The impact of ABO and RhD blood types on Babesia microti infection.
The impact of ABO and RhD blood types on Babesia microti infection.
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ABO和RHD血型对Babesia Microti感染的影响。
DOI：
10.1371/journal.pntd.0011060
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发表时间：
2023-01
影响因子：
3.8
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中科院分区：
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巴贝斯虫病是由红细胞内巴贝斯虫寄生虫引起的一种新发传染病，可导致严重疾病和死亡。虽然已知血型影响恶性疟疾患者的死亡率，但红细胞(RBC)抗原与微小巴贝斯虫感染和疾病严重程度之间缺乏联系。我们在美国东北部和中西部北部的10个流行州评估了感染巴贝斯虫(18S rRNA反应)的献血者的RhD和ABO血型。我们还评估了在康涅狄格州住院的巴贝斯虫病患者中RhD和ABO血型与疾病严重程度之间的可能联系。共分析了768名感染巴贝斯虫的献血员，其中750人(97.7%)具有可检测到的微小巴贝斯虫抗体。微感染献血员中Rh D-的比例高于Rh D+的献血者(OR=1.2 2，P值0.024)。住院的RhD-巴贝斯虫病患者比RhD+患者更有可能出现高峰值寄生虫血症(p值0.017)，这是疾病严重程度的一个标志。东北地区和中西部地区的RhD+血型差异无统计学意义(OR=0.82，p值0.033)。总体而言，ABO血型与献血者B型感染无关，然而，B型微型感染献血者在缅因州和新泽西州与非B型献血者相比更有可能是B型血(OR2.49p=0.008和2.07p=0.009)，而来自宾夕法尼亚州的感染献血者与非B型献血者相比B型血感染的可能性较小(OR0.32p=0.02)。表达RhD抗原的人感染微小球虫的风险和巴贝斯虫病的严重程度可能会降低。B抗原与微小芽孢杆菌感染的相关性不太清楚，因为这种抗原在宾夕法尼亚州感染的献血者中似乎不太常见，但在缅因州和新泽西州感染的献血者中更常见。未来的研究应该量化微小巴贝斯虫基因型、红细胞抗原和微小巴贝斯虫感染的频率和严重程度之间的关系，以增加我们对人类巴贝斯虫发病机制的了解，并改进抗体、疫苗和红细胞交换输血策略。我们发现微小巴贝斯虫感染与红细胞RhD和B抗原有关。许多研究已经量化了ABO血型对恶性疟原虫(PF)感染的影响，恶性疟原虫是一种与巴贝斯虫同属一个尖端复合门的红细胞内病原体。例如，人们注意到O型血可以预防严重的疟疾，这可能解释了为什么O型血在肺结核病流行地区盛行。缺乏对ABO和RhD血型以及微小球虫感染的研究。美国红十字会有一个来自微小杆菌流行州的大型献血者数据库，可以用来研究ABO和RhD血型如何与微小杆菌感染有关，这是通过微小杆菌18S rRNA的存在来衡量的。来自10个微结核杆菌流行州的数据显示，微结核杆菌感染的献血者患RhD+的可能性显著低于RhD-献血者(OR0.82，p值0.024)。耶鲁大学纽黑文医院2011年至2021年间收治的巴贝斯虫病患者的回顾显示，RhD+患者的寄生虫血症峰值(>；5%)明显低于RhD-患者(p=0.017)，这与疾病的严重程度相关。因此，红细胞膜上的RhD抗原可以降低微小球虫感染的风险和疾病的严重程度。B型血型抗原可能影响微小球虫感染的频率。在缅因州和新泽西州，B型血献血者微小杆菌感染与非B型血的优势比(OR)分别为2.49(p=0.008)和2.07(p=0.009)，而宾夕法尼亚州则为0.32(p=0.02)。未来的研究应该量化RhD、ABO和其他红细胞抗原对巴贝斯虫感染的影响，以及它们影响红细胞侵袭和巴贝斯虫病严重程度的机制。
Babesiosis is an emerging infectious disease caused by intraerythrocytic Babesia parasites that can cause severe disease and death. While blood type is known to affect the mortality of Plasmodium falciparum malaria patients, associations between red blood cell (RBC) antigens and Babesia microti infection and disease severity are lacking. We evaluated RhD and ABO blood types of Babesia-infected (18S rRNA reactive) blood donors in 10 endemic states in the Northeastern and northern Midwestern United States. We also assessed possible associations between RhD and ABO blood types and disease severity among hospitalized babesiosis patients in Connecticut. A total of 768 Babesia-infected blood donors were analyzed, of which 750 (97.7%) had detectable B. microti-specific antibodies. B. microti-infected blood donors were more likely to be RhD- (OR of 1.22, p-value 0.024) than RhD+ donors. Hospitalized RhD- babesiosis patients were more likely than RhD+ patients to have high peak parasitemia (p-value 0.017), which is a marker for disease severity. No differences in RhD+ blood type were noted between residents of the Northeast (OR of 0.82, p-value 0.033) and the Midwest (OR of 0.74, p-value 0.23). Overall, ABO blood type was not associated with blood donor B. microti infection, however, B. microti-infected donors in Maine and New Jersey were more likely to be blood type B compared to non-type B (OR 2.49 [p = 0.008] and 2.07 [p = 0.009], respectively), while infected donors from Pennsylvania were less likely to be type B compared to non-type B (OR 0.32 [p = 0.02]). People expressing RhD antigen may have a decreased risk of B. microti infection and babesiosis severity. The association of B antigen with B. microti infection is less clear because the antigen appeared to be less prevalent in infected Pennsylvania blood donors but more prevalent in Maine and New Jersey infected donors. Future studies should quantify associations between B. microti genotypes, RBC antigens, and the frequency and severity of B. microti infection to increase our understanding of human Babesia pathogenesis and improve antibody, vaccine, and RBC exchange transfusion strategies. We found an association between Babesia microti infection and both red blood cell RhD and B antigens. Numerous studies have quantified the impact of ABO blood type on Plasmodium falciparum (Pf) infection, an intraerythrocytic pathogen in the same Apicomplexa phylum as Babesia. For example, type O blood has been noted to protect against severe malaria, which may explain why type O is prevalent in Pf-endemic regions. Studies of ABO and RhD blood types and B. microti infection are lacking. The American Red Cross has a large blood donor dataset from B. microti-endemic states that can be used to study how ABO and RhD blood types are linked to B. microti infection, as measured by the presence of B. microti 18S rRNA. Data from 10 B. microti-endemic states showed that B. microti-infected blood donors were significantly less likely to be RhD+ (OR 0.82, p-value 0.024) than RhD- donors. A review of babesiosis patients admitted to Yale New Haven Hospital between 2011 and 2021 revealed that RhD+ patients were significantly less likely than RhD- patients to have a high (>5%) peak parasitemia (p = 0.017), which correlates with disease severity. Thus, the RhD antigen on the RBC membrane may decrease the risk of B. microti infection and disease severity. The blood type B antigen may affect the frequency of B. microti infection. The odds ratios (ORs) of B. microti infection in blood donors for blood type B compared to non-type B were 2.49 (p = 0.008) in Maine and 2.07 (p = 0.009) in New Jersey, but 0.32 (p = 0.02) in Pennsylvania. Future studies should quantify the impact of RhD, ABO, and other RBC antigens on Babesia infection, and the mechanisms by which they impact RBC invasion and babesiosis severity.