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. 2023 Jan 25;17(1):e0011060.
doi: 10.1371/journal.pntd.0011060. eCollection 2023 Jan.

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

Ryan Philip Jajosky  1   2 , Jane O'Bryan  3   4 , Anne Spichler-Moffarah  3 , Philip G Jajosky  2 , Peter J Krause  3 , Laura Tonnetti  5
Affiliations

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

Ryan Philip Jajosky et al. PLoS Negl Trop Dis. .

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.

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Conflict of interest statement

We have read the journal’s policy and the authors of this manuscript have the following competing interests. P.J.K. reports payments made to him for a chapter that addresses the modalities available for treatment of human babesiosis in UpToDate, Inc, and serving on the Board of Directors for the American Lyme Disease Foundation (received no monetary compensation). R.P.J. is CEO and part owner of Biconcavity Inc. (biotechnology research and development company exploring drug-linked-erythrocytes). P.G.J. is CMO and part owner of Biconcavity Inc. (biotechnology research and development company exploring drug-linked-erythrocytes). J.O’B, A.S-M, and L.T. have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The association of Babesia-reactive blood donors with blood type RhD+ compared to RhD-.
The associations were statistically significant (p<0.05) in the Northeast and the combined Northeast and Midwest using a chi-square test. This map was cropped from a public domain version created by Brian Szymanski found at Wikimedia Commons website https://commons.wikimedia.org/wiki/File:Usa-state-boundaries-lower48%2B2.png.
Fig 2
Fig 2. The association of Babesia-reactive blood donors with blood type B compared to non-type B.
The associations were statistically significant (p<0.05) for PA, NJ, and ME using a chi-square test. This map was cropped from a public domain version created by Brian Szymanski found at Wikimedia Commons website https://commons.wikimedia.org/wiki/File:Usa-state-boundaries-lower48%2B2.png.
Fig 3
Fig 3. Peak parasitemia percentages in babesiosis patients at Yale New Haven Hospital by RhD blood type.
The p-value for Fisher’s exact test was 0.017, indicating a significant association between peak parasitemia and RhD- blood type.
See this image and copyright information in PMC

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