Forum for Nordic Dermato-Venereology Nr2,2017 | Page 11

Paul-Erik Uggeldahl – Malaria from Ticks – Babesiosis
cal entomologists. It is not reported (4) how these percentage
prevalences are measured: in nymphs, also the main vectors in
this disease, or in adult female ticks? Nymphs are less infected
than adult females. And what about the larvae? Can more than
one human pathogenic microbe occur in a single tick? Differ-
ences of opinion exist regarding this question (4). More likely
is that one tick has one microbe of the diseases mentioned at
the start of this article, and another tick another, and so on.
Simultaneous infections, as in the Finnish case report (1), with
Babesia and Borrelia, are possible, but probably from separate
ticks. In cases of simultaneous clinical borreliosis (1) or some
other tick-borne disease the patient has more prominent and
longer-lasting symptoms.
Incubation time
the Ministry of Agriculture and Forestry (1). Although cattle
babesiosis is endemic in Finland, infections have greatly re-
duced over the period 1965–2004. This seems very odd, and
raises the question as to the reasons for this: nothing similar
has been observed in Europe (4) or in the USA (3).
Clinical symptoms
The symptoms of babesiosis are fever, chills, headache, myalgia,
sometimes joint pain, dry cough and nausea. Flu-like symptoms
may also be present, as seen in anaplasmosis. Fever is the dom-
inating symptom. Usually the urine appears very dark, and in
severe infections haemoglobinuria occurs (4). “Acute respira-
tory distress syndrome (ARDS) and disseminated intravascular
coagulopathy are the most common complications…” (3, 10).
The incubation time is 5–33 days after the tick has attached
(4). A review article from the USA reported 1–4 weeks after the
infection of B. microti and [sic]! 1–9 weeks, sometimes even
months, if the pathogen is contracted via blood transfusion
(TTB) (3). In the USA more than 160 cases of blood transfu-
sion babesioses have been detected. Because the problem is
severe the question of how to allow blood donation without
“donating babesia” must be considered (9). The protozoan can affect persons from childhood, but usually
affects people in the age range 40–60 years.
Reporting of cases Laboratory diagnosis
Babesiosis, as with ehrlichioses and borreliosis, are diseases
to be reported to the US authorities, which is not the case in
Europe. In Finland, veterinarians must report new cases to Changes in hemolytic anemia for hemolytic disorders are low
levels of haemoglobin and haematocrit (B-HKR), a normocytic
anaemia, often thrombocytopaenia but rarely leucopaenia (3,
Immunity
Is it possible to be infected more than once? I could not find
an answer to this question, despite reading many reviews and
other articles.
Fig. 1. Microscopy of a blood smear in which intraerythrocytic Babesia prozoans are visible. Published with permission from Skinfo (7).
Forum for Nord Derm Ven 2017, Vol. 22, No. 2
D ermato -V enereology in the N ordic C ountries
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