Archive for the ‘Babesia’ Category

Babesia Infections Explode In Hudson Valley, NY

https://danielcameronmd.com/babesia-infections-explode-in-hudson-valley-region/

BABESIA INFECTIONS EXPLODE IN HUDSON VALLEY, NY

man sick with babesia infection

Babesia, a parasitic infection usually transmitted through a tick bite, was once thought to be a coastal tick-borne disease limited to Suffolk County on Long Island. Some doctors had been reluctant to acknowledge that Babesia could be found in other locations. But in 2001, Babesia infections were reported in lower Hudson Valley, New York, a region north of Manhattan and has since continued to spread with an increase in the number of cases far beyond the borders of Long Island.

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In their article “Increasing incidence and changing epidemiology of babesiosis in the Hudson Valley region of New York State: 2009-2016,” ¹ Joseph and colleagues question how cases of Babesia infections are spreading given that the animal reservoirs mice, shrews, and voles typically do not travel large distances.
Cases of Babesia have been reported in two counties located east of the Hudson River: Dutchess County and Westchester County, the authors write. (Westchester County alone has a population of nearly 1 million residents.)

Read More: Babesia remains a clinical diagnosis for some patients.

But since 2009, there has been an explosion of Babesia infections in the Upper Hudson Valley, New York region. This area consists of Albany County, Columbia County, Greene County, and Rensselaer County.

Over an 8-year period (between 2009-2016), there was a 16.8-fold increase in the incidence of Babesia cases in the Upper Hudson Valley region.

The number of Babesia cases explodes in the upper Hudson Valley, NY region. CLICK TO TWEET

The number of cases also increased in the Lower Hudson Valley region, which consists of Dutchess County, Putnam County, Westchester County, Orange County, Rockland County, Sullivan County, and Ulster County.

The actual number of Babesia cases is likely higher:

  1. It was not until 2011, that the Centers for Disease Control and Prevention (CDC) made Babesia a reportable disease. Between 2011 and 2016, New York State had a reported 2,750 cases of Babesia, the highest number in any state in the U.S.
  2. Babesia can be difficult to identify since the parasites in the red blood cells can quickly clear.
  3. Lastly, Babesia cases may not be recorded if the physician does not report the case to the CDC.

“In conclusion, babesiosis is a rapidly emerging infection in the Hudson Valley region of New York State, the geographic region now accounting for more cases than any other single geographic area in the state,” the authors write.

Therefore, “clinicians caring for patients with symptoms compatible with babesiosis, who live in or have traveled to the Hudson Valley region of New York State, should consider the possibility of babesiosis.”

Editor’s Note: I have practiced medicine in the Hudson Valley, New York region for more than 33 years. I have treated patients with Babesia infections for the past three decades. Many of the first patients first described with Babesia were caught early when Babesia microti was seen in the red blood cells. I typically diagnose cases of Babesia with a positive antibody test or using clinical judgment.

In addition, the authors addressed Babesia microti in their paper. I have seen evidence that Babesia duncani appears to be a problem in the area. Babesia duncani was first identified on the West Coast. We need more research on this tick-borne disease.

Lastly, the presence of Babesia has important treatment considerations. Neither doxycycline nor amoxicillin are effective in treating Babesia. Patients with Lyme disease, co-infected with Babesia, would need a combination of antimicrobials to include an anti-parasitic medication (i.e., azithromycin combined with Atovaquone).

Related Articles:

Severe Babesia infection leads to exchange transfusion

Case series looks at the complexity of Babesia

Podcast: Two children who contracted Babesia from their mothers

References:
  1. Joseph JT, John M, Visintainer P, Wormser GP. Increasing incidence and changing epidemiology of babesiosis in the Hudson Valley region of New York State: 2009-2016. Diagn Microbiol Infect Dis. 2020 Feb;96(2):114958.

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**Comment**

If doctors aren’t reporting it (and it wasn’t even a reportable illness until 2011) the CDC isn’t counting it.  

