Human Babesiosis in Europe: what clinicians need to know
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REVIEW
Human Babesiosis in Europe: what clinicians need to know A. Hildebrandt • J. S. Gray • K.-P. Hunfeld
Received: 10 April 2013 / Accepted: 14 August 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Although best known as an animal disease, human babesiosis is attracting increasing attention as a worldwide emerging zoonosis. Humans are commonly infected by the bite of ixodid ticks. Rare ways of transmission are transplacental, perinatal and transfusion-associated. Infection of the human host can cause a very severe host-mediated pathology including fever, and hemolysis leading to anemia, hyperbilirubinuria, hemoglobinuria and possible organ failure. In recent years, apparently owing to increased medical awareness and better diagnostic methods, the number of reported cases in humans is rising steadily worldwide. Hitherto unknown zoonotic Babesia spp. are now being reported from geographic areas where babesiosis was not previously known to occur and the growing numbers of travelers and immunocompromised individuals suggest that the frequency of cases in Europe will also continue to rise. Our review is intended to provide clinicians with practical information on the clinical management of this rare, but potentially life-threatening zoonotic disease. It covers epidemiology, phylogeny,
Jeremy S. Gray, Klaus-Peter Hunfeld are members of the ESCMID Study Group for Lyme Borreliosis (ESGBOR). A. Hildebrandt (&) Medical University Laboratories, Institute of Medical Microbiology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747 Jena, Germany e-mail: [email protected] J. S. Gray UCD School of Biology and Environmental Science, University College Dublin, Dublin 4, Ireland K.-P. Hunfeld Institute of Laboratory Medicine, Microbiology and Infection Control, Northwest Medical Centre, Frankfurt/Main, Germany
diagnostics and treatment of human babesiosis and the potential risk of transfusion-transmitted disease with a special focus on the European situation. Keywords Babesia Ticks Zoonosis Europe Phylogeny Human disease Blood transfusion IFAT PCR Diagnostics Treatment Prevention
Introduction Tick-transmitted hemoparasites of the protozoan genus Babesia (phylum Apicomplexa) are the second most common blood-borne parasites of mammals after trypanosomes [1]. The disease shows a worldwide distribution and affects a wide variety of many mammalian species, occasionally including man. The major impact of the disease, however, occurs in the cattle industry and in companion animals, and the species affecting cattle and dogs are the most studied. Human disease due to babesia was first confirmed in Europe with the description of a fatal Babesia divergens infection in 1956 in the former Yugoslavia [2] and, ever since, babesiosis has been viewed as a potentially life-threatening zoonotic disease in humans [3– 5]. Since the late 1950s, two species of babesia in particular, the cattle species B. divergens in Europe and the rodent species B. microti in North America have been shown to
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