Archive for the ‘Babesia’ Category

Blood Screening for Babesia

http://doi.org/10.1056/NEJMoa1600897

Screening for Babesia microti in the U.S. Blood Supply
Erin D. Moritz, Ph.D., Colleen S. Winton, S.B.B. (A.S.C.P.), Laura Tonnetti, Ph.D., Rebecca L. Townsend, B.A., Victor P. Berardi, Mary-Ellen Hewins, B.S., Karen E. Weeks, B.S., Roger Y. Dodd, Ph.D., and Susan L. Stramer, Ph.D.
New England Journal of Medicine 2016; 375:2236-2245. Online first, December 8, 2016.

Abstract

Background
Babesia microti, a tickborne intraerythrocytic parasite that can be transmitted by means of blood transfusion, is responsible for the majority of cases of transfusion-transmitted babesiosis in the United States. However, no licensed test exists for screening for B. microti in donated blood. We assessed data from a large-scale, investigational product-release screening and donor follow-up program.

Methods
From June 2012 through September 2014, we performed arrayed fluorescence immunoassays (AFIAs) for B. microti antibodies and real-time polymerase-chain-reaction (PCR) assays for B. microti DNA on blood-donation samples obtained in Connecticut, Massachusetts, Minnesota, and Wisconsin. We determined parasite loads with the use of quantitative PCR testing and assessed infectivity by means of the inoculation of hamsters and the subsequent examination for parasitemia. Donors with test-reactive samples were followed. Using data on cases of transfusion-transmitted babesiosis, we compared the proportions of screened versus unscreened donations that were infectious.

Results
Of 89,153 blood-donation samples tested, 335 (0.38%) were confirmed to be positive, of which 67 (20%) were PCR-positive; 9 samples were antibody-negative (i.e., 1 antibody-negative sample per 9906 screened samples), representing 13% of all PCR-positive samples. PCR-positive samples were identified all through the year; antibody-negative infections occurred from June through September. Approximately one third of the red-cell samples from PCR-positive or high-titer AFIA-positive donations infected hamsters. Follow-up showed DNA clearance in 86% of the donors but antibody seroreversion in 8% after 1 year. In Connecticut and Massachusetts, no reported cases of transfusion-transmitted babesiosis were associated with screened donations (i.e., 0 cases per 75,331 screened donations), as compared with 14 cases per 253,031 unscreened donations (i.e., 1 case per 18,074 unscreened donations) (odds ratio, 8.6; 95% confidence interval, 0.51 to 144; P=0.05). Overall, 29 cases of transfusion-transmitted babesiosis were linked to blood from infected donors, including blood obtained from 10 donors whose samples tested positive on the PCR assay 2 to 7 months after the implicated donation.

Conclusions
Blood-donation screening for antibodies to and DNA from B. microti was associated with a decrease in the risk of transfusion-transmitted babesiosis. (Funded by the American Red Cross and Imugen; ClinicalTrials.gov number, NCT01528449 http://clinicaltrials.gov/show/NCT01528449.)

***For more on Babesia:   https://madisonarealymesupportgroup.com/2011/09/25/the-babesia-checklist-copyrighted-2011-james-schaller-md-mar-version-20/

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

https://madisonarealymesupportgroup.com/2016/11/19/seroprevalence-of-babesia-in-individuals-with-ld/

https://madisonarealymesupportgroup.com/2016/12/05/babesia-cure-update/

 

Category:

Babesia, research

Babesia Cure Update

Just heard back from the lead researcher at Yale on the mysterious ELQ compound discussed in:  https://madisonarealymesupportgroup.com/2016/06/17/babesia-cure/.

“Since the publication of our work, I have received several emails and phone calls from members of the public and with a similar request.  We are working on optimizing the ELQ compound to identify the best partner drug to use with atovaquone to develop a combination to use in clinical trials. This process can go from few months to years depending on the outcome of the preclinical studies. Once clinical trials start we will share this information with the general public.”

