Human Babesiosis

Human babesia infection (Babesiosis)

Babesiosis is caused by intraerythrocytic protozoan parasites — meaning they live inside red blood cells — that are transmitted by ticks, and more rarely through blood transfusion or transplacentally, from mother to fetus during pregnancy. Babesia parasites (and the closely related genus Theileria) are among the most common and widespread blood parasites in the world. Several Babesia species are capable of infecting humans, with Babesia microti being perhaps the most prevalent. Infections with different Babesia species usually follow regional patterns: in the United States, most cases are caused by B. microti, while in Europe, confirmed cases are generally due to Babesia divergens [1].

Babesia in a red blood cell – under dark-field microscopy

Human babesiosis was first identified in Europe in a patient who had undergone spleen removal, but most reported cases come from the northeastern and upper midwestern regions of the United States, occurring in individuals with intact spleens and no immune impairment. Cases have been reported across nearly the entire globe — in Asia, Africa, Australia, Europe, and South America. Babesiosis shares several clinical features with malaria and can be fatal, particularly in elderly or immunocompromised patients [2]. Special attention should therefore be given in cases where Lyme disease has been present for a long time, as the persistent presence of Borrelia bacteria may weaken the immune system, making it easier for the parasites to spread.

The life cycle and developmental stages of Babesia

The spectrum of disease manifestations is broad, ranging from silent infection to fulminant, malaria-like illness that can cause severe hemolysis — the destruction of red blood cells — and, in some cases, death. Babesia infections therefore range from almost asymptomatic to severe. The specific laboratory diagnosis of Babesia infection is performed through morphological examination of (Giemsa-stained) blood smears, serology, and, with variable success, DNA testing (PCR). Babesia infection causes alterations (protrusions and perforations) on the surface of red blood cells, and the pathogen itself can be identified inside the cells [1][3][4]. High-level infection can be detected through simple microscopic blood examination; in certain confirmed cases, the parasite infected a large proportion of red blood cells [4]. In general cases, concentration of infected red blood cells is required — for example, using the DualDur co-infection preparation method. According to the recommendation of the U.S. Centers for Disease Control and Prevention (CDC), babesiosis is primarily diagnosed through microscopic examination of the blood [5].

  1. Homer MJ, Aguilar-Delfin I, Telford SR, Krause PJ, Persing DH. Babesiosis. Clin Microbiol Rev 2000; 13:451–469.
  2. Vannier EG, Diuk-Wasser MA, Ben Mamoun C, Krause PJ. Babesiosis. Infectious Disease Clinics of North America 2015; 29:357–370.
  3. Braga W, Venasco J, Willard L, Moro MH. Ultrastructure of Babesia WA1 (Apicomplexa: Piroplasma) During Infection of Erythrocytes in a Hamster Model. Journal of Parasitology 2006; 92:1104–1107.
  4. Sun T, Tenenbaum MJ, Greenspan J, et al. Morphologic and Clinical Observations in Human Infection with Babesia microti. Journal of Infectious Diseases 1983; 148:239–248.
  5. https://www.cdc.gov/babesiosis/about/index.html

Surface changes in red blood cells caused by Babesia – electron microscopic image

Babesia in the red blood cell – electron microscopic image

Surface changes in red blood cells caused by Babesia – electron microscopic image