Humane Babesiose – eine seltene, aber potenziell gefährliche Zoonose

 

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Zusammenfassung

Die humane Babesiose ist eine Erkrankung durch intraerythrozytäre Parasiten des Genus Babesia (Stamm Apicomplexa). Die Übertragung auf den Menschen erfolgt in der Regel durch Zecken, seltener ist auch eine Transmission über kontaminierte Blutprodukte oder perinatal möglich. Während in den USA endemische Staaten bekannt sind und die Bedeutung der Erreger in der Transfusionsmedizin jährlich zunimmt, gibt es für Europa nur unzureichende Daten zur klinischen Relevanz der humanpathogenen Spezies. Der folgende Beitrag soll die Gefahr der Erkrankung für Deutschland näher beleuchten.

Die humane Babesiose ist eine zoonotische Erkrankung, die aufgrund der steigenden Anzahl immunsupprimierter Personen weltweit zunehmende Bedeutung erlangt. Das klinische Bild reicht von asymptomatischen bis zu sehr schweren letalen Verläufen. Die bisherigen Ergebnisse zum Nachweis infizierter Zecken sowie zur Seroepidemiologie in Europa zeigen das Vorkommen von 3 humanpathogenen Spezies: B. microti, B. divergens und B. venatorum (EU1–3). Die dazu verhältnismäßig geringe Anzahl von ca. 50 dokumentierten humanpahogenen Fällen resultiert sehr wahrscheinlich aus der Unkenntnis der Existenz und mangelnden diagnostischen Möglichkeiten.

Umfassende systematisierte flächendeckende Untersuchungen der Prävalenz in Zecken, weitere seroepidemiologische Studien und verbesserte diagnostische Tests sind zur Evaluation der Bedeutung des Erregers unter Einbezug der Transfusionsmedizin dringend erforderlich.

Abstract

Human babesiosis is caused by the intraerythrocytic parasite of the genus Babesia (phylum Apicomplexa). Humans are commonly infected by the bite of Ixodid ticks. Rarely, transmission does occur perinatal or via contaminated blood transfusion. There is only insufficient data available on the clinical relevance in Europe, whereas there are known endemic states in the United States with an increasing importance of the disease in transfusion medicine. The following article gives an overview of the situation in Germany.

Human babesiosis is a zoonotic disease with a worldwide increasing importance according to the increasing number of immunocompromised patients. Clinical symptoms have a wide range from asymptomatic to severe and letal cases. So far, the detection of the parasites in ticks and seroepidemiological data in Europe identified 3 humanpathogenic species: B. microti, B. divergens und B. venatorum (EU1–3). The relative small number of approximately 50 documented human cases is probably due to the lack of knowledge of the disease and the availability of diagnostic tools.

Comprehensive systematic investigations of the prevalence in ticks, seroepidemiological data and improved diagnostic tests are urgently needed to evaluate the importance of the parasite.

