Fatal Babesiosis in Man, Finland, 2004 | CDC EID

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Volume 16, Number 7–July 2010
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Fatal Babesiosis in Man, Finland, 2004
Karita Haapasalo, Pekka Suomalainen, Antti Sukura, Heli Siikamäki, and T. Sakari Jokiranta
Author affiliations: University of Helsinki, Helsinki, Finland (K. Haapasalo, A. Sukura, T.S. Jokiranta); Hospital District of Helsinki and Uusimaa, Helsinki (K. Haapasalo, T.S. Jokiranta); South Karelia Central Hospital, Lappeenranta, Finland (P. Suomalainen); and Helsinki University Central Hospital, Helsinki (H. Siikamäki)

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Abstract
We report an unusual case of human babesiosis in Finland in a 53-year-old man with no history of splenectomy. He had a rudimentary spleen, coexisting Lyme borreliosis, exceptional dark streaks on his extremities, and subsequent disseminated aspergillosis. He was infected with Babesia divergens, which usually causes bovine babesiosis in Finland.
Babesiosis is an arthropod-transmitted infection caused by an apicomplexan parasite. Most zoonotic cases in humans have been reported from the eastern coast of the United States, where the causative agent is Babesia microti, which is transmitted from white-footed mice to humans by Ixodes scapularis ticks (1,2). Rare cases of human babesiosis caused by B. divergens have been reported in Europe. B. divergens is a bovine parasite transmitted mainly by I. ricinus ticks. Both Ixodes spp. ticks also transmit Borrelia burgdorferi, the etiologic agent of Lyme borreliosis. In certain areas of the United States, >10% of patients with a diagnosis of Lyme disease are co-infected with B. microti (3). Co-infections with Borrelia spp. and B. divergens infections have been documented only serologically (4).

Babesia sporozoites are transmitted to the vertebrate host by a tick bite (5). The sporozoites invade erythrocytes and transform into ring-form trophozoites and typical Maltese cross assemblies of merozoites. Parasites lyse infected erythrocytes, which release merozoites that can invade new erythrocytes (6,7). Trophozoites can alternatively develop into gametocytes, enabling continuation of the life cycle in the tick after it has had a blood meal.

Most disease manifestations of human babesiosis are related to hemolysis (1). Symptoms are anemia, malaise, fever, chills, myalgia, and fatigue. High parasitemia levels can cause massive hemoglobinuria, acute renal tubular necrosis, and renal failure. In addition to hemolysis-associated manifestations, acute respiratory distress syndrome may occur as a complication and lead to death (8). B. divergens infections in Europe have been severe, and the mortality rate is high (42%) compared with that of B. microti infections in the United States (5%–20%) (1,2,9). All 22 published cases of B. divergens infection in Europe have occurred in patients who have undergone splenectomy (2). We report an unusual case of human babesiosis in Finland.

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Suggested Citation for this Article
Haapasalo K, Suomalainen P, Sukura A, Siikamäki H, Jokiranta TS. Fatal babesiosis in man, Finland, 2004. Emerg Infect Dis [serial on the Internet]. 2010 Jul [date cited]. http://www.cdc.gov/EID/content/16/7/1116.htm

DOI: 10.3201/eid1607.091905