickettsiae and Rickettsial Diseases. Heraklion (Greece), June 5–7, 2011.

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**Comment**

This important letter to the editor highlights many contentious issues Lyme/MSIDS patients have to muddle through.  From where I sit, I disagree with the author’s statements that these infections are ‘mild and self-limited’, but I deal with sick people – not healthy.  If there’s one thing I DO know, it’s that these infections have been downplayed for far too long, and it’s been a real problem.  Patients haven’t been taken seriously for over 40 years!

The consideration of coinfections; unfortunately, is not common in mainstream medicine regarding Lyme/MSIDS.  They still treat this as a one germ disease with doxycycline curing it, when nothing could be further from the truth:  https://madisonarealymesupportgroup.com/2018/10/30/study-shows-lyme-msids-patients-infected-with-many-pathogens-and-explains-why-we-are-so-sick/

Category:

Activism, Anaplasmosis, Babesia, Ehrlichiosis, Lyme, Testing, Ticks

“Repurposing” Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years’ Experience in One Medical Practice

https://www.mdpi.com/2079-6382/9/12/868

“Repurposing” Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years’ Experience in One Medical Practice

by Jiachen Gao1, Zhaodi Gong2, Dawn Montesano3,Erica Glazer3 and Kenneth Liegner3,4,5,*
*Author to whom correspondence should be addressed.
Antibiotics 2020, 9(12), 868; https://doi.org/10.3390/antibiotics9120868 (registering DOI)
Received: 7 August 2020 / Revised: 19 November 2020 / Accepted: 3 December 2020 / Published: 4 December 2020
(This article belongs to the Special Issue The Evidence Base for Treatment of Tickborne Infections)
Abstract
A total of 71 patients with Lyme disease were identified for analysis in whom treatment with disulfiram was initiated between 15 March 2017 and 15 March 2020. Four patients were lost to follow-up, leaving 67 evaluable patients. Our retrospective review found patients to fall into a:
  • “high-dose” group (≥4 mg/kg/day)
  • “low-dose” group (<4 mg/kg/day)
  • 62 of 67 (92.5%) patients treated with disulfiram were able to endorse a net benefit of the treatment with regard to their symptoms.
  • 12 of 33 (36.4%) patients who completed one or two courses of “high-dose” therapy enjoyed an “enduring remission”, defined as remaining clinically well for ≥6 months without further anti-infective treatment.
  • The most common adverse reactions from disulfiram treatment in the high-dose group were fatigue (66.7%), psychiatric symptoms (48.5%), peripheral neuropathy (27.3%), and mild to moderate elevation of liver enzymes (15.2%).
  • We observed that although patients on high dose experienced a higher risk for adverse reactions than those on a low dose, high-dose patients were significantly more likely to achieve enduring remission. View Full-Text

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For more:  https://madisonarealymesupportgroup.com/2020/11/30/patients-can-respond-very-differently-to-disulfiram-be-cautious/

https://madisonarealymesupportgroup.com/2019/11/19/if-disulfiram-is-the-cure-for-lyme-disease-should-it-be-prescribed-to-all-lyme-disease-patients/

https://madisonarealymesupportgroup.com/2020/05/26/potential-patient-reported-toxicities-with-disulfiram-treatment-in-late-disseminated-lyme-disease/

https://madisonarealymesupportgroup.com/2020/10/01/study-shows-dsm-works-for-lyme-reduces-inflammatory-markers-antibody-titers/

https://madisonarealymesupportgroup.com/2019/07/14/disulfiram-breakthrough-drug-for-lyme-other-tick-borne-diseases/

Category:

Babesia, Lyme, research, Treatment