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

https://madisonarealymesupportgroup.com/2020/02/09/severe-babesia-infection-leads-to-exchange-transfusion/

https://madisonarealymesupportgroup.com/2019/09/05/babesia-subverts-adaptive-immunity-and-enhances-lyme-disease-severity/

https://madisonarealymesupportgroup.com/2018/10/11/babesia-found-in-patient-with-persistent-symptoms-following-lyme-treatment/

https://madisonarealymesupportgroup.com/2018/03/22/what-is-air-hunger-anyway/

https://madisonarealymesupportgroup.com/2018/05/31/widespread-babesiosis-in-canada/

https://madisonarealymesupportgroup.com/2017/11/07/congenital-babesiosis-in-two-infants/

Category:

Babesia, research, Treatment

Frequency & Magnitude of Seroreactivity to Babesia Microti in 245 Patients Diagnosed by PCR in N.Y. State

https://www.ncbi.nlm.nih.gov/pubmed/32113703

2020 Jan 29:115008. doi: 10.1016/j.diagmicrobio.2020.115008. [Epub ahead of print]

Frequency and magnitude of seroreactivity to Babesia microti in 245 patients diagnosed by PCR in New York State.

Madison-Antenucci S1, Wormser GP2, Levin AE3, Wong SJ4.

Abstract

Multiple methodologies have been used to detect antibodies to Babesia microti. Use of an indirect immunofluorescence assay (IFA) has been the most widely used approach, but IFAs have varied as to which antibody class or classes are being detected and in regard to cutoff titers. In this study, 245 different patients with polymerase chain reaction (PCR)-confirmed B. microti infection were tested by a polyvalent IFA using serum collected within 3 days of the date the blood sample for PCR testing was obtained. Of the 245 patients, 243 (99.2%) had a positive serologic test result (i.e., ≥1:64). Of the 243 patients who were seropositive, 242 (99.6%) had a titer of ≥1:256, 236 (97.1%) had a titer of ≥1:512, and 210 (86.4%) had a titer of ≥1:1024. In conclusion, high titer seropositivity based on a polyvalent IFA is to be expected at the time of PCR confirmation of active babesiosis in clinical practice.

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

Category:

Babesia, research, Testing

Lyme Podcast: 6-Week Old Boy With Babesia

https://danielcameronmd.com/lyme-disease-podcast-6-week-old-boy-babesia/  Go here for Podcast

LYME PODCAST: 6-WEEK-OLD BOY WITH BABESIA

Lyme Disease Podcast: 6-week-old boy with Babesia

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this case study, I will be discussing a 6-week old baby boy with Babesia. This case series will be discussed on my Facebook and made available on podcast and YouTube.

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This case was described in the journal Pediatrics, written by Handel and colleagues in 2019.

The baby boy was seen in an emergency department in Long Island, New York, an area endemic for Lyme disease.  The baby spent “minimal time outside,” according to Handel.  There was tall grass in the yard and the father painted home exteriors. The parents did not report seeing a tick. Instead, the parents removed a bloody “flea” from his arm 20 days before hospitalization writes Handel

This highlights the difficulties parents can face in recognizing a tick.

The baby boy was irritable, throwing up, not eating well, and had a temperature of 101.1°F. The doctors were initially not able to identify the reason the baby boy was ill or why there was anemia or a low platelet count. The doctors prescribed three antibiotics – ampicillin, ceftriaxone, and vancomycin until they could determine a cause of the illness.

The baby boy was transferred to a second hospital. The blood tests again showed anemia and a low platelet count along with abnormal liver function tests. The spleen appeared large. The laboratory tests now revealed the parasite Babesia in the red blood cells under the microscope.  3.6% of the baby’s red cells showed parasites seen with Babesia.

Babesia is a parasitic disease that is typically contracted by the same tick that carries Lyme disease.  Babesia can also be contracted through the blood supply or during pregnancy.

