Two Imported Cases of Babesiosis with Complication or Co-Infection with Lyme Disease in Republic of Korea

Babesiosis, caused by Babesia microti and B. divergens, is transmitted by Ixodid ticks. Symptoms of babesiosis vary from a mild flu-like illness to acute, severe, and sometimes fatal and fulminant disease. In Korea, 7 imported babesiosis cases and 1 endemic case have been reported. We report 2 cases of severe babesiosis initially mistaken as malaria. The first patient was complicated by shock and splenic infarction, the other co-infected with Lyme disease. As the population traveling abroad increases every year, physicians should be aware of babesiosis which mimics malaria, co-infection with other diseases, and its complications.

Serological and Molecular Detection of Toxoplasma gondii and Babesia microti in the Blood of Rescued Wild Animals in Gangwon-do (Province), Korea

Infections of Toxoplasma gondii and Babesia microti are reported in many wild animals worldwide, but information on their incidence and molecular detection in Korean wild fields is limited. In this study, the prevalence of T. gondii and B. microti infection in blood samples of 5 animal species (37 Chinese water deer, 23 raccoon dogs, 6 roe deer, 1 wild boar, and 3 Eurasian badgers) was examined during 2008–2009 in Gangwon-do (Province), the Republic of Korea (=Korea) by using serological and molecular tests. The overall seropositivity of T. gondii was 8.6% (6/70); 10.8% in Chinese water deer, 4.3% in raccoon dogs, and 16.7% in roe deer. PCR revealed only 1 case of T. gondii infection in Chinese water deer, and phylogenic analysis showed that the positive isolate was practically identical to the highly pathogenetic strain type I. In B. microti PCR, the positive rate was 5.7% (4/70), including 2 Chinese water deer and 2 Eurasian badgers. Phylogenetic analysis results of 18S rRNA and the β-tubulin gene showed that all positive isolates were US-type B. microti. To our knowledge, this is the first report of B. microti detected in Chinese water deer and Eurasian badger from Korea. These results indicate a potentially high prevalence of T. gondii and B. microti in wild animals of Gangwon-do, Korea. Furthermore, Chinese water deer might act as a reservoir for parasite infections of domestic animals.

Molecular Detection and Seroprevalence of Babesia microti among Stock Farmers in Khutul City, Selenge Province, Mongolia

Babesiosis is an emerging tick-borne disease in humans worldwide; however, little is known about the frequency of infection or prevalence of this disease in other parts of the world, excluding North America. In this study, we aimed to investigate Babesia microti infection frequency in a human population in Mongolia. One hundred blood samples were collected from stock farmers living in Khutul city of Selenge province, Mongolia. The sera and DNA from blood samples were evaluated for the presence of B. microti infection by using indirect fluorescent antibody (IFA) tests and PCR. The positive detection rates obtained using the IFA tests and PCR assays were 7% and 3%, respectively. This study is the first to detect of B. microti infections based on antibody seroprevalence or PCR assays for the presence of B. microti DNA in a Mongolian population.

Molecular survey of Babesia microti, a causative agent of human babesiosis, in rodents in Egypt

In Egypt, to date and to the best of our knowledge, two cases of human babesiosis have been reported; at the same time, very few surveys for detection of B. microti in rodents have been published. These studies were solely relied on microscopic examination of stained blood smears; hence, the molecular confirmative evidence for the presence of B. microti is not revealed. In addition, the epidemiology of human babesiosis, such as competent vectors and reservoirs is still unclear. The present study is a molecular survey of B. microti in wild Egyptian rodents. A total of 30 rodents [26 Rattus norvegicus and 4 Rattus rattus] were collected from different areas in Giza Governorate and tested for Babesia-specific DNA. Nested PCR targeting 18S rRNA gene marker was used to detect the agent in rodents blood. Positive amplification of 154-bp fragment was detected in 8 [30.8%] R. norvegicus and 1 [25%] R. rattus with a total prevalence rate of 30%. Unidentified Babesia was detected in 3 rodents [2 R. norvegicus and 1 R. rattus] when tested using standard PCR with genus-specific primers. These 3 rodents yielded negative for B. microti. Significant correlation [P<0.05] between positivity to B. microti and splenomegaly was found. The difference between the positive rates for B. microti in R. norvegicus and in R. rattus was also revealed to be significant [P<0.05]. This study is considered to be the first molecular survey of B. microti in Egyptian rodents. These findings confirm the presence of one of the causative agents of human babesiosis in the country with a relative high prevalence among the suspected reservoir host that warrants more risk for human infections

