Babesiosis (Babesia)

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Chapter 281 Babesiosis (Babesia)

Babesiosis is an emerging malaria-like disease caused by intraerythrocytic protozoa that are transmitted by hard body (ixodid) ticks. The clinical manifestations of babesiosis range from subclinical illness to fulminant disease resulting in death.


Babesia are transmitted to humans from vertebrate reservoir hosts by the Ixodes ricinus family of ticks. B. microti is the most common cause of babesiosis in humans. The primary reservoir for B. microti is the white-footed mouse, Peromyscus leucopus, and the primary vector is the black legged tick, Ixodes scapularis. I. scapularis also transmits the causative agents of Lyme disease and human granulocytic anaplasmosis and may simultaneously transmit all 3 microorganisms. White-tailed deer (Odocoileus virginianus) serve as the host on which adult ticks feed most abundantly but are incompetent reservoirs. Babesiosis may be transmitted through blood transfusion, and B. microti is the most frequently reported transfusion-transmitted microbial agent in the USA. Rarely, babesiosis is acquired by transplacental transmission.

Human B. microti infection is endemic in the northeastern and upper midwestern USA and in Europe. Human babesial infections caused by the cattle parasite, Babesia divergens, have been described in many countries in Europe, while B. divergens–like infections have been described in Kentucky, Missouri, and Washington. B. duncani infects humans along the Pacific coast. B. venatorum infection has been documented among people in Austria, Germany, and Italy. Human babesiosis cases also have been documented in Asia, Africa, and South America, including KO1 in Korea and TW1 in Taiwan.

In certain sites and in certain years of high transmission, babesiosis constitutes a significant public health burden. Nantucket Island reported 21 such cases in 1994, which translates to 280 cases/100,000 population, placing the community burden of disease in a category with gonorrhea as “moderately common.” Comparable incidence rates have been described elsewhere on the southern New England coast.

Clinical Manifestations

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