Complement activation by
may lead to the generation of tumor necrosis factor (TNF) andinterleukin-1 (IL-1). Decreased complement levels, increased circulating C1q-binding activity, anddecreased C4, C3, and CH50 levels are observed in patients with babesiosis. The generation of theseprimarily macrophage-produced mediators may explain many of the clinical features, such as fever,anorexia, arthralgias, myalgias, and the fulminant shock syndrome of bovine babesiosis.Babesiosis elicits a B-cell response and a T-cell response. Patients with acute babesiosis have an increasein T-suppressor lymphocytes, T-cytotoxic lymphocytes, or both and decreased responses to lymphocytemitogens with a polyclonal hypergammaglobulinemia.
parasites from rodents (primarily the white-footed deer mouse but also the field mouse, vole,rat, and chipmunk) are transmitted to humans during tick bites in endemic areas. Babesiosis isunderstandably more prevalent during the periods of tick activity, such as spring and summer.Although rodents are infected with
, the white-tailed deer does not carry the organism.
is transmitted from the larval phase of
to the nymphal phase (transstadialtransmission) but not transovarially. Human infection is primarily produced by the bite of an infectednymph during a blood meal. Restocking of deer populations and curtailment of hunting has increaseddeer herds in certain areas. The proximity of deer, mouse, and tick create the conditions for humaninfection.Several reported cases of infection via blood transfusions from donors who lived in or traveled to anendemic area have been documented.
All of these cases have occurred in the United States, with theexception of 1 patient in Canada (acquired from a donor who became infected while in the UnitedStates) and 1 in Japan. The incubation period in transfusion-associated disease appears to be 6-9 weeks.The rate of acquiring
from a unit of packed RBCs has been estimated to be 1 in 600-1800 inendemic areas.Case reports of transplacental or perinatal transmission have been documented. Transplacentaltransmission has also occurred rarely.Babesiosis has a spectrum of severity, which may be divided into 3 distinct parts as follows
A mild-to-moderate viral-like syndrome
Severe disease with a fulminant course resulting in death or a persistent relapsing courseBabesiosis in otherwise healthy hosts produces an acute infectious disease that resembles malaria. Mostcases of babesiosis are subclinical or are mildly symptomatic. Babesiosis may continue for more than 2months after treatment; asymptomatic infections can persist silently for months to years. Patients withpositive smears or positive polymerase chain reaction (PCR) test results more than 3 months after initialtreatment should be treated again, regardless of the presence or absence of seizures.