The baby was prescribed oral atovaquone and intravenous azithromycin.  These drugs are marketed as Mepron and Zithromax in the US. The anemia worsened. The hemoglobin dropped to 6.9 gram/dl, which is quite low. The doctors transfused a unit of blood. The doctors were concerned that the baby might also have suffered from Lyme disease. The doctors added 14 days of amoxicillin to the treatment.

The baby remained well on follow-up, according to the doctors.

What can we learn from this case?

  1. This paper reminds parents of the need to look for tick bites even in babies.
  2. Babies can be infected with a tick-borne infection even with little outdoor exposure.
  3. It can be difficult to determine if a baby has Babesia.  The baby was not diagnosed with Babesia until transferred to a second hospital and then only because parasites were seen in the blood.
  4. It can be difficult to be sure a baby does not suffer from Lyme disease.  In this case, the doctors elected to treat the baby with amoxicillin in case there was a co-infection.  I might have continued azithromycin rather than add amoxicillin, as azithromycin has also been effective in Lyme disease.

What questions does this case raise?

  1. Would it have been helpful if the parents had recognized the “the bloody flea” as a tick?
  2. Would the doctor have recognized Babesia if the parasite were not seen in the red cells under the microscope?
  3. What if the baby girl had evidence of Ehrlichia or Anaplasmosis?  If so, the doctors would have to consider doxycycline.  Doctors have been reluctant to prescribe doxycycline in young children as the medication may discolor the teeth.  The age of which doctors are uncomfortable prescribing doxycycline has dropped to eight. Moreover, the CDC had notified doctors that two weeks of doxycycline is safe in all children up for up to two weeks. I am sure we have not heard the last of this discussion.
  4. What is the best combination of treatment and length of treatment to prevent long-term complications in children?
  5. How do you know a baby is well when they cannot communicate how they are feeling?  We only know that the parasite Babesia is no longer visible under the microscope.

TREATING TICK-BORNE DISEASE IN MY PRACTICE

In my practice, each individual requires a careful assessment. That is why I order tests a broad range of tests, including blood counts, liver and kidney function, thyroid disease, lupus, and rheumatoid arthritis, in addition to tests for tick-borne infections. I also arrange consultations such as neurologists, rheumatologists, and ophthalmologists.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills diagnosing and treating Babesia in children. We could use a reliable test to determine who has Babesia and a test to be sure Babesia  has resolved. We need to determine the best course of treatment for babies. We hope that if a professional sees a baby that they can use this case to remind them to look for Babesia and treat accordingly.

We also need to give doctors the freedom to treat these difficult cases without undue interference by colleagues, insurance companies, medical societies, and medical boards.
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.

Sign up for our newsletter to keep up with our cases.

References:
  1. Two Neonates With Postnatally Acquired Tickborne Infections Andrew S. Handel, Harriet Hellman and Saul R. Hymes Pediatrics 2019;144;

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

Category:

Babesia, Treatment

Detection of Novel Piroplasmid Species & Babesia Microti & Theileria Orientalis Genotypes Discovered in Chinese Hard Ticks

https://www.ncbi.nlm.nih.gov/pubmed/32060726/

2020 Feb 14. doi: 10.1007/s00436-020-06622-6. [Epub ahead of print]

Detection of novel piroplasmid species and Babesia microti and Theileria orientalis genotypes in hard ticks from Tengchong County, Southwest China.

Li LH1,2, Wang JZ3, Zhu D2, Li XS3, Lu Y2, Yin SQ3, Li SG3, Zhang Y4, Zhou XN2.

Abstract

To reveal the genetic diversity of Babesia microti and Theileria orientalis in Southwest China, we conducted a molecular survey of piroplasms in hard ticks in a China-Myanmar border county. Host infesting and questing ticks were collected from Tengchong County in 2013 and 2014. Piroplasm infection in ticks was detected by PCR, and then, phylogenetic analysis was conducted to study the genetic diversity of the pathogens identified in ticks.

