The Red Cross is providing Babesiosis-free blood to hospitals in a few states. Why aren't more hospitals ordering blood tested for this tick-borne disease, and why might this matter? Babesiosis is the number one tick-borne parasitic co-infection contributing to chronic illness in my patients. Sixteen years ago in my Hudson Valley medical practice, I uncovered my first case of stealth Babesiosis. A patient of mine with chronic Lyme disease who was paralyzed in a wheelchair for approximately 5-6 years complained during her appointment of drenching night sweats and day sweats. I did a differential diagnostic work-up and sent out her blood for Babesia testing. When it returned positive, I started her on Mepron and Zithromax, one of the newer treatment regimens for Babesia (Clindamycin and Quinine was the classic protocol until that time). Although she had failed years of classical antibiotics for her Lyme disease and complained of severe ongoing symptoms, she walked for the first time in years after 10 days of Mepron and Zithromax. I subsequently informed my local health department of my findings, and decided to have local ticks provided by Dr Rick Ostfeld from the Institute for Ecosystems Studies in Millbrook, N.Y, tested for Babesia. It turned out that we did in fact have Babesiosis in the Hudson Valley, but only a few percentage of these local ticks contained this malaria like parasite. I reported my findings of Babesiosis in the Hudson Valley at the Lyme Disease Foundation's (LDF's) International Scientific Conference in NYC (Horowitz, R,I., Osfeldt, R. Babesiosis in Upstate NY: PCR and RNA Evidence of Co-Infection with Babesia Microti Among Ixodidae Ticks in Dutchess County, N.Y. Abstract, 12th International Scientific Conference on Lyme Disease and Other Spirochetal Disorders. April 1999, NYC). Now,16 years later, over 40% of the ticks in the Hudson Valley are testing positive for Lyme and Babesia, with increasing rates of transmission of both organisms simultaneously (Co-Infection of Blacklegged Ticks with Babesia microti and Borrelia burgdorferi Is Higher than Expected and Acquired from Small Mammal Hosts, Ostfeld, R., et al. June 18, 2014; http://www.plosone.org/…/info%3Adoi%2F10.1371%2Fjournal.pon…). The result of this increased infection rate in ticks and in humans, is that the blood supply in the United States is now contaminated. How badly contaminated is the blood supply?
"A recent test of 115,000 blood donations from Minnesota, Wisconsin, and parts of New England showed about 460—or about four in 1,000—samples indicated babesia contamination...Currently, there is no FDA-approved test for the parasite, though many are in development, meaning that blood collectors depend on a questionnaire to determine the safety of a donor" according to this report in the Daily Beast .
Babesiosis can be acquired through a tick bite, a blood transfusion or through maternal-fetal transmission, and can be fatal in the very young or elderly with a compromised immune system. Not all hospitals are testing for it before giving blood to patients. Really? Is there a solution? "There is babesia-free blood available from the American Red Cross, but only hospitals in a couple states are ordering it. The reason so many choose to take a gamble with their patients’ well being? Money, of course". “The problem is most hospitals don’t do that because it costs them an additional charge for us to do the testing,” Susan Stramer, the American Red Cross’ vice president of scientific affairs, said in a recent interview. “It really leaves the rest of the patient population vulnerable.” This means that until the FDA mandates testing, or until hospitals can be reimbursed for testing from federal agencies, hospitals won’t incorporate screening blood for babesiosis as part of what Stramer calls their “standard of care.”
Screening the blood for Babesia is essential if we are to prevent unnecessary deaths, but we face a complex situation. One of the classic tests done for Babesiosis is the Giemsa stain. This may not be positive unless the level of parasitemia is greater than 5% in the blood. There are also multiple strains of Babesia that I am finding in my patients. I have had patients with negative LabCorp test results for Babesia microti, but they test positive for another strain of Babesia, Babesia WA-1. I have found B. duncani in my patients from the entire northeast seaboard (Florida to Maine), and reported these results at the ILADS International Lyme Conference in Toronto several years ago. The results of LabCorp testing was that we did 137 total tests at the Hudson Valley Healing Arts Center between June 2010 and July 2011, and 26/137 patients tested positive (19%) with patients testing positive from Hamlin, Maine to Winter Park, Florida. I discussed these results with Ben Beard from the CDC, as well as Dr Peter Krause, when I was at the Harvard Lyme conference last year, explaining how Babesia is spreading and how we need to expand the testing. My approach is to do a Babesia panel with an IFA for B.microti and Babesia duncani/WA-1, as well as a Babesia FISH test (RNA) and occasionally a PCR (DNA) test to find the malaria like parasite. One test can be negative and the other positive, so a Babesia panel approach is often necessary. I use the Horowitz-MSIDS screening questionnaire as a first step to screen for Babesia by focusing on symptoms such as fevers, day sweats, night sweats, flushing, chills, air hunger and an unexplained cough. These symptoms should be incorporated into the questionnaire used before donating blood, since the classical symptoms of Babesiosis discussed in text books (high fevers, hemolytic anemia, low platelet counts (thrombocytopenia), elevated liver functions and renal failure) may not be present in patients who are co-infected with Lyme and Babesia unless they are immune compromised (lacking a spleen), or have a underlying severe medical condition like congestive heart failure. Different strains of Babesia also cause different clinical manifestations (Babesia divergens in Europe may present more often with classical symptoms), so we need to expand our testing and notions about Babesia, if we are to protect patients and the blood supply.
One way to help remedy this situation would be for Lyme patients and Lyme groups to ask their regional hospitals to order babesia-free blood from the American Red Cross (and create an on-line listing of those hospitals who are willing to participate), and shouldn't we all petition the FDA to mandate testing and require reimbursement of hospitals from the federal government? We need to improve the standard of care for all Americans. This is especially important since "with babesiosis cases multiplying tenfold in just a few years and showing no signs of slowing, receiving a blood transfusion becomes an increasingly dangerous gamble. And it’s a gamble scientists have been warning us about since at least 2006" and one danger I've been reporting since 1999.
http://www.thedailybeast.com/…/hospitals-knowingly-dispense…
One way to help remedy this situation would be for Lyme patients and Lyme groups to ask their regional hospitals to order babesia-free blood from the American Red Cross (and create an on-line listing of those hospitals who are willing to participate), and shouldn't we all petition the FDA to mandate testing and require reimbursement of hospitals from the federal government? We need to improve the standard of care for all Americans. This is especially important since "with babesiosis cases multiplying tenfold in just a few years and showing no signs of slowing, receiving a blood transfusion becomes an increasingly dangerous gamble. And it’s a gamble scientists have been warning us about since at least 2006" and one danger I've been reporting since 1999.
http://www.thedailybeast.com/…/hospitals-knowingly-dispense…
Humans in the northeastern and midwestern United States are at increasing risk of acquiring tickborne...
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