Archive for the ‘Babesia’ Category

Possible Transfusion-Transmitted Babesia divergens-like/MO-1 in Arkansas Patient

https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/cix216/3067352/Possible-Transfusion-Transmitted-Babesia-divergens?redirectedFrom=fulltext  Mary J. Burgess, MD Eric R. Rosenbaum, MD, MPH Bobbi S. Pritt, MD, MSc Dirk T. Haselow, MD, PhD Katie M. Ferren, MD Bashar N. Alzghoul, MD Juan Carlos Rico, MD Lynne M. Sloan, BS Poornima Ramanan, MD Raghunandan Purushothaman, MD Robert W. Bradsher, MD    Published March 13, 2017

A patient with asplenia and multiple red blood cell transfusions acquired babesiosis infection with Babesia divergens-like/MO-1 and not Babesia microti, the common United States species. He had no known tick exposure. This is believed to be the first transfusion-transmitted case and the fifth documented case of Babesia divergens-like/MO-1.

Systematic Review: Human Diseases From Deer Ticks

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857413/#!po=47.6331

Mark P. Nelder,corresponding author Curtis B. Russell, Nina Jain Sheehan, Beate Sander, Stephen Moore, Ye Li, Steven Johnson, Samir N. Patel, and Doug Sider

I condensed information from the above link.

Abstract

Background

The blacklegged tick Ixodes scapularis transmits Borrelia burgdorferi (sensu stricto) in eastern North America; however, the agent of Lyme disease is not the sole pathogen harbored by the blacklegged tick. The blacklegged tick is expanding its range into areas of southern Canada such as Ontario, an area where exposure to blacklegged tick bites and tick-borne pathogens is increasing. We performed a systematic review to evaluate the public health risks posed by expanding blacklegged tick populations and their associated pathogens.

Methods

Researchers searched Ovid MEDLINE, Embase, BIOSIS, Scopus and Environment Complete databases for the years 2000 through 2015 using specific eligibility criteria such as field-collected backlegged ticks and studies that did NOT focus solely on B. burgdorferi (Bb) and performed quality assessments on eligible studies.  

Results

Seventy-eight studies were chosen.  The ticks in the studies harbored 91 distinct taxa, 16 of which are tick-transmitted human pathogens including Anaplasma, Babesia, Bartonella, Borrelia, Ehrlichia, Rickettsia, Theileria and Flavivirus.

Conclusions

Our review is the first systematic assessment of the literature on the human pathogens associated with the blacklegged tick. As Lyme disease awareness continues to increase, it is an opportune time to document the full spectrum of human pathogens transmittable by blacklegged ticks.

If you go to the link at the top of page, Table One in the study has an informative table that shows the various states the studies were derived from as well as the human infections they found.  For Wisconsin the following were found:

*Arboviral infection (encephalitis, meningitis)

*Anaplasmosis

*Babesiosis

*Lyme Disease

*Ehrlichiosis

*Rocky Mountain Spotted Fever

**Bartonella is NOT reportable, which we need to do something about.  Frankly, it is as nasty if not nastier than borrelia, and just as hard to get rid of.  Also, other borrelia species are also NOT reportable.  

***Also, just because it wasn’t found in this systemic review doesn’t mean it doesn’t exist.  

 

TBI’s Increasing and Spreading

Tick Borne Infections (TBI’s) were tested in 9 national parks in this study.

As a patient and advocate, I wish researchers would carefully choose their wording when reporting results.  For instance the authors state:  “Ba. microti occurred at just 20% of the parks.   http://jme.oxfordjournals.org/content/early/2016/12/28/jme.tjw213.  That wording will bias people into thinking it isn’t significant, but 20% is nothing to sniff at, particularly when you are one of the 20%.  Also, that is what they discovered.  Someone else may discover something else and if time is any indicator, that number will probably rise.  I would also like to see Bartonella strains added to the pathogen list.  Interesting to note: there are 210 cases of locally acquired Zika in the Continental U.S., yet Congress is considering appropriating billions of dollars toward it.   https://www.cdc.gov/zika/intheus/maps-zika-us.htmlhttp://www.usatoday.com/story/news/2016/01/28/who-warns-zika-spread/79451430/http://www.usatoday.com/story/news/politics/2016/05/25/zika-funding-mired-congress/84914934/