• Literatur

• 1 Blaschitz M, Narodoslavsky-Gföller M, Kanzler M et al. Babesia species occurring in Austrian Ixodes ricinus ticks. Appl Environ Microbiol 2008; 74: 4841-4846
  CrossrefPubMedGoogle Scholar
• 2 Blum S, Gattringer R, Haschke E et al. The case: hemolysis and acute renal failure. Babesiosis. Kidney int 2011; 80: 681-683
  CrossrefPubMedGoogle Scholar
• 3 Foppa IM, Krause PJ, Spielman A et al. Entomologic and serologic evidence of zoonotic transmission of Babesia microti, eastern Switzerland. Emerg Infect Dis 2002; 8: 722-726
  CrossrefPubMedGoogle Scholar
• 4 Franke J, Fritzsch J, Tomaso H et al. Coexistence of pathogens in host-seeking and feeding ticks within a single natural habitat in Central Germany. Appl Environ Microbiol 2010; 76: 6829-6836
  CrossrefPubMedGoogle Scholar
• 5 Gelfand JA, Vannier E. Clinical manifestations, diagnosis, treatment, and prevention of babesiosis. http://www.uptodate.com/contents/clinical-manifestations-diagnosis-treatment-and-prevention-of-babesiosis (letzter Zugriff 12.03.2014)
  Google Scholar
• 6 Gray JS, Pudney M. Activity of atovaquone against Babesia microti in the Mongolian gerbil, Meriones unguiculatus. J Parasitol 1999; 85: 723-728
  CrossrefPubMedGoogle Scholar
• 7 Hartelt K, Oehme R, Frank H et al. Pathogens and symbionts in ticks: prevalence of Anaplasma phagocytophilum (Ehrlichia sp.), Wolbachia sp., Rickettsia sp., and Babesia sp. in Southern Germany. Int J Med Microbiol 2004; 293 (Suppl. 37) 86-92
  PubMedGoogle Scholar
• 8 Hartelt K, Pluta S, Oehme R et al. Spread of ticks and tick-borne diseases in Germany due to global warming. Parasitol Res 2008; 103 (Suppl. 01) S109-116
  CrossrefPubMedGoogle Scholar
• 9 Häselbarth K, Tenter AM, Brade V et al. First case of human babesiosis in Germany – Clinical presentation and molecular characterisation of the pathogen. Int J Med Microbiol 2007; 297: 197-204
  CrossrefPubMedGoogle Scholar
• 10 Hasle G, Leinaas HP, Røed KH et al. Transport of Babesia venatorum-infected Ixodes ricinus to Norway by northward migrating passerine birds. Acta veterinaria Scandinavica 2011; 53: 41
  CrossrefPubMedGoogle Scholar
• 11 Herwaldt BL, Cacció S, Gherlinzoni F et al. Molecular characterization of a non-Babesia divergens organism causing zoonotic babesiosis in Europe. Emerg Infect Dis 2003; 9: 942-948
  CrossrefPubMedGoogle Scholar
• 12 Herwaldt BL, Linden JV, Bosserman E et al. Transfusion-associated babesiosis in the United States: a description of cases. Ann Intern Med 2011; 155: 509-519
  CrossrefPubMedGoogle Scholar
• 13 Hildebrandt A. Bedeutung des Vektors Ixodes ricinus und verschiedener Wirte im Transmissionszyklus zeckenassoziierter Pathogene. Kumulative Habilitationsschrift: Jena: Friedrich-Schiller-Universität; 2011. http://www.db-thueringen.de/servlets/DerivateServlet/Derivate-25006/Diss/Anke_a.pdf (letzer Zugriff 12.03.2014)
  Google Scholar
• 14 Hildebrandt A, Gray JS, Hunfeld KP. Human Babesiosis in Europe: what clinicians need to know. Infection 2013; 41: 1057-1072
  CrossrefPubMedGoogle Scholar
• 15 Hildebrandt A, Hunfeld KP, Baier M et al. First confirmed autochthonous case of human Babesia microti infection in Europe. Eur J Clin Microbiol Infect Dis 2007; 26: 595-601
  CrossrefPubMedGoogle Scholar
• 16 Hildebrandt A, Tenter AM, Straube E et al. Human babesiosis in Germany: Just overlooked or truly new?. Int J Med Microbiol 2008; 298 (Suppl. 01) 336-346
  CrossrefPubMedGoogle Scholar
• 17 Homer MJ, Aguilar-Delfin I, Telford 3rd SR et al. Babesiosis. Clin Microbiol Rev 2000; 13: 451-469
  CrossrefPubMedGoogle Scholar
• 18 Humiczewska M, Kuźna-Grygiel W. A case of imported human babesiosis in Poland. Wiad Parazytol 1997; 43: 227-229
  PubMedGoogle Scholar
• 19 Hunfeld KP, Allwinn R, Peters S et al. Serologic evidence for tick-borne pathogens other than Borrelia burgdorferi (TOBB) in Lyme borreliosis patients from midwestern Germany. Wien Klin Wochenschr 1998; 110: 901-908
  PubMedGoogle Scholar
• 20 Hunfeld KP, Hildebrandt A, Gray JS. Babesiosis: recent insights into an ancient disease. Int J Parasitol 2008; 38: 1219-1237
  CrossrefPubMedGoogle Scholar
• 21 Hunfeld KP, Lambert A, Kampen H et al. Seroprevalence of Babesia infections in humans exposed to ticks in midwestern Germany. J Clin Microbiol 2002; 40: 2431-2436
  CrossrefPubMedGoogle Scholar
