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Infections after tick-bites in transplanted patients: Borreliosis and Babesiosis
M
Int.J. Med.Microbiol.291, Suppl. 33, 227 (2002) © Urban & FischerVerlag http://www.urbanfischer.de/journalslijmm
Abstract Infections after tick-bites in transplanted patients: Borreliosis and Babesiosis D.Habedank 1*, B.Habedank 2 I
2
German Heart Institute, Berlin, Germany Institute of Parasitology and International Animal Health, Free University Berlin, Germany
Organ transplantation has led to a population of chronically immunosuppressed people. On the one hand organ transplantation enables them to lead an active life style including outdoor activities but on the other hand there is a higher susceptibility to tick -borne zoonoses. Immunodeficiency may permit more severe and chronic infections. To date, two cases of tick-borne diseases have been reported in renal transplant recipients: One patient acquired the hemophagocytic syndrome and pancytopenia after infection with Babesia microti, a nd another patient developed a severe neuroborreliosis caused by Borrelia burgdorferi. In addiron, there is a new case of Lyme carditis after heart transplantation to report. Diagnosis was confirmed by serological markers, indirectly by histopathology and retrospecti vely by tr eatment succe ss.
Therapy contained i. v. ceftriaxon and long-time oral doxycycline and led to incomplete resolution. The application of cyclosporine and azathioprin to transplanted patients led to chronical depletion in T cells, with uncertain influence on CD4 +or CD8+ cells. Different effects of CD4+ and CD8+ cells in Lyme carditis have to be assumed. Furthermore, B-cell activation during a T-cellindependent response may be critical for resolution of arthritis and carditis. Epidemiological, serol ogical, histological and tre atment aspects of borrcliosis and babesiosis are discussed , with speci al focus on immunological effects in immunodeficient pati ents. Due to T cell depl etion, an elevated risk of tick -borne infections in transplanted patients is assumed , and early treatment is dem anded.
* Corresponding author: Birgit Habcdnnk, Freie Universirar Berlin, Insr. f. Parasitologic und Int.Tiergesundh eir, Konigsweg67, D-14163 Berlin,German)' 1438-4221/011291/8-000 S 15.00/0
Int.J. Med.Microbiol.291, Suppl. 33, 227 (2002) © Urban & FischerVerlag http://www.urbanfischer.de/journalslijmm
Abstract Infections after tick-bites in transplanted patients: Borreliosis and Babesiosis D.Habedank 1*, B.Habedank 2 I
2
German Heart Institute, Berlin, Germany Institute of Parasitology and International Animal Health, Free University Berlin, Germany
Organ transplantation has led to a population of chronically immunosuppressed people. On the one hand organ transplantation enables them to lead an active life style including outdoor activities but on the other hand there is a higher susceptibility to tick -borne zoonoses. Immunodeficiency may permit more severe and chronic infections. To date, two cases of tick-borne diseases have been reported in renal transplant recipients: One patient acquired the hemophagocytic syndrome and pancytopenia after infection with Babesia microti, a nd another patient developed a severe neuroborreliosis caused by Borrelia burgdorferi. In addiron, there is a new case of Lyme carditis after heart transplantation to report. Diagnosis was confirmed by serological markers, indirectly by histopathology and retrospecti vely by tr eatment succe ss.
Therapy contained i. v. ceftriaxon and long-time oral doxycycline and led to incomplete resolution. The application of cyclosporine and azathioprin to transplanted patients led to chronical depletion in T cells, with uncertain influence on CD4 +or CD8+ cells. Different effects of CD4+ and CD8+ cells in Lyme carditis have to be assumed. Furthermore, B-cell activation during a T-cellindependent response may be critical for resolution of arthritis and carditis. Epidemiological, serol ogical, histological and tre atment aspects of borrcliosis and babesiosis are discussed , with speci al focus on immunological effects in immunodeficient pati ents. Due to T cell depl etion, an elevated risk of tick -borne infections in transplanted patients is assumed , and early treatment is dem anded.
* Corresponding author: Birgit Habcdnnk, Freie Universirar Berlin, Insr. f. Parasitologic und Int.Tiergesundh eir, Konigsweg67, D-14163 Berlin,German)' 1438-4221/011291/8-000 S 15.00/0