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==Overview==
==[[Babesiosis overview|Overview]]==
'''Babesiosis''' is an uncommon [[malaria]]-like [[parasitic disease]] caused by [[protozoa]]n parasites of the genus ''[[Babesia]]''. Babesiosis is a [[Vector (biology)|vector]]-borne illness usually transmitted by [[tick]]s(''Babesia microti'' uses the same tick vector, ''[[Ixodes scapularis]]'', as [[Lyme disease]] does, and frequently occurs in conjunction with it.)
 
==Pathophysiology==
Babesiosis is caused by apicomplexan parasitic organism within the genus Babesia. B. Microti and B. divergens are the two species of Babesia that have been frequently reported as parasitic within human populations. Babesia parasites reproduce in red blood cells, where they can be seen as cross-shaped inclusions (4 merozoites asexually budding but attached together forming a structure looking like a "Maltese Cross") and cause hemolytic anemia, quite similar to malaria.
Babesia parasites reproduce in [[red blood cell]]s, where they can be seen as cross-shaped inclusions (4 [[merozoite]]s asexually budding but attached together forming a structure looking like a "Maltese Cross") and cause [[hemolytic anemia]], quite similar to [[malaria]].Note that unlike the [[Plasmodium]] parasites that cause malaria, Babesia species lack an exo-erythrotic phase, so the liver is usually not affected.
 
==Causes==
Babesiosis is a vector-borne illness usually transmitted by ticks. Often referred to as "The Malaria of The North East," babesiosis is a worldwide distributed disease, reported within tick endemic regions such as Asia, Europe, the United StatesKey endemic areas within the United States include the northeastern coastal region including islands off the coast of New York, Massachusetts, and Rhode Island.
In the United States, babesiosis usually is caused by a [[parasite]] called "Babesii microti". The parasite attacks [[red blood cells]] in much the same way as the parasite that causes [[malaria]]. When a Babesia-infected [[tick]] bites a person, it introduces parasites that may cause symptoms of the disease.
 
The most potent risk factors in the development of Babesiosis are a combined effort between environment and season. Babesia parasites are transmitted via tick bites in tick-populated areas.
 
==[[Babesiosis historical perspective|Historical Perspective]]==
 
Babesiosis was originally reported by the Romanian scientist, Victor Babes, in 1888. The disease was investigated for its renown infection in domesticated animals and cattle. In 1957, the first human babesiosis infection was documented in a splenectomized, Yugoslavian patient. All patients observed with babesiosis had also undergone a splenectomy, it wasn't until 1969 that  the infection was observed within a normal patient.
 
==[[Babesiosis pathophysiology|Pathophysiology]]==
 
Babesia parasites reproduce in red blood cells, where they can be seen as cross-shaped inclusions (4 merozoites asexually budding but attached together forming a structure looking like a "Maltese Cross") and cause hemolytic anemia, quite similar to malaria.
 
Note that unlike the Plasmodium parasites that cause malaria, Babesia species lack an exo-erythrotic phase, so the liver is usually not affected.
 
==[[Babesiosis causes|Causes]]==
 
Babesiosis is caused by apicomplexan parasitic organism within the genus Babesia. B. Microti and B. divergens are the two species of Babesia that have been frequently reported as parasitic within human populations.
 
==[[Babesiosis differential diagnosis|Differentiating Babesiosis from other Diseases]]==
 
==[[Babesiosis epidemiology and demographics|Epidemiology and Demographics]]==
 
Babesiosis is a vector-borne illness usually transmitted by ticks. Often referred to as "The Malaria of The North East," babesiosis is a worldwide distributed disease, reported within tick endemic regions such as Asia, Europe, the United States.  Key endemic areas within the United States include the northeastern coastal region including islands off the coast of New York, Massachusetts, and Rhode Island. Cases have also been reported throughout the United States and Europe, though not as frequently as the United States, Northeastern coast. Reported cases have identified a median age of 62 years and a higher rate of infection amongst males. Other factors contributing the heightened infection rates are, tick activity by season, level of tick exposure, and an individual's medical history.
 
==[[Babesiosis risk factors|Risk Factors]]==
 
The most potent risk factors in the development of Babesiosis are a combined effort between environment and season. Babesia parasites are transmitted via tick bites in tick-populated areas.  Transmission occurs more frequently during the spring and summer in correlation with heightened periods of tick activity. Other risk factors include repeated exposure to the following potential I. scapularis and Ixodes rodent hosts; white-footed deer mice, rats, voles, chipmunks, and field mice; As well as blood transfusions from donors living within endemic areas.
 
==[[Babesiosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
Babesiosis causes a disease very similar to Malaria.  In mild cases, people may experience mild fevers and anemia.  In more severe cases, fevers go up to 105 degrees with shaking chills, and anemia (hemolytic anemia) can become severe.  Organ failure may follow including adult respiratory distress syndrome.
 
==Diagnosis==
==Diagnosis==
===Laboratory Findings===
[[Babesiosis history and symptoms|History and Symptoms]] | [[Babesiosis physical examination|Physical Examination]] | [[Babesiosis laboratory findings|Laboratory Findings]] | [[Babesiosis other imaging findings|Other Imaging Findings]] | [[Babesiosis other diagnostic studies|Other Diagnostic Studies]]
Babesiosis is easy to diagnose but only if it is suspected.  It will not show up on any routine tests.  It must be suspected when a persons with exposure in an endemic area develops persistent [[fevers]] and [[hemolytic anemia]].
 
