Babesia, babesiosis (tick-borne disease)

Very cool, in a not-cool-sort of way. I don't think they found a new tick. I think they found a species of babesia not normally found in Scotland. And one never found in sheep before, which is somewhat alarming.

The article says the chances of contracting this form of babesia are remote. It was remote when a babesia cousin first turned up not far from Montauk, Long Island, NY back in the late 60's. Now, in the Northeast US at least, if you get bitten by a tick you'd best get checked for babesia, as I believe it's endemic in some counties in some states. I test positive for babesia off and on, and my understanding is I will likely carry the parasite for the rest of my life (b microti, not b venatorum)

I seem to recall a unique form of borrelia being found in Scotland a few years back, or maybe that was a new species of tick? Cannot recall, but I DO recall it also was in Scotland.
 
This was written up in The Grauniad too. (I'm unable to access the first link as it's behind a paywall)

Potentially deadly tick-borne parasite found in UK.

Willie Weir, senior university clinician, said: “The presence of B venatorum in the UK represents a new risk to humans working, living, or hiking in areas with infected ticks and livestock, particularly sheep.
Click to expand...

I'm guessing this is "our" Willie Weir.
 
Post from ProMed Mail.

BABESIA VENATORUM - UK: (SCOTLAND) FIRST REPORT, ASYMPTOMATIC, SHEEP,
ZOONOTIC
******************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 20 Nov 2019
Source: BBC News (Scotland) [edited]
<https://www.bbc.com/news/uk-scotland-50491068>


An exotic and potentially deadly tick-borne parasite has been found in
the UK for the 1st time.

A study conducted by the University of Glasgow found the parasite in
sheep in the north east of Scotland.

This is the 1st time the organism, called _Babesia venatorum_, has
ever been found in sheep anywhere in the world.

The parasite causes a disease called babesiosis which is recognised as
an emerging infection in human health.

It has been extensively recorded in China and in Europe with 2 human
infections confirmed in Italy in the last 20 years.

Babesiosis is treatable in most cases, although this depends on rapid
and accurate diagnosis.

The European Centre for Disease Prevention and Control said infected
people may get symptoms such as flu and jaundice but severe cases can
lead to death.

Scientists believed the risk of people contracting this infection,
however, is believed to be low.

Researchers targeted areas where tick-borne viruses had been
previously detected and collected blood from sheep, cattle, and deer.

Scientists believed the parasite could have travelled to the north
east of Scotland via migrating birds from Scandinavian countries.

Dr Willie Weir, from the University of Glasgow, said: "The presence of
_B. venatorum_ in the UK represents a new risk to humans working,
living, or hiking in areas with infected ticks and livestock,
particularly sheep.

"Although we believe the threat to humans to be low, nevertheless
local health and veterinary professionals will need to be aware of the
disease if the health risk from tick-borne disease in the UK is to be
fully understood."

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[For the University of Glasgow study mentioned above please see ref. 1
below. Its "conclusions" section (references omitted) follows:

"This study confirms that _B. venatorum_ is present in the UK, but it
remains unclear how the parasite entered the country because there was
no history of imported animals at either farm surveyed. However, the
survey sites are situated near the main landing areas for migratory
birds coming to the UK from continental Europe, particularly Norway,
and _B. venatorum_ has been found in ticks collected from the
environment and in migratory birds in Scandinavia. We postulate that
birds could act as an import vector for ticks carrying _B.
venatorum_.

"The presence of _B. venatorum_ in the UK represents a new risk to
humans working, living, or hiking in areas harboring infected ticks
and livestock, particularly sheep. As such, local health and
veterinary professionals will need to be aware of the disease if the
risk for tick-borne disease in the UK is to be fully understood.

"Current UK medical inclusion criteria for babesiosis focus on
identifying cattleborne _B. divergens_. Going forward, consideration
of _B. venatorum_, through careful morphologic description of blood
smears and sequencing of informative regions of the 18S SSU rRNA gene,
will
be necessary for accurate diagnosis and correctly targeted treatment
regimens.

"Our study has revealed that sheep are a natural host for _B.
venatorum_ in the UK. Previously, roe deer were believed to be the
main vertebrate host for this parasite in Europe. It is unclear why
_B. venatorum_ has not previously been detected in sheep, although it
may be that infection in this host species occurs only in particular
foci or is limited to the UK. Thus, ongoing active surveillance of
Babesia species in UK livestock would be useful to fully understand
the prevalence and transmission of the disease. Such information may
be critical for controlling the spread of babesiosis because sheep are
routinely transported large distances (including across international
borders) and are closely associated with tick habitats. Our study also
suggests that the role that livestock plays in _B. venatorum_
transmission in continental Europe should be reassessed."

