is believed to infect only red blood cells, further research may include investigation of the possibility of alternative sites of infection during various stages in the pathogen life cycle. Neurologic manifestations of Babesia, such as coma, have not been shown to be the result of Babesia infection of neuronal tissue and may occur because of electrolyte imbalance or other side effects of the overall infection.

The disease severity of Babesia duncani and its implication for treatment was another topic of discussion. In response to a participant’s question, Krause indicated that B. duncani infections that have been reported have been more severe than B. microti infections (Persing et al., 1995). He added that although it is generally true that initially the most critical manifestations of a disease receive the most attention, there is evidence in a hamster model that B. duncani is a significantly more severe disease than B. microti is (Wozniak et al., 1996). Krause advocated aggressive treatment for patients diagnosed with B. duncani, including the possibility of exchange transfusion to replace infected red blood cells and remove toxic by-products of infection.

Finally, one participant asked whether there may be some utility in investigating antibiotic alternatives to cure Babesia. Krause indicated that there is limited evidence that the anti-malarial drug Artemisinin may be useful in clearing a babesial infection, but that more research is needed to determine the effectiveness of this and other alternative therapies, including new drugs and herbal remedies (Krause et al., 2008).

Concluding Thoughts on Surveillance, Spectrum, and Burden of Tick-Borne Disease, and At-Risk Populations

Gordon Schutze, M.D., Baylor College of Medicine

Creating a repository for specimens of blood and cerebrospinal fluid from patients with tick-borne diseases can improve the accuracy of diagnostic tests and disease diagnosis. Such a repository needs to include demographic information on patients and information on their diagnosis, treatment, and outcome. A well-funded network of researchers investigating tick-borne diseases could maintain such a repository, which also would enable them to advance knowledge of these diseases.

Clinicians clearly need new methods for diagnosing tick-borne diseases, given the genetic diversity among different strains of a pathogen (e.g., Borrelia burgdoferi) and the realization that new species may be responsible for a larger burden of disease than previously recognized (e.g., Rickettsia parkeri in spotted fever rickettsiosis). Clinicians also need better tests to accurately differentiate between patients with acute tick-borne illness and those previously infected with tick-borne disease.

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