Category:

Babesia, research, Treatment

Seroprevalence of Babesia in Individuals with LD

http://online.liebertpub.com/doi/full/10.1089/vbz.2016.2020

Curcio Sabino R., Tria Laurel P., and Gucwa Azad L.. Vector-Borne and Zoonotic Diseases. October 2016, ahead of print. doi:10.1089/vbz.2016.2020.

Online Ahead of Print: October 24, 2016
Full Text HTML Full Text PDF (417.5 KB) Full Text PDF with Links (248.1 KB)
Author information
Sabino R. Curcio1, Laurel P. Tria,2 and Azad L. Gucwa1
1Department of Biomedical Sciences, Long Island University, Post Campus, Brookville, New York.
2Northwell Health Laboratories, Lake Success, New York.
Address correspondence to:
Azad L. Gucwa
Department of Biomedical Sciences
LIU Post
720 Northern Boulevard
Brookville, NY 11548
E-mail: azad.gucwa@liu.edu

ABSTRACT

Introduction: Babesiosis is an emerging tick-borne disease (TBD) caused by Babesia microti, an intracellular parasite of red blood cells. Currently, it is the highest ranked pathogen transmitted by blood transfusion. Most healthy individuals infected with B. microti are asymptomatic, but may be at risk for chronic infection. Similar to Lyme disease transmitted by Borrelia burgdorferi, B. microti is spread by Ixodes scapularis ticks. The rate of coinfection with these TBDs in humans is unclear as most studies have focused their prevalence in ticks or rodent reservoirs.

Materials and Methods: In this study, we aimed to determine the seroprevalence of B. microti infection in individuals who tested positive for Lyme disease. Serum samples obtained from 130 subjects in New York were tested by immunofluorescence assay (IFA) for the presence of IgM and IgG antibodies against B. microti.

Results: Overall, 26.9% of the serum samples tested were positive for IgM and IgG antibodies against B. microti, suggesting exposure to TBD (tick borne disease). Individuals who tested positive for Lyme disease as determined by two-tiered serological testing and the presence of both IgM and IgG antibodies directed against B. burgdorferi, were significantly increased for antibodies directed against B. microti (28.6%; p < 0.05), suggesting the possibility of coinfection with both TBDs. In contrast, the Lyme disease-negative control group had only 6.7% of samples seropositive for B. microti.

Conclusions: These findings suggest the need for more extensive studies investigating infection rates with multiple TBDs in areas where they are endemic and further support for the need to implement an FDA-approved screening test for blood products to help prevent transfusion-transmitted babesiosis.

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**My comment**

This study further shows evidence that when a person contracts LD, they are at risk for other co-infections as the LD lowers their immune function making them sitting ducks for other pathogens.  This is a real and present problem as most general practitioners haven’t a clue about co-infections.  The testing for all the TBI’s are poor and experience with symptomology is crucial in treating folks with TBI’s.  I truly believe that the addition of co-infections make TBI cases exponentially more difficult to treat.

If you type the various coinfections (Bartonella, Babesia, Mycoplasma, etc.) into the search bar on this website you can read about them and  various treatment options.  Feel free to copy these and take them to your health care provider for discussion.

Category:

Babesia, Lyme, research

Probable Transfusion-Transmission of Babesiosis

The Brief case: Probable transfusion-transmitted babesiosis in a transplant recipient

Kitt E, Keaton AA, Graf EH.
Journal of Clinical Microbiology 54:2632–2634.

http://dx.doi.org/10.1128/JCM.00981-16

Case

A 3-year-old immunocompromised male who had been hospitalized for 7 months in the cardiac intensive care unit developed fever and tachycardia in December. He was prenatally diagnosed with hypoplastic left heart syndrome and received right ventricle to pulmonary artery conduit surgery days after delivery. Due to worsening right ventricular function, after a hemi-Fontan procedure, he received an orthotopic heart transplant at the beginning of his 3rd year of life.

