Peter J. Krause, M.D., Andrew Spielman, Sc.D., Sam R. Telford, Sc.D., Vijay K. Sikand, M.D., Kathleen McKay, B.A., Diane Christianson, R.N., Richard J. Pollack, Ph.D., Peter Brassard, M.D., Jenifer Magera, B.S., Raymond Ryan, Ph.D., and David H. Persing, M.D., Ph.D.
Background Babesiosis, a zoonosis caused by the protozoan Babesiamicroti, is usually not treated when the symptoms are mild,because the parasitemia appears to be transient. However, themicroscopical methods used to diagnose this infection are insensitive,and few infected people have been followed longitudinally. Wecompared the duration of parasitemia in people who had receivedspecific antibabesial therapy with that in silently infectedpeople who had not received specific therapy.
Methods Forty-six babesia-infected subjects were identifiedfrom 1991 through 1996 in a prospective, community-based studydesigned to detect episodes of illness and of seroconversionamong the residents of southeastern Connecticut and Block Island,Rhode Island. Subjects with acute babesial illness were monitoredevery 3 months for up to 27 months by means of thin blood smears,Bab. microti polymerase-chain-reaction assays, serologic tests,and questionnaires.
Results Babesial DNA persisted in the blood for a mean of 82days in 24 infected subjects without specific symptoms who receivedno specific therapy. Babesial DNA persisted for 16 days in 22acutely ill subjects who received clindamycin and quinine therapy(P=0.03), of whom 9 had side effects from the treatment. Amongthe subjects who did not receive specific therapy, symptomsof babesiosis persisted for a mean of 114 days in five subjectswith babesial DNA present for 3 or more months and for only15 days in seven others in whom the DNA was detectable for lessthan 3 months (P<0.05); one subject had recrudescent diseaseafter two years.
Conclusions When left untreated, silent babesial infection maypersist for months or even years. Although treatment with clindamycinand quinine reduces the duration of parasitemia, infection maystill persist and recrudesce and side effects are common. Improvedtreatments are needed.
Source Information
From the Department of Pediatrics, Division of Pediatric Infectious Diseases, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford (P.J.K., K.M., D.C., R.R.); the Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston (A.S., S.R.T., R.J.P.); the Department of Medicine, Tufts University School of Medicine, Boston (V.K.S.); the Department of Medicine, Brown University School of Medicine, Providence, R.I. (P.B.); and the Division of Experimental Pathology and Molecular Microbiology Laboratory, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minn. (J.M., D.H.P.).
Address reprint requests to Dr. Krause at the Department of Pediatrics, Division of Pediatric Infectious Diseases, Connecticut Children's Medical Center, Hartford, CT 06106.
Schwint, O. N., Ueti, M. W., Palmer, G. H., Kappmeyer, L. S., Hines, M. T., Cordes, R. T., Knowles, D. P., Scoles, G. A.
(2009). Imidocarb Dipropionate Clears Persistent Babesia caballi Infection with Elimination of Transmission Potential. Antimicrob. Agents Chemother.
53: 4327-4332
[Abstract][Full Text]
Mayer, L., Merz, S., Maloney, E. L., Holmes, K. D., Volkman, D. J., Cameron, D. J., Drapkin, M. S., Feder, H. M. Jr., the Ad Hoc International Lyme Disease Group,
(2008). An Appraisal of "Chronic Lyme Disease". NEJM
358: 428-431
[Full Text]
Stowell, C. P., Gelfand, J. A., Shepard, J.-A. O., Kratz, A.
(2007). Case 17-2007 -- A 25-Year-Old Woman with Relapsing Fevers and Recent Onset of Dyspnea. NEJM
356: 2313-2319
[Full Text]
Feder, H. M. Jr., Lawlor, M., Krause, P. J.
(2003). Babesiosis in Pregnancy. NEJM
349: 195-196
[Full Text]
KRAUSE, P. J., MCKAY, K., GADBAW, J., CHRISTIANSON, D., CLOSTER, L., LEPORE, T., TELFORD, S. R. III, SIKAND, V., RYAN, R., PERSING, D., RADOLF, J. D., SPIELMAN, A.
(2003). INCREASING HEALTH BURDEN OF HUMAN BABESIOSIS IN ENDEMIC SITES. Am J Trop Med Hyg
68: 431-436
[Abstract][Full Text]
Yokoyama, N., Bork, S., Nishisaka, M., Hirata, H., Matsuo, T., Inoue, N., Xuan, X., Suzuki, H., Sugimoto, C., Igarashi, I.
(2003). Roles of the Maltese Cross Form in the Development of Parasitemia and Protection against Babesia microti Infection in Mice. Infect. Immun.
