Coinfección de babesiosis y ehrlichiosis: un caso en Cartagena de indias, Colombia
Coinfección de babesiosis y ehrlichiosis: un caso en Cartagena de indias, Colombia
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Introducción: múltiples son las entidades transmitidas por garrapatas, una de ellas es la babesiosis, entidad producida por especies de hemoparásitos que producen en el huésped humano hemolisis secundaria a la invasión parasitaria. Otra de las entidades es la ehrlichiosis, caracterizada por la infección de microorganismos intracelulares cuyos síntomas hacen parte del espectro de un cuadro febril.
Caso clínico: paciente procedente de área rural, con historia de exposición a ixodoideos (garrapatas) de forma permanente. Ingresa cursando signos de respuesta inflamatoria sistémica, síntomas constitucionales y fiebre de predominio vespertino.
Hepatomegalia y adenomegalias en región supraclavicular. Con impresión clínica de cuadro febril prolongado y anemia hemolítica, se solicita extendido de sangre periférica para hemoparásitos. Reporte positivo para dos especies: Babesia spp. y Ehrlichia spp., fueron visualizadas por tinción de Giemsa-Whright. Se realizó tratamiento con doxiciclina, clindamicina y quinina, con buena evolución clínica. No se presentaron complicaciones.
Conclusiones: este es el primer caso de coinfección conocido de la región Caribe colombiana. El diagnóstico se sospechó debido a la importancia dada a los antecedentes epidemiológicos, a la historia de exposición a ixódidos y a la clínica de síndrome febril persistente. Este, se realizó bajo técnica de microscopía por tinción de Wrihgt-Giemsa y el resultado, tras el tratamiento antibiótico conjugado, fue exitoso. Rev.Cienc.Biomed. 2012;3(2): 339-345
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Vannier E, Krause P. Human babesiosis. N Engl J Med. 2012;366:2397-407.
Skrabalo Z, Deanovic Z, Piroplasmosis in man: report of a case. Doc Med Geogr Trop. 1957;9(1):11–16.
Rios L, Alvarez G, Blair S. Serological and parasitological study and report of the first case of human babesiosis in Colombia. Rev Soc Bras Med Trop. 2003;36(4):493- 498.
Vannier E, Gewurz BE, Krause PJ. Human babesiosis. Infect Dis Clin North Am. 2008;22(3):469–488.
Swanson SJ, Neitzel D, Reed KD, Belongia EA. Coinfections acquired from ixodes ticks. Clin Microbiol Rev. 2006;19(4):708–727.
Grunwaldt E, Barbour AG, Benach JL. Simultaneous occurrence of babesiosis and Lyme disease. N Engl J Med. 1983;308:1166-1168.
Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis- United States: a
practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. 2006;55(RR-4):1–27.
Foppa IM, Krause PJ, Spielman A, et al. Entomologic and serologic evidence of zoonotic transmission of Babesia microti, eastern Switzerland. Emerg Infect Dis, 2008;8(7):722–726.
Chauvin A, Moureau E. Babesia and its hosts: adaptation to long-lasting interactions as a way to achieve efficient transmission. Vet. Res. 2009;40(2):37.
Hunfeld KP, Hildebrandt A, Gray JS. Babesiosis: recent insights into an ancient disease. Int J Parasitol. 2008;38(11):1219–1237.
Krause PJ, Spielman A, Telford SR 3rd, et al. Persistent parasitemia after acute babesiosis. N Engl J Med. 1998;339:160–165.
Hatcher JC, Greenberg PD, Antique J, Jiménez-Lucho VE. Severe babesiosis in Long Island: review of 34 cases and their complications. Clin Infect Dis. 2001;32(8):1117–1125.
Martinot M, Zadeh MM, Hansmann Y, et al. Babesiosis in Immunocompetent Patients, Europe. Emerg Infect Dis. 2011;17(1):114–116.
Rosner F, Zarrabi MH, Benach JL, Habicht GS. Babesiosis in splenectomized adults: review of 22 reported cases. Am J Med. 1984;76(4):696–701.
Shih CM, Liu LP, Chung WC, et al. Human babesiosis in Taiwan: asymptomatic infection with a Babesia microti-like organism in a Taiwanese woman. J Clin Microbiol. 1997;35(2):450–454.
Healy GR, Ruebush TK. Morphology of Babesia microti in human blood smears. Am J Clin Pathol. 1980;73(1):107–109.
Krause PJ, Telford SR, Spielman A, et al. Comparison of PCR with blood smear and inoculation of small animals for diagnosis of Babesia microti parasitemia. J Clin Microbiol. 1996;34(11):2791–
Krause PJ, Ryan R, Telford SR, et al. Efficacy of immunoglobulin M serodiagnostic test for rapid diagnosis of acute babesiosis. J Clin Microbiol. 1996;34(8):2014–2016.
