Forum for Nordic Dermato-Venereology Nr2,2017 | Page 13

Paul-Erik Uggeldahl – Malaria from Ticks – Babesiosis
Conclusion
In cases of flu-like high-feverish symptoms granulocytic an-
aplasmosis and babesiosis must be considered. The activity
time of ticks (according to meteorology) must be taken into
account. A restricted blood count including thrombocytes is
an important and cheap investigation. The ABC of ticks must
be managed. Both of these diseases have a precise treatment,
although they usually resolve spontaneously. Concerning
prevalence, I refer to my article about ehrlichioses in Forum
for Nordic Dermato-Venereology (12).
I have discussed babesiosis with two Finnish vets and one
from the USA (California). Comments from the New World
were especially welcome. Unfortunately, rare diseases, such as
babesiosis, risk being forgotten. However, it is also the case
that babesiosis is a fascinating disease!
References
Fig. 3. Caravaggio, portrait of Alof de Wignacourt, size 144  × 95 cm,
Florence, Palazzo Pitti. The large white Maltese cross on a black back-
ground. Published with permission from Skinfo (7).
authors justify this astonishing statement by reporting that
the immune response slowly weakens in people over 50 years
of age (3). How many doctors in Finland and other Nordic
countries are then in the risk group? One-third?
Ticks, the vectors of babesiosis
The majority of ticks spreading babesiosis are hard ticks
(family Ixodidae), but because of the almost global prev-
alence of this disease soft ticks (family Argasidae) are also
vectors (11).
When considering an infection it is important to understand
some basic facts about ticks (I. ricinus, and evidently also I.
persulcatus in Europe). When and where are they waiting for
their prey? These ticks are near us, rather than far away in
the woods. Dumler & Walker, in my ehrlichiosis-article (12),
state that: “most infections occur within hundred yards from
home”. Here in Finland Ixodes ricinus may be active from early
spring to late autumn; a mean temperature of +5°C 24 hours
a day is sufficient. Thus, for approximately 6 months of the
year an infection is possible in middle Finland, for example
here in North Karelia.
Forum for Nord Derm Ven 2017, Vol. 22, No. 2
1. Haapasalo K, Suomalainen P, Sukura A, Siikamäki H, Jokiranta TS.
Fatal babesiosis in man, Finland, 2004. Emerg Infect Dis 2010;
16: 1116–1118.
2. Mosqueda J, Olvera-Ramirez A, Aguilar-Tipacamu G, Canto GJ.
Current advances in detection and treatment of babesiosis. Curr
Med Chem 2012; 19: 1504–1518.
3. Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012; 366:
2397–2407.
4. Hildebrandt A, Gray JS, Hunfeld K-P. Human babesiosis in Europe:
what clinicians need to know. Infection 2013; 41: 1057–1072.
5. Babes V. Sur l’hemoglobinurie bacterienne du boeuf. C R Acad Sci
1888; 107: 692–694.
6. Smith T, Kilborne FL. Investigations into the nature, causation,
and prevention of Texas or southern cattle fever. Department of
Agriculture Bureau of Animal Industry bulletin no. 1. Washington,
DC: Government Printing Office, 1893; 177–304.
7. Uggeldahl P-E. Puutiaismalaria – babesioosi. Skinfo 2014; 41: 8–12
(in Finnish).
8. Hildebrandt A, Hunfeld K-P. Humane Babesiose- eine seltene, aber
potenziell gefährliche Zoonose. Dtsch Med Wochenschr 2014;
139: 957–962.
9. Simon MS, Leff JA, Pandya A, Cushing M, Shaz BH, Calfee DP, et
al. Cost-effectiveness of blood donor screening for Babesia microti
in endemic regions of the United States. Transfusion 2014; 54:
889–899.
10. Panduranga V, Kumar A. Severe babesiosis presenting as acute
respiratory distress syndrome in an immunocompetent patient.
Conn Med 2014; 78: 289–291.
11. Gray J, Zintl A, Hildebrandt A, Hunfeld K-P, Weiss L. Zoonotic
babesiosis: overview of the disease and novel aspects of pathogen
identity. Ticks and Tick Borne Dis 2010; 1: 3–10.
12. Uggeldahl P-E. Doxycycline deficiency synrome: Ehrlichiosis.
Forum for Nord Derm Venereol 2017; 22: 13–15.
13. Bonsanti G: Caravaggio. The Library of Great Masters. Scala Riv-
erside, Riverside Book Company, Inc., New York, 1984.
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