Assessing the risk of human granulocytic anaplasmosis and lyme borreliosis after a tick bite in Bavaria, Germany

Introduction: Human granulocytic anaplasmosis is a tick-borne disease with an increasing incidence associated with morbidity and mortality. Uncertainty remains whether a prophylactic dose of doxycycline is effective in prevention. Case Report: We present a case of an 80-year-old female with syncope, resultant facial trauma, and fever two weeks after a tick bite for which she received prophylaxis. Workup revealed anaplasmosis, and treatment led to symptomatic improvement. Conclusion: We review the presenting symptoms, laboratory findings, and treatment of anaplasmosis, as well as give caution about the limitations in prescribing a prophylactic dose of doxycycline following a tick bite.

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Bacterial tick-associated infections in Australia: current studies and future directions

Microbiology Australia ◽

10.1071/ma18063 ◽

2018 ◽

Vol 39 (4) ◽

pp. 200

Author(s):

Peter Irwin ◽

Siobhon Egan ◽

Telleasha Greay ◽

Charlotte Oskam

Keyword(s):

Northern Hemisphere ◽

Lyme Borreliosis ◽

High Throughput ◽

Diagnostic Methods ◽

Future Directions ◽

Human Granulocytic Anaplasmosis ◽

Boutonneuse Fever ◽

Granulocytic Anaplasmosis ◽

Tick Borne Encephalitis ◽

Shed Light

It may seem perplexing that there is any uncertainty in Australia about the existence of zoonotic tick-associated infections1–3. Outside this country, particularly in the northern hemisphere, tick-borne diseases such as human granulocytic anaplasmosis, babesiosis, Boutonneuse fever, ehrlichiosis, Lyme borreliosis, and tick-borne encephalitis, have well documented aetiologies, epidemiology, diagnostic methods, and treatments. Why is Australia different and what research is being conducted to address this issue? This article briefly addresses these questions and explains how high-throughput metagenomic analysis has started to shed light on bacterial microbiomes in Australian ticks, providing new data on the presence and distribution of potentially zoonotic microbial taxa.

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666. Human Granulocytic Anaplasmosis and Ehrlichiosis Presenting to an Upstate New York Emergency Department

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.673 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S241-S241

Author(s):

Michael Waxman ◽

Jennifer White ◽

Elizabeth M Dufort ◽

Abigale Eichelman ◽

Kathleen Stellrecht ◽

...

Keyword(s):

Emergency Department ◽

New York ◽

Medical Center ◽

Tick Bite ◽

Laboratory Findings ◽

Positive Polymerase Chain Reaction ◽

Human Granulocytic Anaplasmosis ◽

North East ◽

The North ◽

Granulocytic Anaplasmosis

Abstract Background Human granulocytic anaplasmosis (HGA) is an increasingly common tickborne infection in the North-East United States. Statewide incidence of human cases of anaplasmosis in New York (excluding New York City) increased 407% from 2010–2017, with a corresponding increase in Anaplasma phagocytophilum prevalence in ticks. While previous observational studies have described the clinical features of HGA, there has been little documentation of HGA diagnosed in the emergency department (ED) setting. Methods Demographic and clinical data were extracted from electronic records of cases with a positive polymerase chain reaction (PCR) for HGA or the closely related clinical entity ehrlichiosis from 2016 to 2017. HGA and ehrlichiosis PCR were performed by the Albany Medical Center laboratory on patients treated in the ED. Basic descriptive analyses were performed. Results During the 2-year period, there were 37 cases of PCR-positive HGA and four cases of PCR-positive ehrlichiosis treated in the ED. Electronic data were available for extraction for 40 of these cases. Mean age was 54 years old (range 7–94 years). Thirty-four (85%) patients presented with fever, and 9 (23%) reported a tick bite or tick exposure. Twenty-two (55%) patients had leukopenia; 32 (80%) thrombocytopenia; 26 (65%) hyponatremia; 24 (60%) elevated transaminases; 38 (95%) at least one of these laboratory abnormality; and 13 (33%) all four laboratory abnormalities. Twenty-four patients (60%) were given the empiric diagnosis of a tickborne illness upon disposition from the ED, with 19 (48%) patients admitted to the hospital. Conclusion To our knowledge, this study represents the first description of patients diagnosed with HGA (and ehrlichiosis) in the ED setting. Because of the inherent testing bias, further study is needed to establish the true ED prevalence of HGA in highly endemic regions. Notably, only 23% reported either a tick bite or tick exposure, highlighting the need to consider this for diagnosis in patients presenting to the ED with consistent symptoms and laboratory findings in endemic areas. Further study might explore whether there exists a collection of laboratory findings that could accurately identify HGA in ED patients. Disclosures All authors: No reported disclosures.