A wide range of physical findings may be associated with patients suffering from babesiosis. Asymptomatic patients will generally appear healthy without any external signs of infection. However physical examination findings are variable depending on the severity of the infection as well as the patient’s medical history. For patients exhibiting symptoms apparent during physical examination, the most common physical findings may range from a moderate fever and minor display of flu-like symptoms to Hepatomegaly, Petechiae, Ecchymoses and Acute respiratory distress syndrome (ARDS).
 
==Treatment==
==Treatment==
Most cases of babesiosis resolve without any specific treatmentFor ill patients, treatment is usually a two-drug regimen.
[[Babesiosis medical therapy|Medical Therapy]] | [[Babesiosis primary prevention|Primary Prevention]]  | [[Babesiosis secondary prevention|Secondary Prevention]] | [[Babesiosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Babesiosis future or investigational therapies|Future or Investigational Therapies]]
 
The mainstay of therapy for babesiosis is antimicrobial therapyPatients with mild or moderate disease are treated with a combination of Atovaquone and Azithromycin.  Patients with severe disease are treated with either Clindamycin or Clindamycin and Quinine.  In life-threatening cases, exchange transfusion is performed.
 
==Case Studies==
[[Babesiosis case study one|Case #1]]
 


==References==
==References==

Revision as of 15:45, 11 December 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Babesiosis is caused by apicomplexan parasitic organism within the genus Babesia. B. Microti and B. divergens are the two species of Babesia that have been frequently reported as parasitic within human populations. Babesia parasites reproduce in red blood cells, where they can be seen as cross-shaped inclusions (4 merozoites asexually budding but attached together forming a structure looking like a "Maltese Cross") and cause hemolytic anemia, quite similar to malaria.

Babesiosis is a vector-borne illness usually transmitted by ticks. Often referred to as "The Malaria of The North East," babesiosis is a worldwide distributed disease, reported within tick endemic regions such as Asia, Europe, the United States. Key endemic areas within the United States include the northeastern coastal region including islands off the coast of New York, Massachusetts, and Rhode Island.

The most potent risk factors in the development of Babesiosis are a combined effort between environment and season. Babesia parasites are transmitted via tick bites in tick-populated areas.

Historical Perspective

Babesiosis was originally reported by the Romanian scientist, Victor Babes, in 1888. The disease was investigated for its renown infection in domesticated animals and cattle. In 1957, the first human babesiosis infection was documented in a splenectomized, Yugoslavian patient. All patients observed with babesiosis had also undergone a splenectomy, it wasn't until 1969 that the infection was observed within a normal patient.

Pathophysiology

Babesia parasites reproduce in red blood cells, where they can be seen as cross-shaped inclusions (4 merozoites asexually budding but attached together forming a structure looking like a "Maltese Cross") and cause hemolytic anemia, quite similar to malaria.

Note that unlike the Plasmodium parasites that cause malaria, Babesia species lack an exo-erythrotic phase, so the liver is usually not affected.

Causes

Babesiosis is caused by apicomplexan parasitic organism within the genus Babesia. B. Microti and B. divergens are the two species of Babesia that have been frequently reported as parasitic within human populations.

Differentiating Babesiosis from other Diseases

Epidemiology and Demographics

Babesiosis is a vector-borne illness usually transmitted by ticks. Often referred to as "The Malaria of The North East," babesiosis is a worldwide distributed disease, reported within tick endemic regions such as Asia, Europe, the United States. Key endemic areas within the United States include the northeastern coastal region including islands off the coast of New York, Massachusetts, and Rhode Island. Cases have also been reported throughout the United States and Europe, though not as frequently as the United States, Northeastern coast. Reported cases have identified a median age of 62 years and a higher rate of infection amongst males. Other factors contributing the heightened infection rates are, tick activity by season, level of tick exposure, and an individual's medical history.

Risk Factors

The most potent risk factors in the development of Babesiosis are a combined effort between environment and season. Babesia parasites are transmitted via tick bites in tick-populated areas. Transmission occurs more frequently during the spring and summer in correlation with heightened periods of tick activity. Other risk factors include repeated exposure to the following potential I. scapularis and Ixodes rodent hosts; white-footed deer mice, rats, voles, chipmunks, and field mice; As well as blood transfusions from donors living within endemic areas.

Natural History, Complications and Prognosis

Babesiosis causes a disease very similar to Malaria. In mild cases, people may experience mild fevers and anemia. In more severe cases, fevers go up to 105 degrees with shaking chills, and anemia (hemolytic anemia) can become severe. Organ failure may follow including adult respiratory distress syndrome.

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Imaging Findings | Other Diagnostic Studies

A wide range of physical findings may be associated with patients suffering from babesiosis. Asymptomatic patients will generally appear healthy without any external signs of infection. However physical examination findings are variable depending on the severity of the infection as well as the patient’s medical history. For patients exhibiting symptoms apparent during physical examination, the most common physical findings may range from a moderate fever and minor display of flu-like symptoms to Hepatomegaly, Petechiae, Ecchymoses and Acute respiratory distress syndrome (ARDS).

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

The mainstay of therapy for babesiosis is antimicrobial therapy. Patients with mild or moderate disease are treated with a combination of Atovaquone and Azithromycin. Patients with severe disease are treated with either Clindamycin or Clindamycin and Quinine. In life-threatening cases, exchange transfusion is performed.

Case Studies

Case #1


References