Infection with a Babesia-Like Organism in Northern California
David H. Persing, M.D., Ph.D., Barbara L. Herwaldt, M.D., M.P.H., Carol Glaser, D.V.M., M.D., Robert S. Lane, Ph.D., John W. Thomford, Ph.D., Dane Mathiesen, B.A., Peter J. Krause, M.D., Douglas F. Phillip, M.D., and Patricia A. Conrad, D.V.M., Ph.D.
Background Human babesiosis is a tick-transmitted zoonosis associatedwith two protozoa of the family Piroplasmorida: Babesia microti(in the United States) and B. divergens (in Europe). Recently,infection with an unusual babesia-like piroplasm (designatedWA1) was described in a patient from Washington State. We studiedfour patients in California who were identified as being infectedwith a similar protozoal parasite. All four patients had undergonesplenectomy, two because of trauma and two for other medicalreasons. Two of the patients had complicated courses, and onedied.
Methods Piroplasm-specific nuclear small-subunit ribosomal DNAwas recovered from the blood of the four patients by amplificationwith the polymerase chain reaction. The genetic sequences werecompared with those of other known piroplasm species. Indirectimmunofluorescent-antibody testing of serum from the four patientsand from other potentially exposed persons was performed withWA1 and babesia antigens.
Results Genetic sequence analysis showed that the organismsfrom all four patients were nearly identical. Phylogenic analysisshowed that this strain is more closely related to a known caninepathogen (B. gibsoni) and to theileria species than to somemembers of the genus babesia. Serum from three of the patientswas reactive to WA1 but not to B. microti antigen. Serologictesting showed WA1-antibody seroprevalence rates of 16 percent(8 of 51 persons at risk) and 3.5 percent (4 of 115) in twogeographically distinct areas of northern California.
Conclusions A newly identified babesia-like organism causesinfections in humans in the western United States. The clinicalspectrum associated with infection with this protozoan rangesfrom asymptomatic infection or influenza-like illness to fulminant,fatal disease.
Source Information
From the Division of Experimental Pathology and the Molecular Microbiology Laboratory, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, Minn. (D.H.P., D.M.); the Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (B.L.H.); the Division of Pediatric Infectious Diseases and the Center for AIDS Prevention Studies, University of California, San Francisco (C.G.); the Entomology Group, Department of Environmental Science, Policy, and Management, University of California, Berkeley (R.S.L.); the Department of Veterinary Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis (J.W.T., P.A.C.); the Division of Pediatric Infectious Diseases, University of Connecticut, Farmington (P.J.K.); and Preventive Medicine Services, California Medical Detachment, Fort Ord, Calif. (D.F.P.).
Address reprint requests to Dr. Persing at the Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905.
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