BABESIOSIS

Babesiosis is a rare, severe and sometimes fatal tickborne disease caused by various types of Babesia, a microscopic parasite that infects red blood cells. is a malaria-like parasitic disease caused by Babesia, a genus of protozoal piroplasms. After trypanosomes, Babesia are thought to be the second most common blood parasites of mammals and they can have a major impact on health of domestic animals in areas without severe winters. Human babesiosis is uncommon, but reported cases have risen recently because of expanded medical awareness. 

Who gets babesiosis? Babesiosis is seen most frequently in the elderly or in immunocompromised individuals. Cases of this disease have been primarily reported during spring, summer and fall in coastal areas. Babesiosis can be more severe in people who have had their spleen removed.  How is babesiosis transmitted? Babesiosis is transmitted by the bite of an infected deer tick, Ixodes scapularis. Transmission can also occur via transfusion of contaminated blood.

Symptoms of babesiosis 
         

Generalized weakness Fatigue Depression Fever Anorexia and weight loss CNS - Headache, photophobia, neck stiffness, altered sensorium Pulmonary - Cough, shortness of breath GI - Nausea, vomiting, abdominal pain Musculoskeletal - Arthralgia and myalgia Renal - Dark urine Chills And sweating

Symptoms appear when It may take from one to eight weeks, sometimes longer, for symptoms to appear. LIFE CYCLE

To prevent babesiosis? 
When in tick-infested habitat - wooded and grassy

areas - take special precautions to prevent tick bites, such as wearing light-colored clothing (for easy tick discovery) and tucking pants into socks and shirt into pants. Check after every two to three hours of outdoor activity for ticks on clothing or skin. Brush off any ticks on clothing before skin attachment occurs. A thorough check of body surfaces for attached ticks should be done at the end of the day. If removal of attached ticks occurs within 36 hours, the risk of tick-borne infection is minimal.

Babesiosis Classification and external resources 

The disease is named for the genus of the

causative organism, which was in turn named after the bacteriologist Victor Babe . Equine babesiosis is also known as piroplasmosis.

Epidemiology 
Babesiosis is a vector-borne illness usually transmitted by Ixodid ticks. Babesia microti uses the same tick vector, Ixodes scapularis, as Lyme disease and ehrlichiosis, and may occur in conjunction with these other diseases. In endemic areas, the organism can also be transmitted by blood transfusion.  Most cases of babesia infection are asymptomatic or include mild fevers and anemia and go unnoticed. In more severe cases, there are symptoms similar to malaria, with fevers up to 105°F / 40°C, shaking chills, and severe anemia (hemolytic anemia). Organ failure may follow including adult respiratory distress syndrome. Severe cases occur mostly in people who have had their spleen removed surgically. Severe cases are also more likely to occur in the very young, very old, and persons with immunodeficiency, such as HIV/AIDS patients. Some people with babesiosis have additional tick-borne illnesses, such as Lyme disease.

Babesia life cycle

Diagnosis 
Other laboratory findings include decreased numbers of red

blood cells and platelets on complete blood count. 

Babesia parasites in red blood cells on a stained blood smear.  In symptomatic people, babesiosis usually is diagnosed by

examining blood specimens under a microscope and seeing Babesia parasites inside red blood cells.  If babesiosis is being considered, examination of blood smears should be specifically requested. Multiple smears may need to be examined to detect low levels of parasites.

Treatment 
Most cases of babesiosis resolve without any

specific treatment. For ill patients, treatment is usually a two-drug regimen. The regimen of quinine and clindamycin has been used, but is often poorly tolerated; recent evidence suggests that a regimen of atovaquone and azithromycin can be equally effective. In life-threatening cases exchange transfusion is performed. In this procedure the infected red blood cells are removed and replaced with fresh ones. 

Balantidiasis
is defined as large-intestinal infection with Balantidium coli. B coli are known to parasitize the colon, and pigs may be its primary reservoir. Most cases of balantidiasis in individuals are asymptomatic. 

