Human Babesiosis in Europe
Abstract
:1. History
2. Parasite Identity
3. Pathogenesis
4. Vector Biology
5. Epidemiology
5.1. Autochthonous Babesiosis Cases
5.2. Imported Babesiosis
5.3. Ambiguous Babesiosis Cases
5.4. Reports of Possible Cases with Diagnostic Deficiencies/Lack of Clarity
6. Clinical Course of Infections
6.1. Pre-Disposing Factors of Acute Disease
6.2. Babesia divergens
6.2.1. Features of the Disease in Asplenic and Hyposplenic Patients
6.2.2. Features of the Disease in Normosplenic Patients
6.3. Babesia venatorum
6.4. Babesia microti
6.4.1. Autochthonous B. microti Infections
6.4.2. Imported B. microti Infections
7. Laboratory Diagnostics
7.1. Light Microscopy
7.2. Molecular Diagnostics
7.3. Culture
7.4. Infection Serology
8. Clinical Management
8.1. Babesia divergens
8.2. Babesia venatorum
8.3. Babesia microti
8.4. Exchange Transfusion Management
9. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Year | Country | Age, Gender, (Outcome) | Course of Disease * | Co-Morbidities Compl./Unusual Features | Misdiagnosis, Time from Symptoms until Diagnosis: Prior ad./Post ad. | Parasitemia | Antibabesial Therapy | References |
---|---|---|---|---|---|---|---|---|
1957–1998 22 cases | 10× in France (8 cured, 2 died) 6× British Isles (2 cured, 4 died) 1× Russia (died) 2× Spain (1 cured, 1 died) 1× Sweden (cured) 1× Switzerland (cured) ** 1× Ex-Yugoslavia (died) | mild to lethal | Co-morbidities: Hodgkin’s disease, splenectomy, hypertension, diabetes; Compl: ARF, ARDS, shock, HLH, cardio-respiratory arrest, cardiac effusion | malaria, 3 days/10 days or diagnosis post mortem | 2–80% | Drugs used: QN + CLI, QN +CHQ PNT + CTM QN + CLI + PNT QN + DOX CH + CLI CH + DOX + MEF ET | [64] | |
1999–2021 Asplenic and Hyposplenic Patients | ||||||||
1999 | France | 44, M, splenecto-mized (cured) | mild to moderate | NI | 3 days/1 day | 1% | QN + CLI | [69] |
2003 | Portugal | 66, M, splenecto-mized (died) | severe to lethal | Co-morbidities: MI 1984, subtotal gastrectomy; Compl: ARDS, ARF | malaria, 1 week/4 days | 30% | QN + CLI + VI | [14] |
2004 | Finland | 53, M, rudimentary spleen (died) | severe to lethal | Co-morbidities: severe alcohol-induced pancraetitis, diabetes type 1; Compl: Septic shock, multiple organ failure, pulmonary aspergillosis, UF: ECM | 1 week/2 days | 10% | QN + CLI + CFX, ET | [44] |
2005 | France | 51, M, splenecto-mized (cured) | moderate to severe | Compl: ARF, ARDS | 2 days/1 day | 60% | QN + CLI | [70] |
2015 | Norway | 58, M, splenecto-mized (cured) | severe | Compl: ARF, ARDS, atrial fibrillation | FUO, 4 days/2 days | 30% | QN + CLI, ET | [73] |
2015 | Spain | 37, M, splenecto-mized (cured) | moderate to severe | Co-morbidity: newly diagnosed HIV; Compl: HLH, ARDS | Mycobacterium spp., 3 days post ad. | low | QN + CLI, AZM + ATQ | [74] |
2015 | Turkey | 28, F, splenecto-mized (cured) | moderate to severe | NI | malaria, 1 month/2 days | 50% | ET, QN + CLI | [77] |
2017 | Ireland | 79, M, hypo-splenism (cured) | moderate to severe | Co-morbidities: adult celiac disease, pulmonary TB; Compl: ARF, HAP | 7 days/2 days | 20% | ATQ + AZM, CLI + QN | [78] |
1999–2021 Normosplenic Patients | ||||||||
2011 | France | 37, F (cured) | mild | NI | TBD, 3 weeks post ad. | 0.29% | DOX | [71] |
2011 | Spain | 46, M (cured) | moderate to severe | Compl: ARF, relapse | 3 days/1 day | 10% | QN + CLI; relapse: AZM + AP | [75] |
2018 | Spain | 87, F (died) | severe to lethal | Co-morbidities: ovarian tumor, malignant hypertension, transient ischemic attacks, osteoporosis; Compl: ARF, bleeding disorders, cardio-respiratory arrest | 3 months/4 days | 2.9% | AZM + AP | [76] |
