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Babesiosis in Washington State: A New Species of Babesia?

Robert E. Quick; Barbara L. Herwaldt; John W. Thomford; Michael E. Garnett; Mark L. Eberhard; Marianna Wilson; David H. Spach; Jennifer W. Dickerson; Sam R. Telford; Karen R. Steingart; Richard Pollock; David H. Persing; John M. Kobayashi; Dennis D. Juranek; and Patricia A. Conrad
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From the Epidemiology Program Office and the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; University of California, Davis, California; Family Practice Clinic, Goldendale, Washington; University of Washington School of Medicine, Seattle, Washington; The Harvard School of Public Health, Boston, Massachusetts; Southwest Washington Health District, Vancouver, Washington; Washington State University, Pullman, Washington; Mayo Foundation, Rochester, Minnesota; the Department of Health, Seattle, Washington. Requests for Reprints: Barbara L. Herwaldt, MD, MPH, Centers for Disease Control and Prevention, Parasitic Diseases Branch, 4700 Buford Highway NE, Atlanta, GA 30341-3724. Acknowledgments: The authors thank Paul Catts, PhD; Carl Conroy, DVM; Andre Gorenflot, PhD; George R. Healy, PhD; Steve Hines, DVM, PhD; Laura Kentala, BS; Susan Pennington, RN; Robert L. Rausch, PhD; Virginia R. Rausch, MS; Fred Schubert, MD; Essie M. Walker; and Doris A. Ware for their contributions Grant Support: In part by National Institutes of Health (NIH) grants (R01-32403, R01-41497, R01-30548, AI19693), the NIH Biomedical Research Support Program, and a University of California (Davis) Companion Animal Grant.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(4):284-290. doi:10.7326/0003-4819-119-4-199308150-00006
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Objective: To characterize the etiologic agent (WA1) of the first reported case of babesiosis acquired in Washington State.

Design: Case report, and serologic, molecular, and epizootiologic studies.

Setting: South-central Washington State.

Patient: A 41-year-old immunocompetent man with an intact spleen who developed a moderately severe case of babesiosis.

Measurements: Serum specimens from the patient were assayed by indirect immunofluorescent antibody (IFA) testing for reactivity with seven Babesia species and with WA1, which was propagated in hamsters inoculated with his blood. A Babesia-specific, ribosomal-DNA (rDNA) probe was hybridized to Southern blots of restriction-endonuclease-digested preparations of DNA from WA1, Babesia microti, and Babesia gibsoni. Serum specimens from 83 family members and neighbors were assayed for IFA reactivity with WA1 and B. microti. Small mammals and ticks were examined for Babesia infection.

Results: The patient's serum had very strong IFA reactivity with WA1, strong reactivity with B. gibsoni (which infects dogs), but only weak reactivity with B. microti. DNA hybridization patterns with the rDNA probe clearly differentiated WA1 from B. gibsoni and B. microti. Four of the patient's neighbors had IFA titers to WA1 of 256. The tick vector and animal reservoir of WA1 have not yet been identified, despite trapping 83 mammals and collecting 235 ticks.

Conclusions: WA1 is morphologically indistinguishable but antigenically and genotypically distinct from B. microti. Some patients elsewhere who were assumed to have been infected with B. microti may have been infected with WA1. Improved serodiagnostic and molecular techniques are needed for characterizing Babesia species and elucidating the epidemiology of babesiosis, an emergent zoonosis.


Grahic Jump Location
Figure 1.
Photographs of Giemsa-stained peripheral blood smears from a patient who acquired babesiosis in Washington State.Left.Right.

Oil immersion objective (original magnification, 1250). Ring form. Tetrad.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Hybridization of HindIII-digested babesial and leukocyte DNA with a chemiluminescent Babesia-specific ribosomal- DNA probe.Babesia microtiBabesia gibsoni

WA1 (lanes 2 and 3); (lane 4); (lane 6); control leukocytes from an uninfected hamster (lane 1); control leukocytes from an uninfected dog (lane 5). Molecular sizes are indicated on the left in kilobases; standards representing molecular size fragments (HindIII digest of DNA; Bethesda Research Laboratory) were used on the gel. Exposure time to the film (X-Omat; Kodak, Rochester, New York) was 17 minutes.

Grahic Jump Location




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