Causative agent: 

Balantidium coli> is a protozoan parasite responsible for the disease
Balantidiasis. is the largest protozoan and the only ciliate known to parasitize humans. 

infection is most often asymptomatic, but the parasite can invade the large intestine leading to diarrhea, dysentery (bloody diarrhea), colitis, and abdominal pain. This collection of symptoms is Balantidiasis, which can be treated effectively with antibiotics and can be prevented with proper hand washing practices, water treatment, separation of human and swine habitats, and proper waste disposal.

Signs and symptoms 
       

Diarrhea - watery, bloody, and mucoid Nausea and vomiting Abdominal pain/cramps Anorexia Weight loss Headache Mild colitis Fever Severe and marked fluid loss resulting in dehydration (resembling amebic dysentery)

Risk factors for balantidiasis  Contacts with pigs  Handling fertilizer contaminated with pig excrement  Living in areas where the water supply may be contaminated by the excrement of infected animals.  Poor nutrition  Achlorhydria  Alcoholism  Immunosuppression 

Tests and diagnosis 
 

Wet smear stool specimens Chest X-ray may show pulmonary involvement in patients with balantidiasis. CT- chest reveals reveal pulmonary parenchymal and lymph node involvement. 

Complications 
  

Perforation of ulcer Peritonitis Gastro intestinal bleeding Severe dehydration 

Preventive measures 
   

Purification of drinking water Proper handling of food stuffs Careful disposal of human feces and excreta Monitoring the contacts of balantidiasis patients Avoiding contact with pigs and fertilizer that is contaminated with pig excrement can decrease the risk.

Diagnosis of Balantidiasis 
>As with other similar diseases, can be

complicated, partly because symptom may or may not be present. The diagnosis of balantidiasis may be considered when a patient has diarrhea combined with a possible history of recent exposure to amebiasis through travel, contact with infected persons, or anal intercourse. 

Transmission
Infection is particularly common in pigs, and are the main source of transmission to man. More than 50% of human cases had contact with pigs. The handling and slaughtering of pigs and the use of pig excrement for fertilizing vegetables favor increase transmission. Person-to-person contact occurs through fecal contamination. Cysts are the infective stage and may remain viable for weeks in moist feces. Excystation occurs in the bowel, and the trophozoites live in the large intestine, where they either remain in the lumen or invade the intestinal mucosa. Encystation occurs either as fecal material being moved down the bowel or after passage of semi-formed stool.

Treatment
Antibiotics- Tetracycline 500 mg 4 times a day for 10 days Contact Amebicide- Iodoquinol 
 

(1) Tetracyclines 500 mg four times daily for 10 days (Contraindicated in pregnant women and children younger than 8 years of age) (2) Metronidazole 750 mg three times daily for 5 days 

 



(3) Iodoquinol 640 mg three times daily for 20 days 

Most cases of Balantidium coli infection are

asymptomatic. If possible, asymptomatic individuals should still be treated in order to halt further transmission of the disease. 
Many people clear the infection spontaneously without

treatment. Infected individuals usually respond well to treatment using one of the aforementioned regimens. 
If left untreated, Balantidiasis can become chronic.

Persistent diarrhea can lead to high fluid loss and dehydration. Abdominal bleeding can lead to death. 

Balantidiasis is diagnosed by microscopic

examination of a patient s feces. A stool sample is collected and a wet mount is prepared. Cysts or trophozoites can be detected in the feces. Balantidium coli is passed periodically, therefore stool samples should be collected frequently and examined immediately in order to make a definitive diagnosis. 

Trophozoites can also be detected in tissue. In order to collect a tissue

specimen from the large intestine, a sigmoidoscopy procedure is used. A thin, hollow instrument called a sigmoidoscope is used to visually inspect the last sections of the large intestine: the rectum and the sigmoid colon. A physician can look for bleeding, ulcers, and inflammation in order to diagnose the cause of diarrhea and other GI complaints, and can take a tissue biopsy for inspection.