The authors state that their finding "represents a novel potential
threat to animal and human health"; however, clinical signs in sheep,
in case observed, have not become available yet. In this respect, a
case report describing fatal acute babesiosis associated with _B.
venatorum_ infection in a captive reindeer calf in Switzerland
deserves attention (ref. 2).

_Babesia_ are intraerythrocytic protozoan pathogens transmitted by
ticks; their clinical manifestation is comparable to malaria. More
than 100 _Babesia_ spp have been identified in wild and domestic
animals. Babesia that infect livestock have had a significant
worldwide economic impact and include _B. bigemina_, _B. bovis_, _B.
divergens_, and _B. major_. Other animals infected by _Babesia_ spp
include horses (_B. caballi_), dogs (_B. canis_), cats (_B. felis_),
deer (_B. odocolei_), and rodents (_B. microti_). Several _Babesia_
spp have been found to cause disease in humans. These are _B.
microti_, _B. crassa_-like pathogen, _B. divergens_, _B. duncani_, and
_B. venatorum_, as well as several other _Babesia_ that are closely
genetically related (_B. divergens_-like, _B. duncani_-type, _B.
microti_-like) or described in a single case (K01, XXB/Hang/Zhou). In
Europe, the probable or confirmed vector of _Babesia_ is the tick
_Ixodes ricinus_. Parts of the above information have been extracted
from ref. 3.

References
----------
1. Gray A, Capewell P, Loney C, et al. Sheep as host species for
zoonotic _Babesia venatorum_, United Kingdom. Emerg Infect Dis. 2019;
25(12): 2257-60;
<https://wwwnc.cdc.gov/eid/article/25/12/19-0459_article>.
2. Novacco M, Hofmann-Lehmann R, Grimm F, et al. Fatal acute
babesiosis associated with _Babesia venatorum_ infection (_Babesia_
sp. EU1) in a captive reindeer calf in Switzerland. Veterinary
Parasitology: Regional Studies and Reports. 2019; 18: 100336;
<https://doi.org/10.1016/j.vprsr.2019.100336>.
3. Krause PJ. Human babesiosis (2019). Int J Parasitol. 2019; 49(2):
165-74; <https://doi.org/10.1016/j.ijpara.2018.11.007>.
- Mod.AS

HealthMap/ProMED-mail map of the United Kingdom:
<http://healthmap.org/promed/p/280>]

[See Also:
Babesiosis - USA: blood transfusion
http://promedmail.org/post/20190525.6486731
2017
----
Babesiosis - United States: (WI) 2001 - 2015:
http://promedmail.org/post/20170707.5158091
2016
----
Lyme disease, anaplasmosis, babesiosis - Canada: (MB):
http://promedmail.org/post/20161020.4574061
Babesiosis, canine - UK (02): (England) alert:
http://promedmail.org/post/20160909.4477064
Anaplasmosis, babesiosis, Lyme disease - USA: (ME) increased
incidence: http://promedmail.org/post/20160825.4442433
2015
----
Babesia - USA: blood supply:
http://promedmail.org/post/20150509.3351998
2011
----
Babesia - USA: blood supply http://promedmail.org/post/20110907.2729
2010
----
Babesia - USA: (NY) http://promedmail.org/post/20100727.2519
Tick-borne infections - USA: Ehrlichia, Babesia
http://promedmail.org/post/20100727.2518
2003
----
Babesia, new species - Austria and Italy
http://promedmail.org/post/20030903.2210]
.................................................sb/mhj/arn/mj/lm

------------------------------
 
Babesiosis case identified in the UK

Thought this might be of interest to UK folk who live in or visit rural areas where ticks are common:

https://www.bbc.co.uk/news/health-53613459

"People are being urged to be on alert for tick bites, following the diagnosis for the first time in England of a rare illness.

Public Health England (PHE) says the risk to the public is "very low", but it's important to be "tick aware" when enjoying green spaces this summer.

Babesiosis is caused by a parasite which infects red blood cells."
 
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Establishment of a continuous in vitro culture of Babesia duncani reveals unusually high tolerance to recommended therapies (2018, Abraham et al)

Human babesiosis is an emerging tick-borne disease caused by apicomplexan parasites of the genus Babesia Clinical cases caused by Babesia duncani have been associated with high parasite burden, severe pathology, and death. In both mice and hamsters, the parasite causes uncontrolled fulminant infections, which ultimately lead to death. Resolving these infections requires knowledge of B. duncani biology, virulence, and susceptibility to anti-infectives, but little is known and further research is hindered by a lack of relevant model systems.