Krause PJ, Telford SR, Ryan R, et al. Diagnosis of babesiosis: evaluation of a serologic test for the detection of Babesia microti antibody. J Infect Dis. 1994;169(4):923–926.
Horowitz RI. Chronic Persistent Babesiosis After Acute Treatment with Cleocin and Quinine, and Atovaquone and Azithromycin, Abstract, Presented at: 12th International Scientific Conference on Lyme Disease and Other Spirochetal Disorders. NYC. 1999.
Tonnetti L, Proctor MC, Reddy HL, Goodrich RP, Leiby DA. Evaluation of the Mirasol pathogen [corrected] reduction technology system against Babesia microti in apheresis platelets and plasma. Transfusion. 2010;50(5):1019-1027.
Wormser GP, Prasad A, Neuhaus E, et al. Emergence of resistance to Azithromycin-Atovaquone in immunocompromised patients with babesia microti Infection. Clin Infect Dis. 2010;50(3):381–386.
Dumler JS, Barbet AF, Bekker CP, et al. Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales: Unification of some species of Ehrlichia with
Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and ‘HE agent’ as subjective synonyms of Ehrlichia phagocytophila. Int J Syst Evol Microbiol. 2001;51(Pt 6):2145–65.
Dedonder SE, Cheng C, Willard LH, Boyle DL, Ganta RR. Transmission Electron Microscopy Reveals Distinct Macrophage- and Tick Cell-Specific Morphological Stages of Ehrlichia chaffeensis. PLoS One. 2012;7(5):e36749.
Dumler JS, Choi KS, Garcia-Garcia JC, et al. Human granulocytic anaplasmosis and Anaplasma phagocytophilum. Emerg Infect Dis. 2005;11(12):1828–1834.
Stone JH, Dierberg K, Aram G, Dumler JS. Human monocytic Ehrlichiosis. JAMA. 2004;292(18):2263–2270.
Olano JP, Masters E, Hogrefe W, Walker DH. Human monocytotropic ehrlichiosis, Missouri. Emerg Infect Dis, 2003;9(12):1579–1586.
Demma LJ, Holman RC, McQuiston JH, et al. Epidemiology of human ehrlichiosis and anaplasmosis in the United States, 2001–2002. Am J Trop Med Hyg. 2005;73(2):400–409.
Paddock CD, Folk SM, Shore GM, et al. Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus. Clin Infect Dis. 2001;33(9):1586–
Bakken JS, Dumler JS. Human granulocytic Ehrlichiosis. Clin Infect Dis. 2000;31(2):554–560.
Dumbler JS, Madigan JE, Pusterla N, Bakken JS. Ehrlichioses in humans: epidemiology clinical presentation, diagnosis and treatment. Clin Infect Dis. 2007;45 (supl 2):s45-s51.
Bakken JS, Dumler JS. Clinical diagnosis and treatment of human granulocytotropic anaplasmosis. Ann N Y Acad Sci. 2006;1078:236–247.
Horowitz HW, Aguero-Rosenfeld ME, McKenna DF, et al. Clinical and laboratory spectrum of culture-proven human granulocytic ehrlichiosis: comparison with culture-negative cases. Clin
Infect Dis. 1998;27(5):1314–1317.
Goodman JL. Human granulocytic anaplasmosis. In: Goodman JL, Dennis DT, Sonenshine DE (eds), Tick-Borne Diseases of Humans, Washington, DC: ASM Press, 2005: 218–238.
Dawson JE, Ewing SA, Davidson WR. Human monocytotrophic Ehrlichiosis. In: Goodman JL, Dennis DT, Sonenshine DE (eds), Tick-Borne Diseases of Humans, Washington, DC: ASM Press,
: 239–257.
Standaert SM, Yu T, Scott MA, et al. Primary isolation of Ehrlichia chaffeensis from patients with febrile illnesses: clinical and molecular characteristics. J Infect Dis. 2000;181(3):1082–1088.
Horowitz HW, Kilchevsky E, Haber S, et al. Perinatal transmission of the agent of human granulocytic Ehrlichiosis. N Engl J Med. 1998;339(6):375–378.
Bakken JS, Haller I, Riddell D, et al. The serological response of patients infected with the agent of human granulocytic Ehrlichiosis. Clin Infect Dis. 2002;34(1):22–27.
Thomas RJ, Dumbler JS, Carlyon JA. Nulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Current management of human granulocytic Ehrlichiosis. Expert
Rev Anti Infect Ther. 2009;7(6):709–722.
Skotarczak B, Adamska M, Rymaszewska A, Suproń M, Sawczuk M, Maciejewska A. Anaplasma phagocytophila and protozoans of Babesia genus in dogs from endemic areas of Lyme disease in north-western Poland. Wiad Parazytol. 2004;50(3):555-561.
Krause P, Telford S, Spielman A, et al., Concurrent Lyme disease and babesiosis: evidence for increased severity and duration of illness. JAMA, 1996;275:1657–1660.
