The impact of ABO and RhD blood types on Babesia microti infection

Abstract

Background Babesiosis is an emerging infectious disease caused by intraerythrocytic Babesia parasites that can cause severe disease and death. While blood type is known to affect the mortality of Plasmodium falciparum malaria patients, associations between red blood cell (RBC) antigens and Babesia microti infection and disease severity are lacking. Methods We evaluated RhD and ABO blood types of Babesia-infected (18S rRNA reactive) blood donors in 10 endemic states in the Northeastern and northern Midwestern United States. We also assessed possible associations between RhD and ABO blood types and disease severity among hospitalized babesiosis patients in Connecticut. Results A total of 768 Babesia-infected blood donors were analyzed, of which 750 (97.7%) had detectable B. microti-specific antibodies. B. microti-infected blood donors were more likely to be RhD- (OR of 1.22, p-value 0.024) than RhD+ donors. Hospitalized RhD- babesiosis patients were more likely than RhD+ patients to have high peak parasitemia (p-value 0.017), which is a marker for disease severity. No differences in RhD+ blood type were noted between residents of the Northeast (OR of 0.82, p-value 0.033) and the Midwest (OR of 0.74, p-value 0.23). Overall, ABO blood type was not associated with blood donor B. microti infection, however, B. microti-infected donors in Maine and New Jersey were more likely to be blood type B compared to non-type B (OR 2.49 [p = 0.008] and 2.07 [p = 0.009], respectively), while infected donors from Pennsylvania were less likely to be type B compared to non-type B (OR 0.32 [p = 0.02]). Conclusions People expressing RhD antigen may have a decreased risk of B. microti infection and babesiosis severity. The association of B antigen with B. microti infection is less clear because the antigen appeared to be less prevalent in infected Pennsylvania blood donors but more prevalent in Maine and New Jersey infected donors. Future studies should quantify associations between B. microti genotypes, RBC antigens, and the frequency and severity of B. microti infection to increase our understanding of human Babesia pathogenesis and improve antibody, vaccine, and RBC exchange transfusion strategies.

Babesia divergens Shows Equal Predilection for Human ABO Blood Types in an In Vitro Erythrocyte Preference Assay

“…Our results also suggest that any possible differences in the intrinsic nutrients between the ABO blood groups do not have any effects on the multiplication rate of the parasite. This study is in agreement with a recent clinical study on blood donors and patients admitted with B. microti infections, in which they could not find any association between ABO blood groups and risk of getting infected, having high peak parasitemias or intensive care unit admissions [ 17 ]. However, this same study found RhD+ individuals to be less susceptible to Babesia infection than RhD- individuals.…”

“…Whilst we investigated here for the first time the influence of ABO on Babesia invasion and multiplication parameters, there are numerous other blood group systems that are independently inherited but not routinely typed. Some of them have been implicated in other host–pathogen interactions, either as receptors or other susceptibility or resistance factors [ 17 , 39 , 40 ] and may constitute future targets of study. Documentation of the blood groups of babesiosis patients and any associated unique or severe reactions across different regions will also help to enhance our knowledge about the interactions of this important parasite with humans.…”

“…Such antibodies may complicate the ABO preference of mosquitoes or ticks, but the relationship between anti-α-gal antibodies and ABO blood group preference has not been demonstrated experimentally. A recent study, conducted in areas of the USA where B. microti is prevalent, found no association between ABO blood group in blood donors or patients and susceptibility to B. microti infection [ 17 ]. Currently, there is no information about the blood type preference of any of the Babesia species when studied on a cellular level grown in vitro, and no data on patients with B. divergens .…”