First diagnostic cases of human babesiosis in Montenegro

Andrić, Bogdanka; Golubović, Mileta; Terzic, Dragica; Dupanovic, Brankica; Icevic, Milos

doi:10.1016/j.bjid.2012.04.001

LETTER TO THE EDITOR

First diagnostic cases of human babesiosis in Montenegro

Bogdanka Andrić^* * Corresponding author at: Clinic Center of Montenegro, School of Medicine, University of Montenegro, Kruševac bb, 81000 Podgorica. E-mail address: bogdankaandric0@gmail.com (B. Andríć). ; Mileta Golubović; Dragica Terzic; Brankica Dupanovic; Milos Icevic

Clinic Center of Montenegro, School of Medicine, University of Montenegro, Podgorica

Dear Editor,

Babesiosis is a parasitic infection similar to malaria. It belongs to the group of vector-borne transmissible zoonoses.¹The primary vectors are various types of ticks.²Dispersion of the infection is enabled by a wide range of reservoirs for parasites (domestic and wild mammals).^2-4 Examinations in Europe proved that the Babesia parasite is the most frequent agent in coinfections with Borrelia burgdorferi.⁵The first diagnosed cases of human babesiosis in Montenegro were registered in 2011, at the Infectious Disease Clinic in Podgorica.⁶

In our ten examined patients, clinical characteristics and laboratory findings were not specific. Manifest Erythema migrans (EM) was observed in six patients. In seven cases, Lyme borreliosis was diagnosed by Elisa method. The diagnosis of babesiosis was confirmed in all ten patients by analysis of the bone marrow biopsy, stained according to Romanowski, and in four patients by analysis of thick drop and peripheral blood smear, stained by Giemsa-I. Seven cases had coinfection with Borrelia burgdorferi and Babesia agents.

In the clinical picture, non-specific symptoms of common infectious syndromes predominated. Changes in blood and differential blood pictures were registered for every patient. Intraerythrocytic annular forms of the parasite Babesia spp. were found in histological cultures (Fig. 1). In comparison with Plasmodium, Babesia does not cause pigment in erythrocytes, nor does it produce schizonts or gametocytes.

After the diagnosis was made in all ten cases, treatment was administered: clindamycin + quinine sulphate in a course of seven days. In seven cases, positive response to the treatment was very good. In three cases of coinfections, treatment was not satisfactory. One case developed transitory thrombocytopenia. One case developed facial palsy and another case had transitory cardiac arrhythmia. Cases with B. burgdorferi and Babesiaspp. coinfections were confirmed. Therapy with doxiciclin 100 mg bid was continued for three weeks.

Although the first cases of human babesiosis in Montenegro were diagnosed in 2011, veterinary health services in Montenegro have been diagnosing cases of the disease in domestic animals for years, in areas where babesiosis is endemic.⁶

Montenegro represents the perfect environment for a wide range of vector-borne zoonoses, because of its geographical position (Mediterranean region), ecological characteristics, and demographic characteristics.⁴

In endemic areas, the asymptomatic forms of babesiosis are the most frequent. Asymptomatic parasitemia can last for months and even years. These latent infections can be reactivated by stress, splenectomy, and immunosuppressive therapy. In human infections, Babesia is a significantly opportunistic agent.

Conflict of interest

All authors declare to have no conflict of interest.

Received 9 March 2012

Accepted 20 April 2012

Available online 11 September 2012

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