diease

Babeosis


OVERVIEW OF Babeosis :

Babesia is a tiny parasite that infects your red blood cells. Infection of babesia is called babesiosis.The parasitic infection is caused by the tick.The babesia parasite is called the Nuttalia.

Incubation period:1-4 weeks after the tick entry


EPIDEMIOLOGY :

It accounts for the 10% of the tick borne infections and it is more common among the farmers


CAUSES :

The infection is more common among the farmers and spherderds. The animals which are infected with the virus include cow,sheep,goat,cattle,pig.

Babesia microti is spread by Ixodes scapularis ticks, which are commonly called blacklegged ticks or deer ticks

The following parasite are the major sourceCauses: B. microti (<3 µm)

  1. B. duncani
  2. B. divergens (cattle parasite) and B. venatorum (roe deer)
  3. B.bovis.


PATHOPHYSIOLOGY :

The infectious stage of the organisms is the asexual reproductive stage of the organisms.(merozite formations due the inclusion of parasites in blood vessels)

When the parasite enters the blood through open skin it results in lysis of the red blood cells which leads to the arising clinical manifestations. The clinical manifestations include heperbilirubinaemia.heamoglobuminuria,jaundice,heamoglobinemia and also the renal failure due to acute tubular necrosis.

Stimulation of proinflammatory cytokines when immune cells comes into contact with the glycosylphophosphadylinositol anchors of babesiol proteins,it is expressed either at the surface of the antigen or at the surface of the infected erythrocytes.these cytokines leads to the production of nitric oxide which eventually destroys the parasite but if secreated in excess it might leads to damage to the healthy tissues.

The immunity that takes part in the role is both cellular and humoral immunity. But cell mediated immunity plays a vital role when compared to the cellular immunity.

Hence T cells plays  role in the production of the antibodies and the subpopulation of T cells which are termed as CD+4 cells is plays an major role in activating the immune response. The Macrophages and natural killer cells also play pivotal role in boosting the immune response.


ROUTES OF TRANSMISSION :

Babesia is transmitted by tick infection.Babesia microti parasite lives in the gut of black legged or deer tick.The tick then easily gets attached with the body of white footed mice and small mammals and then transmits the parasites to the rodents blood.After the tick infects the animals and feed its blood it is shedded off from the animals tissue and again the infective causing tick wait for the arrival of the next animal and this cycle moves on.The white deer is the common infectious agent for deer tick.

After infecting certain animals the tick will rest on the bush or a blade of grass, a low branch or a leaf litter or an climbers.If you brush up against it,it can attach to your shoes.sock.or other pieces of clothing. The tick then attches to other skin surfaces by moving in upward direction and results in opening of the skin surface

Since the size of the tick is very small the person infected with it does not know that the tick has entered his/her  skin surface.The size of the tick is similar to the poppy seeds. After the infection has gone to the level the person is able to recognize the symptoms.

Besides the tick might also spread through blood transfusion from the infected persons,vertical transmission that is the spread from infected pregnant women to the foetus.


COMMON CLINICAL SIGNS AND SYMPTOMS :

The initial symptoms are as follows:

fever,

 a general feeling of ill health (malaise),

 fatigue,

and loss of appetite.

include joint pain (arthralgia),

 muscle pain (myalgia),

 chills,

 sweats, and

 headaches

prostration

erythema migrans

conjunctivitis.


DIAGNOSTIC :

Blood test:

Haemolytic anaemia

Thrombocytopenia(decrease in platelet count)

Peripheral blood smear:

The blood is taken from the infected individuals and it is stained with wright stain or giemsa stain. The organisms within the red blood cells shows the ring form with light blue cytoplasm. Maltese cross formations(cross inclusion bodies formed by the 4 merozoites which undergoes asexual reproduction and linked to each other )are the diagnostic features of babesiosis.

Serological test:

Serological test with indirect immunofluorescence antibody test(IFAT) is  using and  recommended test to detect the antibodies to parasite. IgG antibodies remains declined in the patients with persisitent infection that is the infection that is lasting greater than 3 months.

Molecular diagnostic approach:

With the discovery of PCR (polymerase chain infection) mild infection can also be detected the early stages.Amplification of highly conserved sequence such as amplification in the specific region such as nss-DNA. Patients with detectable babesial DNA in their blood are likely to be parsitemic.

clinically apparent cases may develop high levels of transaminases, alkaline phosphatases, unconjugated bilirubin, and lactic dehydrogenase in serum. Normochromia, normocytic anemia, thrombocytopenia, and, occasionally, leukopenia may also be present. This may be due to TNF-mediated inflammation responses, similar to the pathogenesis of severe malarial infections. However, in light of the recent recognition of coinfection in humans with multiple tick-transmitted agents, it is possible that some of the more variable aspects of the disease could also be associated with coinfection

 


TREATMENT AND PROGNOSIS :

Mild to moderate cases-Atovaquone and azithromycin-taken 7-10 days

The first line of choice is the clindamycin and quinine because thet tend to lower side effects In severe cases-Clindamycin and quinine is preferred

In life threatening conditions exchange transfusion that is the infected blood products are exchange to an extracorporeal system.


PROGNOSIS :

the prognosis is good and the recovery period might takes betwwen 2-8 weeks after the treatment.


PREVENTION :

the use ofpreventive measures is very much helpful to the people who is prone for infection.

Babesia microti is spread by Ixodes scapularis ticks, which are mostly found in wooded, brushy, or grassy areas, in certain regions and seasonsthere are no vaccines available till the date to prevent the patient from babeosis. But the prevention of babeosis include avoidance of person from tick borne areas. Applying repelllants on the skin surface reduces the infection with ticks.

 

  • Walk on cleared trails and stay in the center of the trail, to minimize contact with leaf litter, brush, and overgrown grasses, where ticks are most likely to be found.
  • Minimize the exposed part of the skin by wearing full sleves and socks.
  • Apply  repellants on the skin surface as well as on the dress you wear.
    • Use the product that contains DEET(NN diethylmetatolumide on the skin surface and clothes and also refer the table to know about the amount that should be used.
    • Permethrim products can also be used in clothes and skin surface
    • Remove the ticks from pets and clothes while entering the indoors
    • Wash the clothes and objects that wee used outdoor properly
    • Use the mirror to visualize the whole body after you enter from outdoors.


Medicines used in the Treatment :

Atovaquone

azithromycin

Clindamycin

 quinine


REFERENCE :

http://ncbi.gov.in

http://nih.in

http://cdc.gov.in

http://medicinenews.in