Babesiosis

Abstract

Babesiosis is a tick-borne disease that may be deadly under certain conditions. Occupational health nurses should teach workers about the disease and the importance of prevention strategies.

Babesiosis is a tick-borne disease caused by Babesia microti parasites that infect red blood cells (RBCs) (Centers for Disease Control and Prevention [CDC], 2019). Occupational health nurses need to understand the potential severity of this disease and prevention strategies for babesiosis. The causative agent is small, and workers may be unaware of a bite unless they routinely inspect for ticks after being outdoors. Most are asymptomatic, but the disease can trigger a life-threatening reaction for immunocompromised, elderly, or asplenic individuals (Gray, 2019). Congenital transmission has occurred (CDC, 2019).

In the United States, blacklegged and deer ticks spread babesiosis, which is most prevalent in the Northeast and Upper Midwest; sporadic cases occur along the West Coast (CDC, 2019). Outdoor workers at jobsites with woods, bushes, tall grass, or leaf litter or those taking part in outdoor activities such as gardening, hiking, or camping are most at risk. Gray and Herwaldt (2019) reported 7,612 cases of babesiosis in 27 states during a 2011–2015 surveillance period; the median age affected was 63 years, and half of those infected required hospitalization, most often from an asplenic condition. Impaired immune function (e.g., corticosteroids, chemotherapy, or HIV) increases risk for adverse health outcomes (CDC, 2018). Individuals infected with babesiosis cannot donate blood (CDC, 2018). Gray and Herwaldt (2019) reported fifty-one cases were found among recipients of blood transfusions, but now there is a B. microti screening test for blood (CDC, 2019).

The incubation period for babesiosis is 1 to 9 weeks; signs and symptoms include sweats, malaise, fever, headache, arthralgia, dark urine, sore throat, jaundice, splenomegaly, or hepatomegaly (CDC, 2019). Laboratory results may show decreased hematocrit including hemolytic anemia (from destruction of RBCs) and elevated serum creatine, blood urea nitrogen, or hepatic transaminase. Diagnosis is done through the identification of intraerythrocytic Babesia parasites by light-microscopic examination of a peripheral blood smear, positive Babesia (or B. microti) polymerase chain reaction (PCR) analysis, or isolation of Babesia parasites from a whole blood specimen by animal inoculation (in a reference laboratory) (CDC, 2019). Although indirect fluorescent antibody (IFA) testing for total immunoglobulin (Ig) or IgG can help with the diagnosis, it is unreliable in distinguishing prior infections from active infections.

Occupational health nurses can apply the levels of prevention and help workers protect themselves from this disease. Primary prevention strategies raise awareness about babesiosis and ways to prevent exposure to the disease-causing ticks. The Occupational health nurses should target all workers but specifically those at increased risk of infection or who could become pregnant. There is no vaccine against babesiosis (CDC, 2018). Inform workers to follow these guidelines when in tick habitats: walk on clear trails, sidewalks, or roads, preferably in the path’s center to avoid tick bites. Minimize exposure by wearing long sleeved shirts and long pants tucked in socks; light-colored clothing allows better visualization of the tiny ticks. Apply repellents such as DEET (N,N-diethylmetatoluamide) to skin and clothing. Apply permethrin products to clothes or boots and avoid contacting skin; wash hands well after application of all repellents. Secondary prevention relies on screening for ticks or symptoms of babesiosis. After potential exposures, perform a full-body tick check. Remove ticks by grasping the head with fine-tipped tweezers and pulling straight out; ticks can attach to clothes or skin for more than 36 to 48 hours (CDC, 2018). Tertiary prevention includes antibiotic therapy for 7 to 10 days with atovaquone (750 mg orally twice daily) plus azithromycin (dosages can range from 250 to 1,000 mg); severely ill individuals are treated with clindamycin (600 mg orally 3 times daily) plus quinine (600 mg orally 3 times daily) (CDC, 2019). Remember babesiosis may be difficult to recognize because of nonspecific clinical manifestations. Workers and occupational health nurses need a high index of suspicion if tick bites are a possibility.