All in all, six piroplasm species comprising of the following have been identified after screening goat and cattle-attached ticks:

  • B. microti
  • B. orientalis
  • a novel Babesia species designated Babesia sp. Tengchong, China
  • T. orientalis
  • T. luwenshuni
  • an undescribed piroplasmid species referred to as Piroplasmid sp. Tengchong, China
  • B. bigemina has been identified by screening questing ticks

Phylogenetic analysis based on the 18S rRNA and partial β-tubulin gene revealed two novel potentially zoonotic genotypes designated B. microti Tengchong-Type A and B.

The T. orientalis genotypes identified in the present study represent the seven known genotypes 1-5, 7, and N3 as revealed by phylogenetic analysis of 18S rRNA and MPSP genes. Importantly, an additional genotype designated N4 has also been identified in this study, which brings the number of recognized T. orientalis genotypes to a total of twelve.

Thus, besides the two novel species, Babesia sp. Tengchong, China, closely related to Babesia species isolated from yak and Piroplasmid sp. Tengchong, China, our study demonstrates that additional novel B. microti and T. orientalis genotypes exist in Southwest China.

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**Comment**

Babesia Microti is pathogenic in humans.

Babesia orientalis is pathogenic in water buffalo.

Theileria orientalis is pathogenic in cattle.

Theileria luwenshuni is pathogenic in sheep and goats.

Babesia bigemina is pathogenic in cattle.

They also discovered a NEW Theileria orientalis genotype  (N4).

The study identified TWO NEW Babesia microti genotypes (B. micro Tengchong- Type A & B) which may be pathogenic to humans.

 

 

Category:

Babesia, research, Testing, Ticks

74-Year Old Woman With Triple Tick Attack Podcast

https://danielcameronmd.com/lyme-disease-podcast-74-year-old-woman-triple-tick-attack/  Go here for Podcast

LYME PODCAST: 74-YEAR-OLD WOMAN WITH A TRIPLE TICK ATTACK

Lyme Disease Podcast: 74-year-old woman with a triple tick attack

Welcome to an Inside Lyme case study. I find that the best way to get to know Lyme disease is through reviewing actual cases. In this case study, I will be discussing a 74-year-old woman with a triple tick attack. This case series will be discussed on my Facebook and made available on podcast and YouTube.

By

In this episode, I will be discussing a 74-year-old woman with a triple tick attack.

This case was described in the journal Cureus, written by Kumar and colleagues in 2019.

A 74-year-old woman had underlying medical problems.  She was a smoker with chronic obstructive pulmonary disease (COPD). She also had hypertension. She was initially treated for pneumonia with ceftriaxone and azithromycin. She was also treated for Babesia.

Her red blood test contained parasites typical of Babesia.  That is, they were able to see a parasite typical of Babesia under the microscope. Babesia is a disease from a parasite found in a deer tick. This is the same deer tick that carries the spirochete that causes Lyme disease.  Over 9% of her red cells contained parasites typical of Babesia.

The doctors added atovaquone for Babesia.  Atovaquone is marked under the name Mepron in the US. The doctors also added doxycycline over concerns that the woman might also be infected with Lyme disease. She was quite ill.  She was also placed on a respirator.  She required medications to raise her blood pressure.

The doctors prescribed erythrocytapheresis due to the severity of her illness and the high number of parasites in her red cells. During erythrocytapheresis, some of the red blood cells are removed and replaced with blood from a donor. The number of parasites dropped from 9 to 5.54 percent, but the woman remained in shock. Her kidneys function worsened, which was believed due to hemolysis.

The woman’s blood test was positive for Lyme disease and Anaplasmosis.

There have been a number of studies showing three or more pathogenic infections in the same tick. 

The doctor made one last antibiotic change.  The doctors changed the treatment for Babesia from atovaquone and azithromycin to clindamycin and quinine.  Clindamycin and quinine are still used for difficult to treat cases of Babesia. She improved enough to take her off the respirator. Her blood counts and kidney function returned to normal after 14 days of treatment.

