BABESIOSIS AND TICK-BORNE Public Health England have found two cases of serious tick-
borne co-infections in the UK – how clever of them, but how odd that
many patients have been telling them for decades that they have been
infected with ...
from Dr Horowitz
du Dr Horowitz
In this article published in the UK media,
babesiosis and tick-borne encephalitis viruses (TBE) are described as
'rare' in the UK. I suspect it is because no one has been looking hard
enough. TBE is found in approximately 12,000 individuals per year in
Europe (Beauté J, Spiteri G, Warns-Petit E, Zeller H. Tick-borne
encephalitis in Europe, 2012 to 2016. Euro Surveill.
2018;23(45):1800201. doi:10.2807/1560-7917.ES.2018) and babesiosis is
also known to be prevalent throughout vast parts of the European
continent:
"B. divergens, a natural pathogen of cattle, is the
main pathogen of human babesiosis in Europe [41, 43, 44], with the
majority of cases being reported in the British Isles and France [45],
along with some cases attributed B. microti and B. venatorum, a pathogen
of roe deer (Capreolus capreolus), and all are transmitted by the I.
ricinus tick [20]. However, a case of B. divergens in Norway [46], a
case of B. microti in Germany [47], coupled with the detection of B.
microti in two asymptomatic individuals in Poland [48], and B. venatorum
infections reported in Germany [18], Austria and Italy [19] shows again
that these pathogens are not absolutely segregated geographically, and
are becoming increasingly important as pathogens of human disease" [Ord
RL, Lobo CA. Human Babesiosis: Pathogens, Prevalence, Diagnosis and
Treatment. Curr Clin Microbiol Rep. 2015;2(4):173-181].
In the
US, the number of reported cases of babesiosis, between 2011–2017 was
11,881. I suspect this is also significantly under reported, based on
the number of positive Babesia cases we see in our practice in those
co-infected with Lyme disease (over 50 % show exposure using antibody
tests, increasing to approximately 80% when DNA and RNA (FISH) testing
is also used: Horowitz, R.I.; Freeman, P.R. Precision Medicine:
retrospective chart review and data analysis of 200 patients on dapsone
combination therapy for chronic Lyme disease/post-treatment Lyme disease
syndrome: part 1. International Journal of General Medicine 2019:12
101–119).
So as the summer proceeds, remember that if you develop
symptoms suggestive of COVID (fever, sweats, chills, unexplained 'air
hunger' with a cough, aches and pains) and/or neurological symptoms
(headaches, mental changes), babesia and tick-borne viruses may be
implicated, and a complete differential diagnostic work-up should be
done. In our practice, we have found that the Babesia FISH test from
IgeneX is an excellent test to pick up Babesia not found on standard
antibody testing (Shah, J.S.; Mark, O.; Caoili, E.; Poruri, A.;
Horowitz, R.I.; Ashbaugh, A.D.; Ramasamy, R. A Fluorescence in Situ
Hybridization (FISH) Test for Diagnosing Babesiosis. Diagnostics 2020,
10, 377) and most state laboratories, local laboratories (Quest) as well
as Coppe laboratories have testing for Powassan virus exposure. POWv
has now been shown to be present in 10-16% of those individuals living
in Lyme endemic areas of the US, so please remain vigilant with both
tick and COVID prevention practices. Stay safe.
du Dr Horowitz
In this article published in the UK media,
babesiosis and tick-borne encephalitis viruses (TBE) are described as
'rare' in the UK. I suspect it is because no one has been looking hard
enough. TBE is found in approximately 12,000 individuals per year in
Europe (Beauté J, Spiteri G, Warns-Petit E, Zeller H. Tick-borne
encephalitis in Europe, 2012 to 2016. Euro Surveill.
2018;23(45):1800201. doi:10.2807/1560-7917.ES.2018) and babesiosis is
also known to be prevalent throughout vast parts of the European
continent:
"B. divergens, a natural pathogen of cattle, is the main pathogen of human babesiosis in Europe [41, 43, 44], with the majority of cases being reported in the British Isles and France [45], along with some cases attributed B. microti and B. venatorum, a pathogen of roe deer (Capreolus capreolus), and all are transmitted by the I. ricinus tick [20]. However, a case of B. divergens in Norway [46], a case of B. microti in Germany [47], coupled with the detection of B. microti in two asymptomatic individuals in Poland [48], and B. venatorum infections reported in Germany [18], Austria and Italy [19] shows again that these pathogens are not absolutely segregated geographically, and are becoming increasingly important as pathogens of human disease" [Ord RL, Lobo CA. Human Babesiosis: Pathogens, Prevalence, Diagnosis and Treatment. Curr Clin Microbiol Rep. 2015;2(4):173-181].
In the US, the number of reported cases of babesiosis, between 2011–2017 was 11,881. I suspect this is also significantly under reported, based on the number of positive Babesia cases we see in our practice in those co-infected with Lyme disease (over 50 % show exposure using antibody tests, increasing to approximately 80% when DNA and RNA (FISH) testing is also used: Horowitz, R.I.; Freeman, P.R. Precision Medicine: retrospective chart review and data analysis of 200 patients on dapsone combination therapy for chronic Lyme disease/post-treatment Lyme disease syndrome: part 1. International Journal of General Medicine 2019:12 101–119).
So as the summer proceeds, remember that if you develop symptoms suggestive of COVID (fever, sweats, chills, unexplained 'air hunger' with a cough, aches and pains) and/or neurological symptoms (headaches, mental changes), babesia and tick-borne viruses may be implicated, and a complete differential diagnostic work-up should be done. In our practice, we have found that the Babesia FISH test from IgeneX is an excellent test to pick up Babesia not found on standard antibody testing (Shah, J.S.; Mark, O.; Caoili, E.; Poruri, A.; Horowitz, R.I.; Ashbaugh, A.D.; Ramasamy, R. A Fluorescence in Situ Hybridization (FISH) Test for Diagnosing Babesiosis. Diagnostics 2020, 10, 377) and most state laboratories, local laboratories (Quest) as well as Coppe laboratories have testing for Powassan virus exposure. POWv has now been shown to be present in 10-16% of those individuals living in Lyme endemic areas of the US, so please remain vigilant with both tick and COVID prevention practices. Stay safe.
