[Babesiosis in an immunocompromised German patient]. / Babesiose bei einem immunsupprimierten Patienten.

BACKGROUND: Babesiosis is a tick-borne zoonosis. Human cases of babesiosis occur worldwide but have been mainly described in North America and rarely in Europe. The disease manifestations show a broad clinical spectrum including a malaria-like syndrome. Fulminant and life-threatening infections have been described in the setting of asplenia and/or immunosuppression. CASE REPORT: A 63-year-old splenectomized patient had been treated with rituximab because of B cell lymphoma. 4 weeks later, he developed signs of infection, anemia, subicterus, and dark urine. Laboratory investigation revealed hemolytic anemia, hemoglobinuria, and renal insufficiency. Blood smears showed Plasmodium-like intraerythrocytic parasites. He had not been exposed to malaria. He had taken frequent walks in the woods around Lake Constance in the south of Germany, where tick-borne diseases are endemic. Babesiosis was confirmed by polymerase chain reaction (PCR) and the parasite was identified as EU1. Serology was negative. Therapy with clindamycin and quinine induced remission. Following a relapse, retreatment with atovaquone and azithromycin was initiated. After several months, seroconversion occurred and the patient cleared the parasite 8 months after first admission. CONCLUSION: Human babesiosis does occur in Germany. Patients with splenectomy and/or immunosuppression and malaria-like symptoms should be evaluated for babesiosis by blood smear and PCR.

First case of human babesiosis in Germany - Clinical presentation and molecular characterisation of the pathogen.

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.