Seroprevalence of Babesia infections in humans exposed to ticks in midwestern Germany
Seroprevalence of Babesia infections in humans exposed to ticks in midwestern Germany
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DOI：
10.1128/jcm.40.7.2431-2436.2002
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发表时间：
2002-07-01
影响因子：
9.4
通讯作者：
Tenter, AM
中科院分区：
文献类型：
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作者：
Hunfeld, KP;Lambert, A;Tenter, AM
巴贝虫病被认为是全世界人类中一种新出现的蜱传疾病。然而，迄今为止，大多数关于人类巴贝斯虫病流行病学的研究都是在北美进行的，而对其他地区的感染流行情况和发病频率知之甚少。本研究的目的是调查德国人群中巴贝虫感染的患病率。通过间接荧光抗体（IFA）测试，对1999年5月至10月期间从莱茵-美因地区居住者收集的总共467份血清进行了针对田鼠巴贝虫和分歧巴贝虫抗原的免疫球蛋白G（IgG）和IgM抗体的存在检测。这些血清来自 84 名患有游走性红斑的莱姆疏螺旋体病患者、60 名疏螺旋体病血清学阳性的无症状个体以及 81 名有蜱虫叮咬史的个体。 IFA 测试中区分血清阴性和血清阳性结果的临界值是使用 120 名健康献血者和 122 名患有蜱传疾病以外疾病的患者（疟疾，n = 40；弓形虫病，n = 22；梅毒，n = 20；EB 病毒感染，n = 20；存在抗核抗体，n = 20）的血清确定的。 IFA 测试对田鼠和分歧芽孢杆菌的总体特异性估计大于或等于 97.5%。与健康献血者组（120 人中的 2 人；1.7%）相比，暴露于蜱的患者组（225 人中的 26 人；11.5%）中检测到针对田鼠小蜱抗原（滴度，大于或等于 1:64）或分歧芽孢杆菌抗原（滴度，= 大于或等于 1:128）的阳性 IgG 反应的频率显着更高（P < 0.05）。与对照组（242 人中的 1 人）相比，接触蜱的患者（225 人中的 9 人）中发现针对至少一种巴贝氏菌抗原的 IgG 抗体滴度大于或等于 1:256 的频率显着更高（P < 0.05）。在此调查的人群中，田鼠小杆菌和分歧芽孢杆菌的总体血清流行率分别为 5.4%（467 人中的 25 人）和 3.6%（467 人中的 17 人）。这里获得的结果为德国中西部接触蜱虫的人类同时感染伯氏疏螺旋体和巴贝虫提供了证据。他们还建议，德国人群中巴贝虫属的感染比之前认为的更为频繁，在鉴别诊断接触蜱虫或输血后发生的发热性疾病时应予以考虑，特别是在免疫功能低下的患者中。
Babesiosis is considered to be an emerging tick-borne disease in humans worldwide. However, most studies on the epidemiology of human babesiosis to date have been carried out in North America, and there is little knowledge on the prevalence of infection and frequency of disease in other areas. The aim of this study was to investigate the prevalence of Babesia infections in a human population in Germany. A total of 467 sera collected between May and October 1999 from individuals living in the Rhein-Main area were tested for the presence of immunoglobulin G (IgG) and IgM antibodies to antigens of Babesia microti and Babesia divergens by indirect fluorescent-antibody (IFA) tests. These sera were derived from 84 Lyme borreliosis patients suffering from erythema migrans, 60 asymptomatic individuals with positive borreliosis serology, and 81 individuals with a history of tick bite. Cutoff values for discrimination between seronegative and seropositive results in the IFA tests were determined using sera from 120 healthy blood donors and 122 patients suffering from conditions other than tick-borne diseases (malaria, n = 40; toxoplasmosis, n = 22; syphilis, n = 20; Epstein-Barr virus infection, n = 20; and presence of antinuclear antibodies, n = 20). The overall specificities of the IFA tests for B. microti and B. divergens were estimated to be greater than or equal to97.5%. Positive IgG reactivity against B. microti antigen (titer, greater than or equal to1:64) or B. divergens antigen (titer, = greater than or equal to1:128) was detected significantly more often (P < 0.05) in the group of patients exposed to ticks (26 of 225 individuals; 11.5%) than in the group of healthy blood donors (2 of 120 individuals; 1.7%). IgG antibody titers of greater than or equal to1:256 against at least one of the babesial antigens were found significantly more often (P < 0.05) in patients exposed to ticks (9 of 225) than in the control groups (1 of 242). In the human population investigated here, the overall seroprevalences for B. microti and B. divergens were 5.4% (25 of 467) and 3.6% (17 of 467), respectively. The results obtained here provide evidence for concurrent infections with Borrelia burgdorferi and Babesia species in humans exposed to ticks in midwestern Germany. They also suggest that infections with Babesia species in the German human population are more frequent than believed previously and should be considered in the differential diagnosis of febrile illness occurring after exposure to ticks or blood transfusions, in particular in immunocompromised patients.