There have been a number of studies showing three or more pathogenic infections in the same tick.  “The incidence of a three pathogen infection is rare” writes Kumar. In actual practice, I have seen individuals with three pathogens who have not been published.

I support the Kumar’s call for a low level of suspicion; “A low threshold for suspicion should be held for a co-infection when patients exhibit a presentation that would be atypical for single pathogen exposure. A delay in diagnosis can lead to prolonged disease duration and increases the comorbidities associated with the infectious state.”

I agree with the doctor’s concerns with the reliability of testing for Babesia.  Kumar writes,  “A blood smear is the gold standard for the diagnosis of Babesiosis, however, if a patient has a low level of parasitic load, PCR is more sensitive.”

Kumar also raised concerns about the reliability of testing for Anaplasmosis.  Anaplasmosis has been seen in red cells in some patients.  “PCR and serological testing are also available, which are more sensitive than a thin smear.”

Finally, Dr. Kumar advised a longer course of treatment for Babesia.  “In case of immunocompromised individuals who are at risk of relapsing Babesia, treatment for a total of six weeks is preferred, including a period of two weeks after parasites are no longer visible on a thin smear” writes Kumar.

What can we learn from this case?

  1. It is important to look for a tick-borne infection even in patients with an underlying illness.
  2. Patients can suffer from more than one tick-borne infection at the same time.
  3. Their illness can be severe.

What questions does this case raise?

  1. Would Babesia have been discovered without seeing the parasite under the microscope?
  2. What is the best combination of treatment and length of treatment to prevent long-term complications?

TREATING TICK-BORNE DISEASE IN MY PRACTICE

In my practice, each individual requires a careful assessment. That is why I order tests a broad range of tests, including blood counts, liver and kidney function, thyroid disease, lupus, and rheumatoid arthritis in addition to tests for tick-borne infections. I also arrange consultations such as neurologists, rheumatologists, and ophthalmologists.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills diagnosing and treating individuals with more than one tick-borne infection. We could use a reliable test to determine who has a tick-borne infection and when tick-borne infections have resolved. We need to determine the best course of treatment to prevent chronic illness. We hope a professional can use this case to remind them to look for more than one tick-borne infection and treat them accordingly.

We also need to give doctors the freedom to treat these difficult cases without undue interference by colleagues, insurance companies, medical societies, and medical boards.

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.

Sign up for our newsletter to keep up with our cases.

References:
  1. Kumar M, Sharma A, Grover P. Triple Tick Attack. Cureus. 2019;11(2):e4064.

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**Comment**

A few details:

  • She was an avid gardner
  • It doesn’t specify if she saw a tick or not.  The title is misleading because it infers she was bitten 3 separate times when in fact 1 tick bite could transmit all 3 pathogens simultaneously.
  • The study states that it is COMMON to be infected with 2 pathogens but that being infected with 3 is rare, but that risk increases in endemic areas (like Wisconsin). It is my experience that infection with 3 pathogens or more in WI is fairly common.
  • Dr. Horowitz recommends treating Babesia for 9 months to a year.  https://madisonarealymesupportgroup.com/2016/01/16/babesia-treatment/
  • They don’t state it but ALL Lyme/MSIDS patients are immunocompromised, which means we typically need longer treatment. Mainstream medicine completely ignores this issue.
  • The study states: A treatment duration of a total of 10 days has been shown to be highly effective in treating both Lyme disease and human granulocytic anaplasmosis [12-13].  I couldn’t disagree more.  The study in reference #12 studied 10 days of treatment to eradicate the EM rash.  It’s common knowledge that the disappearance of EM rash does not mean a systemic infection is eradicated.  In fact, the EM rash has been known to disappear without any treatment what so ever!  The study in reference #13 is really about the increased disease severity in those with Anaplasmosis who had a delay in treatment. The study also admitted that their study may have excluded those with PCR-negative cases as well as the fact they are assuming disease course and severity doesn’t differ with different species.

 

 

 

 

 

 

Category:

Anaplasmosis, Babesia, Lyme, research, Uncategorized