title: First case of human babesiosis in Germany - Clinical presentation and molecular characterisation of the pathogen.
abstract: Babesiosis is a common infection of animals and is gaining increasing attention as an emerging tick-borne zoonosis of humans in Europe. Here we report on the first case of human babesiosis in Germany in a 63-year-old splenectomised German patient with a relapse of nodular lymphocyte-predominant Hodgkin's lymphoma. After treatment with a chimeric anti-CD20 antibody preparation (Rituximab), the patient was hospitalised because of anaemia and dark urine from haemoglobinuria. Presumptive diagnosis of babesiosis was made based on piriform parasitic erythrocytic inclusions in peripheral blood smears and confirmed by Babesia-specific 18S rDNA PCR. Sequence analysis revealed a >99% homology of the amplicon with the recently described EU1 organism clustering within the Babesia divergens/Babesia odocoilei complex. Despite treatment with quinine and clindamycin the patient relapsed and developed chronic parasitaemia requiring re-treatment and long-term maintenance therapy with atovaquone before he eventually seroconverted and the parasite was cleared. Our findings suggest that human babesiosis occurs in Germany and can take a chronic course in immunocompromised individuals.
authors.affiliation: Department of Internal Medicine II, Hegau-Bodensee-Medical Center, Singen, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Häselbarth
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Tenter
authors.forename: Volker
authors.initials: V
authors.lastname: Brade
authors.forename: Gerhard
authors.initials: G
authors.lastname: Krieger
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Hunfeld
mesh_terms: D000740:Anemia / Q000473:pathology; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D053626:Atovaquone / Q000627:therapeutic use; D001403:Babesia / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001404:Babesiosis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D004912:Erythrocytes / Q000469:parasitology; D006456:Hemoglobinuria / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D016053:RNA, Protozoan / Q000235:genetics; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D017385:Sequence Homology; D016896:Treatment Outcome
chemical_list: D000981:Antiprotozoal Agents; D016053:RNA, Protozoan; D012337:RNA, Ribosomal, 18S; D053626:Atovaquone