Ssentongo Paddy, Venugopal Natasha, Zhang Yue, Chinchilli Vernon M, Ba Djibril M
Division of Infectious Diseases and Epidemiology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Open Forum Infect Dis. 2024 Oct 8;11(10):ofae504. doi: 10.1093/ofid/ofae504. eCollection 2024 Oct.
The prevalence of coinfecting tick-borne zoonoses and mortality outcomes are not fully elucidated. The objective of the present study was to determine babesiosis coinfection prevalence rates and estimate the association with severe disease and mortality.
We queried the TriNetX database between 2015 and 2022 for patients with babesiosis. The prevalence of coinfecting tick-borne zoonoses was estimated. The analysis focused on babesiosis coinfection with , ehrlichiosis, and anaplasmosis. The exposure was coinfection, and the control group was the -only group. The primary outcome was 90-day mortality from the diagnosis of . Secondary outcomes were prevalence of coinfection, association of coinfection with acute respiratory distress syndrome, multiorgan failure, and disseminated intravascular coagulation. A multivariable logistic regression model was employed to estimate the disease severity and mortality risk associated with coinfections.
Of the 3521 patients infected with , the mean age (SD) was 56 (18) years, 51% were male, and 78% were White. The frequency of overall malignancies, lymphomas, and asplenia was 19%, 2%, and 2%, respectively. Temporal distribution of coinfections followed the overall babesiosis pattern, peaking in the summer months. The prevalence of 1 or more coinfections was 42% (95% CI, 40%-43%). The rate of coinfection with was the highest at 41% (95% CI, 39%-42%), followed by ehrlichiosis at 3.7% (95% CI, 3.1%-4.4%) and anaplasmosis at only 0.3% (95% CI, 0.2%-0.6%). Doxycycline was more likely to be prescribed in the coinfection group than the -only group (25% vs 18%; < .0001). Overall, 90-day mortality was 1.4% (95% CI, 1.0%-1.8%). After adjusting for potential confounding factors, compared with the babesiosis-only group, the likelihood of 90-day mortality was lower in the coinfection group (adjusted odds ratio, 0.43; 95% CI, 0.20-0.91). Severe disease did not differ significantly between the 2 groups.
In this extensive study of >3000 patients with babesiosis in the United States, 4 in 10 patients had coinfecting tick-borne zoonoses. The prevalence rates of coinfection were highest with followed by ehrlichiosis, and lowest with anaplasmosis. Coinfection with other tick-borne infections was not associated with severe disease. It is plausible that this finding is due to the likelihood of treatment of coinfections with doxycycline. Future studies are needed to investigate the possible therapeutic benefits of doxycycline in babesiosis patients as, to date, no trials with doxycycline have been conducted in human patients with infections.
蜱传人畜共患病的合并感染患病率及死亡结局尚未完全阐明。本研究的目的是确定巴贝斯虫病合并感染的患病率，并评估其与严重疾病和死亡的关联。
我们在2015年至2022年间查询了TriNetX数据库中的巴贝斯虫病患者。估算了蜱传人畜共患病合并感染的患病率。分析重点为巴贝斯虫病与埃立克体病、无形体病的合并感染情况。暴露因素为合并感染，对照组为仅感染巴贝斯虫病的组。主要结局是自巴贝斯虫病诊断起90天内的死亡率。次要结局包括合并感染的患病率、合并感染与急性呼吸窘迫综合征、多器官功能衰竭及弥散性血管内凝血的关联。采用多变量逻辑回归模型来评估与合并感染相关的疾病严重程度及死亡风险。
在3521例感染巴贝斯虫病的患者中，平均年龄（标准差）为56（18）岁，51%为男性，78%为白人。总体恶性肿瘤、淋巴瘤和无脾症的发生率分别为19%、2%和2%。合并感染的时间分布与总体巴贝斯虫病模式一致，在夏季达到高峰。一种或多种合并感染的患病率为42%（95%置信区间，40%-43%）。与巴贝斯虫病合并感染的比率最高，为41%（95%置信区间，39%-42%），其次是埃立克体病，为3.7%（95%置信区间，3.1%-4.4%），无形体病仅为0.3%（95%置信区间，0.2%-0.6%）。与仅感染巴贝斯虫病的组相比，合并感染组更有可能使用多西环素治疗（25%对18%；P<0.0001）。总体而言，90天死亡率为1.4%（95%置信区间，1.0%-1.8%）。在调整潜在混杂因素后，与仅感染巴贝斯虫病的组相比，合并感染组90天死亡的可能性较低（调整后的优势比，0.43；95%置信区间，0.20-0.91）。两组之间的严重疾病差异无统计学意义。
在这项对美国3000多名巴贝斯虫病患者的广泛研究中，十分之四的患者感染了蜱传人畜共患病。合并感染的患病率以巴贝斯虫病最高，其次是埃立克体病，无形体病最低。与其他蜱传感染的合并感染与严重疾病无关。这一发现可能是由于多西环素治疗合并感染的可能性。未来需要开展研究，以调查多西环素对巴贝斯虫病患者可能的治疗益处，因为迄今为止尚未在感染巴贝斯虫病的人类患者中进行过多西环素试验。