• 22 Krause PJ, Spielman A, Telford 3rd SR et al. Persistent parasitemia after acute babesiosis. N Engl J Med 1998; 339: 160-165
  CrossrefPubMedGoogle Scholar
• 23 Krause PJ, Telford 3rd SR, Spielman A et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA 1996; 275: 1657-1660
  CrossrefPubMedGoogle Scholar
• 24 Leiby DA. Transfusion-transmitted Babesia spp.: bull's-eye on Babesia microti. Clin Microbiol Rev 2011; 24: 14-28
  CrossrefPubMedGoogle Scholar
• 25 Martinot M, Zadeh MM, Hansmann Y et al. Babesiosis in immunocompetent patients, Europe. Emerg Infect Dis 2011; 17: 114-116
  CrossrefPubMedGoogle Scholar
• 26 Meer-Scherrer L, Adelson M, Mordechai E et al. Babesia microti infection in Europe. Curr Microbiol 2004; 48: 435-437
  PubMedGoogle Scholar
• 27 Moreno Giménez JC, Jiménez Puya R, Galàn Gutiérrez M et al. Erythema figuratum in septic babesiosis. J Eur Acad Dermatol Venereol 2006; 20: 726-728
  CrossrefPubMedGoogle Scholar
• 28 Movila A, Reye AL, Dubinina HV et al. Detection of Babesia sp. EU1 and members of spotted fever group rickettsiae in ticks collected from migratory birds at Curonian Spit, North-Western Russia. Vector Borne Zoonotic Dis 2011; 11: 89-91
  CrossrefPubMedGoogle Scholar
• 29 Overzier E, Pfister K, Herb I et al. Detection of tick-borne pathogens in roe deer (Capreolus capreolus), in questing ticks (Ixodes ricinus), and in ticks infesting roe deer in southern Germany. Ticks Tick Borne Dis 2013; 4: 320-328
  CrossrefPubMedGoogle Scholar
• 30 Overzier E, Pfister K, Thiel C et al. Diversity of Babesia and Rickettsia species in questing Ixodes ricinus: a longitudinal study in urban, pasture, and natural habitats. Vector Borne Zoonotic Dis 2013; 13: 559-564
  CrossrefPubMedGoogle Scholar
• 31 Pantanowitz L, Cannon ME. Extracellular Babesia microti parasites. Transfusion 2001; 41: 440
  CrossrefPubMedGoogle Scholar
• 32 Persing DH, Conrad PA. Babesiosis: new insights from phylogenetic analysis. Infect Agents Dis 1995; 4: 182-195
  PubMedGoogle Scholar
• 33 Piccolin G, Benedetti G, Doglioni C et al. A study of the presence of B. burgdorferi, Anaplasma (previously Ehrlichia) phagocytophilum, Rickettsia, and Babesia in Ixodes ricinus collected within the territory of Belluno, Italy. Vector Borne Zoonotic Dis 2006; 6: 24-31
  CrossrefPubMedGoogle Scholar
• 34 Schorn S, Pfister K, Reulen H et al. Occurrence of Babesia spp., Rickettsia spp. and Bartonella spp. in Ixodes ricinus in Bavarian public parks, Germany. Parasit Vectors 2011; 4: 135
  CrossrefPubMedGoogle Scholar
• 35 Silaghi C, Woll D, Hamel D et al. Babesia spp. and Anaplasma phagocytophilum in questing ticks, ticks parasitizing rodents and the parasitized rodents – analyzing the host-pathogen-vector interface in a metropolitan area. Parasit Vectors 2012; 5: 191
  CrossrefPubMedGoogle Scholar
• 36 Skotarczak B, Cichocka A. Isolation and amplification by polymerase chain reaction DNA of Babesia microti and Babesia divergens in ticks in Poland. Ann Agric Environ Med 2001; 8: 187-189
  PubMedGoogle Scholar
• 37 Swanson SJ, Neitzel D, Reed KD et al. Coinfections acquired from ixodes ticks. Clin Microbiol Rev 2006; 19: 708-727
  CrossrefPubMedGoogle Scholar
• 38 Sytykiewicz H, Karbowiak G, Hapunik J et al. Molecular evidence of Anaplasma phagocytophilum and Babesia microti co-infections in Ixodes ricinus ticks in central-eastern region of Poland. Ann Agric Environ Med 2012; 19: 45-49
  PubMedGoogle Scholar
• 39 Telford III SR, Maguire JH. Babesiosis. In: Guerrant RL, Walker DH, Weller PF, Hrsg. Tropical Infectious Diseases: Principles, Pathogens, and Practice. New York, USA: Churchill Livingstone; 2006: 1063-1071
  CrossrefGoogle Scholar
• 40 Telford 3rd SR, Maguire JH. Babesiosis. In: Guerrant RL, Walker DH, Weller PF, Hrsg. Tropical Infectious Diseases: Principles, Pathogens, and Practice. Churchill Livingstone; 2006: 1063-1071
  CrossrefGoogle Scholar
• 41 Vannier E, Krause PJ. Human babesiosis. N Engl J Med 2012; 366: 2397-2407
  CrossrefPubMedGoogle Scholar
• 42 Weiss LM, Wittner M, Wasserman S et al. Efficacy of azithromycin for treating Babesia microti infection in the hamster model. J Infect Dis 1993; 168: 1289-1292
  CrossrefPubMedGoogle Scholar
• 43 Wittner M, Lederman J, Tanowitz HB et al. Atovaquone in the treatment of Babesia microti infections in hamsters. Am J Trop Med Hyg 1996; 55: 219-222
  PubMedGoogle Scholar