2020 | France | 6 patients, no information about sex and age (cured) | mild to moderate | UF/Compl: 1× unusual cutaneous symptom, 1× K. pneumonia septicemia and hepatic abscesses, 1× acute pneumonia, 1× febrile eosinophilic panniculitis | retrospective analysis | In 2/6 pos. | 2 patients: DOX 2 patients: AZM + ATQ 1 patient: CTX + SPI 1 patient: COX + AMC + OFX | [72] |
2021 | UK | 72, F (NI) | moderate to severe | NI | 3 days/1 day | 20% | NI | [79] |
Year | Country | Age, Gender, (Outcome) | Course of Disease * | Co-Morbidities, Compl. | Misdiagnosis, Time from Symptoms until Diagnosis: Prior ad./Post ad. | Parasitemia | Antibabesial Therapy | References |
---|---|---|---|---|---|---|---|---|
2003 | Italy | 55, M, (cured) | moderate to severe | Co-morbidities: splenectomized because of Hodgkin’s disease, recently started chemotherapy for stage IIIA diffuse large B-cell lymphoma | 4 days/6 days | 30% | QN + CLI | [4] |
Austria | 56, M, (cured) | mild | Co-morbidities: splenectomized, Hodgkin’s disease | 2 days/1 day | 1.3% | CLI | ||
2007 | Germany | 63, M, (cured) | moderate to severe | Co-morbidities: splenectomized, Hodgkin’s disease, immunosuppressive treatment; Compl.: prolonged, relapse | relapse of Hodgkin’s disease, AIHA 3–4 weeks/2 days | 4% | QN + CLI, CLI, relapse: AZM + ATQ, ATQ for 5 months | [5] |
2011 | Austria | 68, M (cured) | mild to moderate | Co-morbidities: splenectomized, hairy cell leukemia, immunosuppressive treatment, granular lymphocyte leukemia; Compl.: ARF | AIHA some weeks/3–4 days | 30% | QN + CLI | [6] |
2015 | Poland | NI | asymptomatic | NI | NI | NI | NI | GenBank: KP072001 |
2017 | Sweden | 52, M (cured) | moderate to severe | Co-morbidities: splenectomized, T-Cell Lymphoma, immunosuppressive treatment; Compl.: HLH | Hemophagocytic syndrome, 2 months/2 days | 4% | QN + CLI, AZM + ATQ | [7] |
Year | Country | Age, Gender, (Outcome) | Course of Disease * | Co-Morbidities Compl./Unusual Features | Misdiagnosis, Time from Symptoms until Diagnosis: Prior ad./Post ad. | Parasitemia | Antibabesial Therapy | Reference |
---|---|---|---|---|---|---|---|---|
Autochthonous B. microti Infections | ||||||||
1981 | Belgium | In the 40 s, M, (cured) | moderate | Compl.: prolonged fever | Rickettsiosis, 1 month | NI | T, CHQ | [81] |
2007 | Germany | 42, F, (cured) | moderate | Co-morbidities: AML, immunocompromizing treatment | MI, some weeks/10 days | 4.5% | QN + CLI, AZM | [8] |
2015 | Poland | 2 patients >45 (NI) | asymptomatic | NI | NI | ND | no treatment | [22] |
2016 | Poland | 6 patients (cured) | mild | Co-morbidities: 1 EM, 1 TBE | NI | Neg. | no treatment | [24] |
2016 | Spain | 35, M (cured) | mild | Compl: prolonged parasitemia | several months/few days second ad. | Neg. | ATQ + AZM, AP | [25] |
Imported B. microti Infections | ||||||||
1992 | Poland | 36, M (cured) | moderate | NI | malaria, NI | NI | CLI | [82] |
2003 | Switzerland | NI | mild | NI | NI | ND | NI | [83] |
2003 | Czech Rep. | 58, M (cured) | mild | NI | 28 days/some days | 0.14% | QN + DOX | [84] |
2010 | Austria | 63, M (cured) | moderate to severe | Compl.: hemodynamic shock, anuria | malaria, 2 weeks/diagnosis retrospective | high | QN + CLI | [85] |
2012 | Germany | 38, M (cured) | moderate to severe | Co-morbidity: splenectomy after injury, Compl: pneumonia | Borreliosis, 3–4 months | 8‰ | QN + CLI, AZM + ATQ + DOX | [86] |
2013 | France | 82, M (cured) | moderate | Compl: HLH | 5 days/some days | 3% | QN + CLI | [87] |
