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Babesiosis rates increased annually between 2015-2022 in the US by an average of 9 per cent year and four out of ten patients were discovered co-infected with another tick-borne illness such as Lyme disease according to research led by Penn State Milton S. Hershey Medical Center and Penn State College of Medicine researchers.
These results imply that clinicians should keep an heightened vigilance against co-infection of other tick-borne illnesses among those admitted with Babesiosis, such as Lyme disease and ticks that carry other bacteria responsible for anaplasmosis and ehrlichiosis. Ticks can transmit several bacteria that lead to other illnesses as well.
Paddy Ssentongo, infectious disease fellow from Penn State Health Milton S. Hershey Medical Center and lead author of this research project.
Today (Oct 8), they published their findings in Open Forum Infectious Diseases journal.
Babesiosis, also referred to as American malaria, is caused by Babesia parasite and transmitted through black-legged tick bites in Northeastern and Midwestern states of the U.S. The parasite infects red blood cells similar to malaria’s, creating similar clinical symptoms; according to the Centers for Disease Control and Prevention (CDC) some individuals don’t experience symptoms but others experience flu-like ones; the disease may prove deadly for older adults or those who lack immune defense mechanisms such as lack of immune defense or lack of spleen.
“Understanding the drivers, dynamics and controls associated with vector-borne diseases endemic and emerging is essential for global health interventions”, according to Ssentongo.
According to the Centers for Disease Control (CDC), prevalence of Babesiosis has been on an upward trend, possibly as a result of climate change. Ssentongo posited that climate change plays a part in this; temperature, humidity, rainfall patterns and length of season all play roles; changing conditions have affected vector population distribution (ticks) as well as animal reservoir hosts (deer). As a result, ticks may now inhabiting larger geographical areas than ever.
The team set out to assess both the prevalence and effect of Babesia co-infection on mortality risk using TriNetX – an extensive national database with clinical patient information from more than 250 million individuals – they identified 3,521 people who became infected between October 2015 and December 2022 with Babesiosis.
Researchers determined that incidence of Babesiosis rose an average of 9% annually; cases often peaked during summer months in Northeastern states and 42% were simultaneously infected with one or more tick-borne diseases – this rate exceeded previous findings by more than 20%; most commonly co-infected were Lyme Disease patients at 41% while 3.7% and 0.3% also shared co-infection from ehrlichiosis or anaplasmosis bacteria, among others.
When the team examined whether co-infection amplified risk of complications or worse outcomes, there were no significant variations between babesiosis-only group and co-infection group when looking at risks to complications or worse outcomes; however when looking at mortality risk levels among the two, mortality risks were higher among babesiosis-only group than other two.
“Having both Babesiosis and Lyme disease did not appear to correlate with increased mortality,” Ssentongo noted, finding this result quite surprising. She speculated that concurrent tick-borne infection might alter immune response by “boosting” it more efficiently against infections.
Ssentongo suggested that differences in outcomes could also stem from how other tick-borne illnesses are handled; his team found that patients in co-infection groups were more likely to be prescribed doxycycline, an antibiotic treatment used against Lyme disease, anaplasmosis and ehrlichiosis than in groups only suffering babesiosis; thus prompting Ssentongo to ask: Is doxycycline effective against treating Babesia parasite?
Treatment options for babesiosis vary according to disease severity, with azithromycin and atovaquone antibiotics often being the first-line treatments. Red blood cell exchange (where abnormal red blood cells are removed and replaced with healthy ones) should also be considered in cases with serious organ dysfunction; although its survival benefits have yet to be researched thoroughly.
At Ssentongo Medical Center in California, for patients diagnosed with Babesiosis we treat them using this approach in addition to exploring whether Lyme disease and/or tick-borne illnesses exist – and have seen better outcomes as a result of using Doxycycline for investigations,” according to reports of success treating Babesiosis with Doxycycline treatment alone in other case reports; more research needs to be completed regarding how physiological pathways underlying co-infection could influence treatment protocols and affect protocols over time.
According to Ssentongo, prevention is by far the best approach when it comes to tick-borne diseases.
“Those living in areas where Babesiosis is prevalent – such as states in the Northeast and Midwest – should take precautions during summer months in particular,” Ssentongo noted. To reduce tick bite risk, they can wear long-sleeved clothing in light colors with long sleeved tops or pants; utilize tick repellant; check their clothes after spending time outdoors for ticks; wear long sleeved tops that cover armpits when outside; use tick repellant; use repellant spray and check after spending time outdoors before checking after spending time outdoors as it might contain ticks as well.”
This research will be presented at IDWeek – Infectious Disease Society of American annual conference – taking place Oct 16-19th in Los Angeles.
Penn State authors include Vernon Chinchilli, distinguished professor of public health sciences; Djibril Ba, assistant professor of public health sciences; Natasha Venugopal, an internal medicine resident at Penn State Health Milton S. Hershey Medical Center and Yue Zhang an epidemiology doctoral student are among those contributing authors.
Source:Ssentongo, P. et al. (2024). Beyond Human Babesiosis: Prevalence and Association of Babesia Coinfection With Mortality in the United States from 2015-2022: A Retrospective Cohort Study, Open Forum Infectious Diseases; doi.org/10.1093/ofid/ofae504.