71: 411-417
[Abstract][Full Text]
Baggish, A. L., Hill, D. R.
(2002). Antiparasitic Agent Atovaquone. Antimicrob. Agents Chemother.
46: 1163-1173
[Full Text]
Ryan, R., Krause, P. J., Radolf, J., Freeman, K., Spielman, A., Lenz, R., Levin, A.
(2001). Diagnosis of Babesiosis Using an Immunoblot Serologic Test. CVI
8: 1177-1180
[Abstract][Full Text]
Wei, Q., Tsuji, M., Zamoto, A., Kohsaki, M., Matsui, T., Shiota, T., Telford, S. R. III, Ishihara, C.
(2001). Human Babesiosis in Japan: Isolation of Babesia microti-Like Parasites from an Asymptomatic Transfusion Donor and from a Rodent from an Area Where Babesiosis Is Endemic. J. Clin. Microbiol.
39: 2178-2183
[Abstract][Full Text]
Kain, K. C., Jassoum, S. B., Fong, I. W., Hannach, B.
(2001). Transfusion-transmitted babesiosis in Ontario: first reported case in Canada. CMAJ
164: 1721-1723
[Abstract][Full Text]
Shadick, N. A., Liang, M. H., Phillips, C. B., Fossel, K., Kuntz, K. M.
(2001). The Cost-effectiveness of Vaccination Against Lyme Disease. Arch Intern Med
161: 554-561
[Abstract][Full Text]
Krause, P. J., Lepore, T., Sikand, V. K., Gadbaw, J., Burke, G., Telford, S. R., Brassard, P., Pearl, D., Azlanzadeh, J., Christianson, D., McGrath, D., Spielman, A.
(2000). Atovaquone and Azithromycin for the Treatment of Babesiosis. NEJM
343: 1454-1458
[Abstract][Full Text]
Homer, M. J., Aguilar-Delfin, I., Telford, S. R. III, Krause, P. J., Persing, D. H.
(2000). Babesiosis. Clin. Microbiol. Rev.
13: 451-469
[Abstract][Full Text]
Kalantarpour, F., Chowdhury, I., Wormser, G. P., Aguero-Rosenfeld, M. E.
(2000). Survival of the Human Granulocytic Ehrlichiosis Agent under Refrigeration Conditions. J. Clin. Microbiol.
38: 2398-2399
[Abstract][Full Text]
Lodes, M. J., Houghton, R. L., Bruinsma, E. S., Mohamath, R., Reynolds, L. D., Benson, D. R., Krause, P. J., Reed, S. G., Persing, D. H.
(2000). Serological Expression Cloning of Novel Immunoreactive Antigens of Babesia microti. Infect. Immun.
68: 2783-2790
[Abstract][Full Text]
Homer, M. J., Bruinsma, E. S., Lodes, M. J., Moro, M. H., Telford, S. III, Krause, P. J., Reynolds, L. D., Mohamath, R., Benson, D. R., Houghton, R. L., Reed, S. G., Persing, D. H.
(2000). A Polymorphic Multigene Family Encoding an Immunodominant Protein from Babesia microti. J. Clin. Microbiol.
38: 362-368
[Abstract][Full Text]
Kordick, S. K., Breitschwerdt, E. B., Hegarty, B. C., Southwick, K. L., Colitz, C. M., Hancock, S. I., Bradley, J. M., Rumbough, R., Mcpherson, J. T., MacCormack, J. N.
(1999). Coinfection with Multiple Tick-Borne Pathogens in a Walker Hound Kennel in North Carolina. J. Clin. Microbiol.
37: 2631-2638
[Abstract][Full Text]
Bronsdon, M. A., Homer, M. J., Magera, J. M. H., Harrison, C., Andrews, R. G., Bielitzki, J. T., Emerson, C. L., Persing, D. H., Fritsche, T. R.
(1999). Detection of Enzootic Babesiosis in Baboons (Papio cynocephalus) and Phylogenetic Evidence Supporting Synonymy of the Genera Entopolypoides and Babesia. J. Clin. Microbiol.
37: 1548-1553
[Abstract][Full Text]
Dobroszycki, J., Herwaldt, B. L., Boctor, F., Miller, J. R., Linden, J., Eberhard, M. L., Yoon, J. J., Ali, N. M., Tanowitz, H. B., Graham, F., Weiss, L. M., Wittner, M.
(1999). A Cluster of Transfusion-Associated Babesiosis Cases Traced to a Single Asymptomatic Donor. JAMA
281: 927-930
[Abstract][Full Text]
(1998). Standard Treatments May Not Cure Babesiosis. JWatch Infect. Diseases
1998: 16-16
[Full Text]
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