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Case Report: Polymerase Chain Reaction Testing of Tick Bite Site Samples for the Diagnosis of Human Granulocytic Anaplasmosis

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.16-0570 ◽

2017 ◽

Vol 97 (2) ◽

pp. 403-406 ◽

Cited By ~ 5

Author(s):

Choon-Mee Kim ◽

Na-Ra Yoon ◽

Seung Hun Lee ◽

Piyush Jha ◽

Seok Won Kim ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Case Report ◽

Tick Bite ◽

Chain Reaction ◽

Human Granulocytic Anaplasmosis ◽

Polymerase Chain Reaction Testing ◽

Granulocytic Anaplasmosis ◽

Polymerase Chain

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A review on the eco-epidemiology and clinical management of human granulocytic anaplasmosis and its agent in Europe

Parasites & Vectors ◽

10.1186/s13071-019-3852-6 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 4

Author(s):

Ioana A. Matei ◽

Agustín Estrada-Peña ◽

Sally J. Cutler ◽

Muriel Vayssier-Taussat ◽

Lucía Varela-Castro ◽

...

Keyword(s):

Laboratory Tests ◽

Clinical Signs ◽

Epidemiologic Studies ◽

Human Infection ◽

Tick Bite ◽

Human Granulocytic Anaplasmosis ◽

Antibiotic Overuse ◽

Granulocytic Anaplasmosis ◽

The Usa ◽

The Difference

AbstractAnaplasma phagocytophilum is the agent of tick-borne fever, equine, canine and human granulocytic anaplasmosis. The common route of A. phagocytophilum transmission is through a tick bite, the main vector in Europe being Ixodes ricinus. Despite the apparently ubiquitous presence of the pathogen A. phagocytophilum in ticks and various wild and domestic animals from Europe, up to date published clinical cases of human granulocytic anaplasmosis (HGA) remain rare compared to the worldwide status. It is unclear if this reflects the epidemiological dynamics of the human infection in Europe or if the disease is underdiagnosed or underreported. Epidemiologic studies in Europe have suggested an increased occupational risk of infection for forestry workers, hunters, veterinarians, and farmers with a tick-bite history and living in endemic areas. Although the overall genetic diversity of A. phagocytophilum in Europe is higher than in the USA, the strains responsible for the human infections are related on both continents. However, the study of the genetic variability and assessment of the difference of pathogenicity and infectivity between strains to various hosts has been insufficiently explored to date. Most of the European HGA cases presented as a mild infection, common clinical signs being pyrexia, headache, myalgia and arthralgia. The diagnosis of HGA in the USA was recommended to be based on clinical signs and the patient’s history and later confirmed using specialized laboratory tests. However, in Europe since the majority of cases are presenting as mild infection, laboratory tests may be performed before the treatment in order to avoid antibiotic overuse. The drug of choice for HGA is doxycycline and because of potential for serious complication the treatment should be instituted on clinical suspicion alone.

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Questionnaire Surveys of Cases of Tick Bite and Lyme Borreliosis in Hunters in Hokkaido with Reference to Detection of Anti-Borrelia burgdorferi Antibody.

Internal Medicine ◽

10.2169/internalmedicine.31.1163 ◽

1992 ◽

Vol 31 (10) ◽

pp. 1163-1168 ◽

Cited By ~ 6

Author(s):

Nobuhiko KUBO ◽

Yasutomo ARASHIMA ◽

Minori YOSHIDA ◽

Masato KAWABATA ◽

Susumu NISHINARITA ◽

...

Keyword(s):

Borrelia Burgdorferi ◽

Lyme Borreliosis ◽

Tick Bite ◽

Questionnaire Surveys

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CXCR2 Blockade Influences Anaplasma phagocytophilum Propagation but Not Histopathology in the Mouse Model of Human Granulocytic Anaplasmosis

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.11.5.963-968.2004 ◽

2004 ◽

Vol 11 (5) ◽

pp. 963-968 ◽

Cited By ~ 34

Author(s):

Diana G. Scorpio ◽

Mustafa Akkoyunlu ◽

Erol Fikrig ◽

J. Stephen Dumler

Keyword(s):

Anaplasma Phagocytophilum ◽

Tissue Injury ◽

Treated Group ◽

Obligate Intracellular Bacterium ◽

Human Granulocytic Anaplasmosis ◽

Obligate Intracellular ◽

Liver Histopathology ◽

Granulocytic Anaplasmosis ◽

Infected Cells ◽

And Control

ABSTRACT Anaplasma phagocytophilum is an obligate intracellular bacterium that infects neutrophils and causes human granulocytic anaplasmosis. Infection induces neutrophil secretion of interleukin-8 or murine homologs and perpetuates infection by recruiting susceptible neutrophils. We hypothesized that antibody blockade of CXCR2 would decrease A. phagocytophilum tissue load by interrupting neutrophil recruitment but would not influence murine hepatic pathology. C3H-scid mice were treated with CXCR2 antiserum or control prior to or on day 14 after infection. Quantitative PCR and immunohistochemistry for A. phagocytophilum were performed and severity of liver histopathology was ranked. Control mice had more infected cells in tissues than the anti-CXCR2-treated group. The histopathological rank was not different between treated and control animals. Infected cells of control mice clustered in tissue more than in treated mice. The results support the hypothesis of bacterial propagation through chemokine induction and confirm that tissue injury is unrelated to A. phagocytophilum tissue load.

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