Pseudomonas aeruginosa 
occur most often in hospitals, where the

organism is frequently found in moist areas such as sinks, antiseptic solutions, and urine receptacles. Cross infection transmitted from patient to patient via the hands of personnel may occur in outbreaks of urinary tract infections, on burn units and in neonatal intensive care nurseries. 

Is a Gram negative bacteria that is commonly found in the environment: 

>water  >soil and  >other moist location

CAUSES oF PSEUDOMONAS AERUGENOSA 
Pseudomonas aeruginosa is an opportunistic pathogen. The

bacteria takes advantage of an individual's weakened immune system to create an infection and this organism also produces tissue-damaging toxins. Pseudomonas aeruginosa causes urinary tract infections, respiratory system infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, gastrointestinal infections and a variety of systemic infections, particularly in patients with severe burns and in cancer and AIDS patients who are immunosuppressed.

Symptoms of Pseudomonas Aeruginosa Infection
The symptoms of pseudomonas aeruginosa infection, depends on the part of the body that is infected. Fever, fatigue, muscle and joint pain are symptoms of pseudomonas bacteremia. The following list gives the respective symptoms of each infection, Bone infection: Swollen infected part, redness. Ear infection: Pain in the ear, reduced ability to hear, facial paralysis. Eye infection: Pain in the eye, reduced vision, swollen eyelids. Cystic fibrosis: Cough, reduced appetite, fast breathing, enlargement of abdomen. Skin infections: Ulcer that can result in bleeding.

Sites of infection; 
Respiratory: bronchitis, pneumonia (often recurrent & or 

 

 

chronic), similar to pts w/ CF; lobar, cavitary, diffuse interstial, bronchiectatic, & empyemas all reported. Skin: papules, nodules, folliculitis, abscesses, & ecthyma gangrenosum (usually as a result of systemic infection) ENT: orbital cellulitis; sinusitis (recurrent &/or chronic); parapharyngeal abscesses, & malignant otitis externa, particularly in diabetic patients. GU: Complicated UTI, pyelonephritis. Bone: osteomyelitis. CV: endocarditis mostly in IDU.

Epidemiology of Pseudomonas aeruginosa 
Pseudomonas aeruginosa is primarily a nosocomial

pathogen. According to the CDC, the overall incidence of P. aeruginosa infections in US hospitals averages about 0.4 percent (4 per 1000 discharges), and the bacterium is the fourth most commonly-isolated nosocomial pathogen accounting for 10.1 percent of all hospital-acquired infections. Within the hospital, P. aeruginosa finds numerous reservoirs: disinfectants, respiratory equipment, food, sinks, taps, and mops. This organism is often reintroduced into the hospital environment on fruits, plants, vegetables, as well by visitors and patients transferred from other facilities. Spread occurs from patient to patient on the hands of hospital personnel, by direct patient contact with contaminated reservoirs, and by the ingestion of contaminated foods and water. 

ncubation Period Usually 24-72 hours. 

Diagnosis of Pseudomonas aeruginosa

Diagnosis of P. aeruginosa infection depends upon isolation and laboratory identification of the bacterium. It grows well on most laboratory media and commonly is isolated on blood agar or eosin-methylthionine blue agar. It is identified on the basis of its Gram morphology, inability to ferment lactose, a positive oxidase reaction, its fruity odor, and its ability to grow at 42° C. Fluorescence under ultraviolet light is helpful in early identification of P. aeruginosa colonies and may also help identify its presence in wounds.

Treatment of Pseudomonas aeruginosa 
Pseudomonas aeruginosa is frequently resistant to

many commonly used antibiotics. Although many strains are susceptible to gentamicin, tobramycin, colistin, and amikacin, resistant forms have developed. The combination of gentamicin and carbenicillin is frequently used to treat severe Pseudomonas infections. Several types of vaccines are being tested, but none is currently available for general use. 

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