Abstract

Tick-borne pathogens transmitted by Ixodes scapularis Say (Acari: Ixodidae), also known as the deer tick or blacklegged tick, are increasing in incidence and geographic distribution in the United States. We examined the risk of tick-borne disease exposure in 9 national parks across six Northeastern and Mid-Atlantic States and the District of Columbia in 2014 and 2015. To assess the recreational risk to park visitors, we sampled for ticks along frequently used trails and calculated the density of I. scapularis nymphs (DON) and the density of infected nymphs (DIN). We determined the nymphal infection prevalence of I. scapularis with a suite of tick-borne pathogens including Borrelia burgdorferi, Borrelia miyamotoi, Anaplasma phagocytophilum, and Babesia microti. Ixodes scapularis nymphs were found in all national park units; DON ranged from 0.40 to 13.73 nymphs per 100 m2. Borrelia burgdorferi, the causative agent of Lyme disease, was found at all sites where I. scapularis was documented; DIN with B. burgdorferi ranged from 0.06 to 5.71 nymphs per 100 m2. Borrelia miyamotoi and A. phagocytophilum were documented at 60% and 70% of the parks, respectively, while Ba. microti occurred at just 20% of the parks. Ixodes scapularis is well established across much of the Northeastern and Mid-Atlantic States, and our results are generally consistent with previous studies conducted near the areas we sampled. Newly established I. scapularis populations were documented in two locations: Washington, D.C. (Rock Creek Park) and Greene County, Virginia (Shenandoah National Park). This research demonstrates the potential risk of tick-borne pathogen exposure in national parks and can be used to educate park visitors about the importance of preventative actions to minimize tick exposure.

In the eastern United States, the blacklegged tick, Ixodes scapularis Say, is the primary vector of Borrelia burgdorferi, the causative agent of Lyme disease, which is the most commonly reported vector-borne disease in the United States (Mead 2015). Ixodes scapularis also vectors other pathogens that can cause potentially serious disease, including Borrelia miyamotoi, Anaplasma phagocytophilum, and Babesia microti (Barbour and Fish 1993, Homer et al. 2000, Jin et al. 2012, Krause et al. 2015). Established blacklegged tick populations are nearly continuous across counties in the Northeastern and North-Central United States where the majority of I. scapularis-borne disease cases are reported (Mead 2015, Eisen et al. 2016). The risk of acquiring Lyme disease is influenced by spatio-temporal variation in the density of host-seeking infected nymphs (Diuk-Wasser et al. 2012). This metric often correlates with Lyme disease incidence, though to varying degrees (Mather et al. 1996, Stafford et al. 1998, Falco et al. 1999, Pepin et al. 2012). Human behavior, including time spent in tick-infested areas or engaged in behaviors that enhance or reduce the likelihood of encounters with ticks (Orloski et al. 2000, Connally et al. 2009), also influences the likelihood of acquiring Lyme disease and may explain some of the lack of concordance between measures of density of infected host-seeking nymphs and Lyme disease incidence (Pepin et al. 2012).

Understanding where people may come into contact with infected vector-competent ticks is central to mitigating tick-borne disease risk. For example, in the Mid-Atlantic and Northeastern United States, peridomestic exposure to I. scapularis likely occurs frequently (Falco and Fish 1988, Maupin et al. 1991, Klein et al. 1996, Connally et al. 2006, Feldman et al. 2015), whereas in the North-Central United States, recreational exposures are believed to be more common than peridomestic exposures (Kitron and Kazmierczak 1997, Paskewitz et al. 2001). Regardless of geographic region, previous studies have demonstrated a risk of human exposure to infected host-seeking I. scapularis nymphs in recreational settings (Falco and Fish 1989, Schulze et al. 1992, Oliver and Howard 1998, Paskewitz et al. 2001, Han et al. 2014, Prusinski et al. 2014, Ford et al. 2015). National parks are popular recreation destinations and may represent areas of elevated acarological risk, yet one cannot adequately infer the risk of tick-borne disease for park visitors or employees from the epidemiological surveillance conducted at the county spatial scale (Eisen et al. 2013). National parks often vary ecologically from surrounding areas, and thus the density of infected ticks may differ between settings; further, human behavior within the parks may differ from behavior in surrounding communities.

In this study, we sought to characterize the acarological risk, that is, the risk of human exposure to tick-borne pathogens, in national parks in the Eastern United States. We surveyed frequently used trails in national park units across six Northeastern and Mid-Atlantic States and the District of Columbia, ranging from Maine in the north to Virginia in the south. Our collection efforts focused on the nymphal stage of I. scapularis. This stage likely poses the greatest threat of transmission of B. burgdorferi and other pathogens to humans, as peak activity of questing nymphs occurs in late spring and early summer which coincides with peak onset of human disease (Piesman 1989, Fish 1993, Falco et al. 1999, Mead 2015). Here, we describe the diversity of ticks collected by drag sampling during summer months, density of host-seeking I. scapularis nymphs, and diversity and prevalence of B. burgdorferi, B. miyamotoi, A. phagocytophilum, and Ba. microti infection in I. scapularis nymphs.

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/

 

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.”