Here, we report the first continuous in vitro culture of B. duncani in human red blood cells. We show that during its asexual cycle within human erythrocytes, B. duncani develops and divides to form four daughter parasites with parasitemia doubling every ∼22 h. Using this in vitro culture assay, we found that B. duncani has low susceptibility to the four drugs recommended for treatment of human babesiosis, atovaquone, azithromycin, clindamycin, and quinine, with IC50 values ranging between 500 nm and 20 μm These data suggest that current practices are of limited effect in treating the disease. We anticipate this new disease model will set the stage for a better understanding of the biology of this parasite and will help guide better therapeutic strategies to treat B. duncani-associated babesiosis.
Click to expand...

Open access, full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311517/
 
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This study has been on my mind a lot recently and I thought maybe people want to discuss.

This is personally of interest to me since I test positive for this parasite. I am also a member of some online patient groups where nobody reports being able to fully eradicate it. From my observation, a lot of people report being able to treat until their symptoms go away, but they relapse easily.

I am not educated enough to do the pharmacokinetic calculations to convert the IC50 values in this study to see how they compare to the dosages of medications that I have been prescribed.

Also, it is worth noting that Babesiosis is usually studied in the sense of acute illness, not a chronic fatiguing illness that typically results when infected with Babesia and Borrelia.
 
Both b duncani and microti may run chronic, at least as far as I can deduce. There is some positive news purportedly for sufferers of long term b microti, but even then, you'll probably know treatment recommendations are a minimum of six weeks, and that with a tier 3 drug, and no guarantees.

I've tested positive muitple times for microti, most recently this year by Mayo.

The three B's get the short shrift quite a bit. There's a reason out there, somewhere.

Edit to add: When they run chronic, my understanding is each of the B's can fall out of character, that is, they can assume qualities that are strikingly similar to ME/CFS.
 
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Antibody titre, off and on. Most of the time I test negative. I can usually anticipate a flare as I test positive for hemolyitic anemia just before I do. I've tested microti-positive through Mayo and the NIH, so, eh, pretty good facilities.

Treatment? Yes, I cannot remember what I took, though. It was three or four years ago. I can't remember much of this morning. I remember I thought it was expensive. Anti malarial with an abx for a protracted period, as I recall, but cannot say with any certainty.

I didn't re-read the duncani study you posted, so I cannot speak to the duration of the treatment protocols for duncani. But, if it can matter for microti, who knows?

You've reached out to the authors, yes?
 
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One thing I've learned over way too long is that research-smarts is not necessarily the same as clinical-smarts. In many ways they are cross-elastic and overlap. Sometimes, however, they can be divorced from one another. I love reading the research, but I often take findings with a grain of salt, and do the best I can to make sure it's grounded. Conversely, I listen intently to what my clinicians advise, but make sure I double check that advice against available reputable research. We are traversing in no-man's land in some regards, and it doesn't hurt to have guard rails.

It can be a crap-shoot relative to know where to go for reliable insight.
 
Yes, I understand completely. Apparently Fallon's group at Columbia also does clinical assessments with patients, which is interesting seeing as they are also on the forefront of the research.

In an ideal world I'd like to have one of the researchers from this paper attempt to culture the Babesia from my blood, and then see which therapies are effective on it. I am not sure if this is even possible.
 
Here is an interesting followup published today:

https://www.frontiersin.org/articles/10.3389/fcimb.2021.624745/full

Botanical Medicines Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum, and Alchornea cordifolia Demonstrate Inhibitory Activity Against Babesia duncani

Abstract:

Human babesiosis is a CDC reportable disease in the United States and is recognized as an emerging health risk in multiple parts of the world. The current treatment for human babesiosis is suboptimal due to treatment failures and unwanted side effects. Although Babesia duncani was first described almost 30 years ago, further research is needed to elucidate its pathogenesis and clarify optimal treatment regimens. Here, we screened a panel of herbal medicines and identified Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Alchornea cordifolia, and Polygonum cuspidatum to have good in vitro inhibitory activity against B. duncani in the hamster erythrocyte model. Furthermore, we found their potential bioactive compounds, cryptolepine, artemisinin, artesunate, artemether, and baicalein, to have good activity against B. duncani, with IC50 values of 3.4 μM, 14 μM, 7.4 μM, 7.8 μM, and 12 μM, respectively, which are comparable or lower than that of the currently used drugs quinine (10 μM) and clindamycin (37 μM). B. duncani treated with cryptolepine and quinine at their respective 1×, 2×, 4× and 8× IC50 values, and by artemether at 8× IC50 for three days could not regrow in subculture. Additionally, Cryptolepis sanguinolenta 90% ethanol extract also exhibited no regrowth after 6 days of subculture at doses of 2×, 4×, and 8× IC50 values. Our results indicate that some botanical medicines and their active constituents have potent activity against B. duncani in vitro and may be further explored for more effective treatment of babesiosis.


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And a personal update: despite the fact that my symptoms are getting progressively more severe, my Babesia FISH and antibody titer are now negative, which I presume is from the months of various treatments.
 
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