His posttransplant course was complicated by multiple episodes of rejection, cytomegalovirus (CMV) pneumonitis, and several central-line-associated bloodstream infections. As a result of the rejection, necessitating plasmapheresis as well as frequent blood draws for management, which led to anemia, he received 36 packed red blood cell transfusions over the course of 7 months posttransplantation. These transfusions were evenly spaced, and he remained hospitalized during the 7 months.

At the time of the febrile episode, he was on caspofungin, trimethoprim-sulfamethoxazole, and ganciclovir. The subsequent diagnostic workup included multiple sets of blood cultures, a urine culture, and a CMV viral load analysis. He was started on vancomycin and cefepime while awaiting microbiologic results. Other pertinent test results included a complete blood count (CBC) with differential showing pancytopenia and an aspartate transaminase (AST) level of 200 U/liter (reference range, 20 to 60 U/liter), an alanine aminotransferase (ALT) level of 84 U/liter (reference range, 5 to 45 U/liter), and a C-reactive protein level of 3.1 mg/dl (reference range, 0 to 0.9 mg/dl), which increased to 7.1 mg/dl over 4 days.

On the 5th day of fever, another CBC with differential was ordered and was noted by the hematopathologist to contain intraerythrocytic parasites. Immediately, a blood smear with Giemsa stain (Harleco Giemsa stain; EMD Millipore, Billerica, MA, USA) was performed by the microbiology laboratory, yielding the definitive diagnosis. Babesia species with a parasitemia level of 18% was reported to the clinical team. Real-time PCR testing, performed by a reference laboratory, provided the species-level identity of Babesia microti. All other infectious workups were negative. The patient was started on azithromycin plus atovaquone due to the contraindications against treatment with quinidine (QT interval prolongation in a heart transplant recipient with declining heart function).

Three days later, clindamycin was added when his parasitemia level did not decline. He was also given an exchange transfusion on day 4 after diagnosis in an attempt to reduce his parasitemia. After 14 days of therapy, his parasitemia became undetectable and he completed 6 full weeks of therapy, at which time he remained aparasitemic. Since transfusion was the child’s only known risk factor for Babesia infection, a complete investigation into the blood products used was conducted, but the infectious unit/donor could not be definitively identified. Banked products from the organ donor were also tested, and it was determined that the heart transplant was not the source of the Babesia infection.

Category:

Babesia, research, Treatment

Unlike Mosquitoes, Ticks Year Long Threat

http://www.omaha.com/living/move-over-mosquitoes-tick-fight-takes-attention/article_996c6495-f986-59cf-8649-6bfd46fc4209.html

According to the Companion Animal Parasite Council (CAPC) 2016 is going to be a banner year for ticks, with the CDC listing 15 different tick borne diseases (TBI’s) which range from debilitating to fatal.

The council sates that they thrive everywhere from wooded areas to gardens, landscape plants and even backyard grasses with most people coming into contact with them in their own backyards.

The article states a big help in lowering the tick population is by deterring deer from your living area by planting vegetation deer don’t like to building a tall fence, although they can jump over fences as high as 10 feet. They state a foliar spray such as Bobbex Deer Repellent is effective year-round and supposedly safe for use around children and pets and won’t wash off from rain or snow. It was found to be 93% effective in deterring deer when compared to other like repellents.

According to Sam Telford, a professor of infectious diseases at Tufts, “One or two years of severe weather may depress their numbers, but remember….the successful feeding of one female tick on a deer translates to 2,000 eggs.”

Many believe that ticks are not active in the winter. Unfortunately, this is a myth.

https://madisonarealymesupportgroup.com/2016/01/20/polar-vorticks/

Category:

Anaplasmosis, Babesia, Bartonella, Lyme, Mycoplasma, research, Ticks, Viruses