2013 | Poland | 48, F (cured) | moderate | Co-morbidity: neuroborreliosis; Compl.: neck stiffness | 10 days/10 days | 3% | AP, DOX + AZM + CLI | [88] |
2013 | Denmark | 64, F (cured) | moderate | Co-morbidity: RF; Compl.: erythematous skin changes | Borreliosis, malaria, IE, some days/1 week | 4% | AP, AP + AZM | [89] |
2015 | Spain | 66, F (cured) | severe | Compl.: multiorgan failure | 2 days/2 days | 20% | QN + CLI, ATQ + AZM, ET | [90] |
2016 | Spain | 66, F (cured) | severe | Compl.: ARDS, ARF, multiorgan failure | malaria, 1 week/some days | 20% | QN + CLI, AZM + ATQ, ET | [91] |
2017 | France | 69, M (cured) | moderate to severe | Compl.: ARF; UF: diffuse purpura of the lower extremities | malaria, 1–2 days/few days | 3% | QN, QN + CLI | [92] |
2019 | UK | 83, M (died) | severe | Co-morbidity: LGLL; Compl.: multiorgan failure | severe sepsis, few days | >20% | Antibabesial therapy, ET | [93] |
2020 | Spain | 72, M (cured) | mild to moderate | Co-morbidity: diabetes | 15 days/1 day | 0.5% | ATQ + AZM | [94] |
Autochthonous or Imported B. microti Infection | ||||||||
2014 | Spain | 43, F (cured) | moderate | Compl.: prolonged disease | malaria, 8 months | >0.5% | AZM-AP | [26] |
Drug (Generic Name) | Regular Single Dose | Application | Dosage Regimen |
---|---|---|---|
Adults | Dose—70 kg adult | ||
Standard drugs | |||
Quinine | 650 mg | p.o. | 3 times daily |
Clindamycin | 600 mg | p.o., i.v. | 3 times daily |
Azithromycin | 500 mg/1st day, 250 mg thereafter a | p.o., i.v. | once daily |
Atovaquone | 750 mg | p.o. | twice daily |
Doxycycline | 200 mg | p.o. | once daily |
Unlicensed Drugs for Human Babesiosis g | |||
Pentamidine | 4 mg/kg/day | i.v. | once daily |
Trimethoprim/sulfametoxazole | 4/20 mg/kg | p.o., i.v. | twice daily |
Proguanil | 400 mg/day | p.o. | once daily |
Imidocarb dipropionate h | 0.6 mg/kg | i.m. | 12 hourly for 4 doses |
Children | Dose/kg | ||
Standard drugs | |||
Quinine | 8 mg c | p.o. | 3 times daily |
Clindamycin | 7–10 mg d | p.o., i.v. | 3 times daily |
Azithromycin b | 10 mg/1st day 5 mg/day thereafter e | p.o., i.v. | once daily |
Atovaquone | 20 mg/day f | p.o. | twice daily |
Parasite | Mild Disease a (Drug) | Severe Disease a,b (Drug) | Adjunctive/Alternative Therapy in Severe Cases b |
---|---|---|---|
B. divergens | clindamycin | clindamycin plus quinine | Exchange transfusion, hemodialysis consider atovaquone/azithromycin, atovaquone/proguanil or pentamidine/ trimethoprim-sulfametoxazole as possible alternatives for severe and intractable infections |
B. venatorum | clindamycin | clindamycin plus quinine | Exchange transfusion, Consider alternative treatment with atovaquone/azithromycin or atovaquone/proguanil in persisting babesiosis |
B. microti | atovaquone plus azithromycin | clindamycin plus quinine | Exchange transfusion hemodialysis Consider adding doxycycline or proguanil in relapsing or persisting babesiosis |
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Hildebrandt, A.; Zintl, A.; Montero, E.; Hunfeld, K.-P.; Gray, J. Human Babesiosis in Europe. Pathogens 2021, 10, 1165. https://doi.org/10.3390/pathogens10091165
Hildebrandt A, Zintl A, Montero E, Hunfeld K-P, Gray J. Human Babesiosis in Europe. Pathogens. 2021; 10(9):1165. https://doi.org/10.3390/pathogens10091165
Chicago/Turabian StyleHildebrandt, Anke, Annetta Zintl, Estrella Montero, Klaus-Peter Hunfeld, and Jeremy Gray. 2021. "Human Babesiosis in Europe" Pathogens 10, no. 9: 1165. https://doi.org/10.3390/pathogens10091165