Babesiosis Humana / Human Babesiosis

La babesiosis es una enfermedad zoonótica poco común, que en la mayoría de los casos es asintomática pero que en personas con alguna inmunodeficiencia puede llegar a ser fatal. La provocan diferentes tipos de babesia, las más frecuentes B. microti en Estados Unidos y B. divergens en Europa y es transmitida por la picadura de la garrapata de ciervo infectada, la lxodes scapularis. El mayor número de casos de la enfermedad se presenta principalmente en verano y primavera, en zonas de la costa noreste de Estados Unidos, Massachussets, especialmente en Nanmcket Island y en Long Island, Nueva York. También hay informes de casos observados en Wisconsin, California, Georgia, Missouri y algunos países europeos. La enfermedad puede causar fiebre, escalofrío, malestar general, fatiga, anemia hemolítica y puede durar desde días hasta meses. El diagnóstico se realiza por examen directo donde se observa al protozoario dentro de los glóbulos rojos. También hay pruebas de inmunofluorescencia y amplificación de ácidos nucleicos por reacción en cadena de la polimerasa PCR. El tratamiento que se ha venido utilizando es Quinina y Clindamicina, aunque tienen muchos efectos secundarios. Se han utilizado también otros medicamentos como azitromicina, tetraciclinas y atovaquona. La principal medida de prevención tiene que ver con el control del vector transmisor de la enfermedad.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

A Case of Human Babesiosis Confirmed by Polymerase Chain Reaction and Treated with Atovaquone and Azithromycin

Human babesiosis is a tick-borne infectious disease caused by Babesia species. The clinical diagnosis is difficult because of nonspecific symptoms like flu. Rapid diagnosis of human babesiosis is microscopic examination in peripheral blood smear (Giemsa-stain) which reveals characteristic forms of an intracellular quadruplet parasite. But differentiation between Babesia microti and Plasmodium species can be quite difficult because of the morphologic similarity. We experienced a case of human babesiosis. The patient was a 62-year old Korean male who had been in New Jersey, U.S.A for 2 months. We initially diagnosed as malaria infection because the peripheral blood smear revealed intracellular single ring form organism. But the patient was not improved significantly by the treatment with chloroquine regimen. Finally we confirmed human babesiosis by polymerase chain reaction for Babesia microti. We treated the patient successfully with a regimen of atovaquone and azithromycin which has fewer adverse reactions than a regimen of clindamycin and quinine.

A Case of Intraerythrocytic Parasitism Treated with Quinine and Clindamycin / 감염

Although rapid diagnosis of human babesiosis usually can be made by microscopic examination of thin and thick blood smears, differentiation between Babesia microti and Plasmodium falciparum can be quite difficult. The parasite is often not visualized in the early course of infection or in a partially treated case and the young trophozoites of these two organisms are similar. Recently, we experienced a case, which was thought as human babesiosis initially by microscopic examination of the Giemsa-stained thin blood smears, but was finally diagno-sed as P. falcifarum infection by indirect immunofluorescent antibody assay and polymerase chain reaction. The patient was treated successfully with quinine and clindamycin, which are effective in both infections. When differential diagnosis is difficult, we suggest combination therapy of quinine and clindamycin as an empirical regimen.