Wiener klinische Wochenschrift

, Volume 118, Issue 21–22, pp 708–713 | Cite as

Epidemiological, clinical and laboratory characteristics of patients with human granulocytic anaplasmosis in Slovenia

  • Stanka Lotrič-Furlan
  • Tereza Rojko
  • Miroslav Petrovec
  • Tatjana Avšič-Županc
  • Franc Strle
Original Article

Summary

Human granulocytic anaplasmosis (HGA) has been recently recognized as an emerging tick-borne disease. Several reports indicate the presence of infection with Anaplasma phagocytophilum in Europe. Between January 1996 and December 2004, 24 adult patients with proven HGA were identified in a prospective study conducted at the Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia, on the etiology of febrile illnesses occurring within 30 days after a tick bite. The diagnosis of acute HGA was established from seroconversion in 18 (75%) patients or at least a four-fold increase in antibody titers to A. phagocytophilum antigens in six (25%) patients and molecular identification of ehrlichial organisms in 15 (62.5%) patients. Clinical characteristics and laboratory findings were similar to those reported from the other European countries. All the patients had an acute febrile illness with headache, malaise, myalgia and/or arthralgia. Leukopenia was found in 16 (66.7%) patients, thrombocytopenia in 20 (83.3%), abnormal liver function test results in 23 (95.8%), elevated erythrocyte sedimentation rates in 18 (75%), and elevated concentration of C-reactive protein in 23 (95.8%). The disease course was relatively mild; none of the patients died and no long-term sequelae were found during a follow-up of one year even though only 15 (62.5%) were treated with doxycycline. At the examination one year after the first visit, 16/24 (66.7%) patients tested seropositive (≥1 : 256) for A. phagocytophilum antibody, and two years after the first visit positive titers were still present in 10/18 (55.6%) patients.

Keywords

Tick-borne infection Human granulocytic anaplasmosis Clinical presentation Laboratory findings Slovenia 

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References

  1. Strle F, Stantic-Pavlinic M (1996) Lyme disease in Europe. N Engl J Med 334: 803CrossRefPubMedGoogle Scholar
  2. Lotric-Furlan S, Petrovec M, Avsic-Zupanc T, Nicholson WL, Sumner JW, Childs JE, et al (1998) Human ehrlichiosis in central Europe. Wien Klin Wochenschr 110: 894–897PubMedGoogle Scholar
  3. Blanco JR, Oteo JA (2002) Human granulocytic ehrlichiosis in Europe. Clin Microbiol Infect 8: 763–772CrossRefPubMedGoogle Scholar
  4. Strle F (2004) Human granulocytic ehrlichiosis in Europe. Int J Med Microbiol 293 [Suppl 37]: 27–35PubMedGoogle Scholar
  5. Petrovec M, Lotric-Furlan S, Avsic-Zupanc T, Strle F, Brouqui P, Roux V, et al (1997) Human disease in Europe caused by a granulocytic Ehrlichia species. J Clin Microbiol 35: 1556–1559PubMedGoogle Scholar
  6. Petrovec M, Sumner JW, Nicholson WL, Childs JE, Strle F, Barlic J, et al (1999) Identity of ehrlichial DNA sequences derived from Ixodes ricinus ticks with those obtained from patients with human granulocytic ehrlichiosis in Slovenia. J Clin Microbiol 37: 209–210PubMedGoogle Scholar
  7. Brouqui P, Bacellar F, Baranton G, Birtles RJ, Bjoersdorff A, Blanco JR, et al (2004) Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect 10: 1108–1132CrossRefPubMedGoogle Scholar
  8. Nicholson WL, Comer JA, Sumner JW, Gingrich-Baker C, Coughlin RT, Magnarelli LA, et al (1997) An indirect immunofluorescence assay using a cell culture-derived antigen for detection of antibodies to the agent of human ehrlichiosis by polymerase chain reaction. J Clin Microbiol 35: 1510–1516PubMedGoogle Scholar
  9. Lotric-Furlan S, Petrovec M, Avsic-Zupanc T, Strle F (2004) Comparison of patients fulfilling criteria for confirmed and probable human granulocytic ehrlichiosis. Scand J Infect Dis 2004: 36: 817–822PubMedCrossRefGoogle Scholar
  10. Lotric-Furlan S, Avsic-Zupanc T, Petrovec M, Nicholson WL, Sumner JW, Childs JE, et al (2001) Prospective assessment of the etiology of acute febrile illness after a tick bite in Slovenia. Clin Infect Dis 33: 503–510CrossRefPubMedGoogle Scholar
  11. Warner CK, Dawson JE (1996) Genus- and species-level identification of Ehrlichia species by PCR and sequencing. In: Persing HD (ed) PCR protocols for emerging infectious diseases. American Society for Microbiology, Washington: pp 101–105Google Scholar
  12. Sumner JW, Nicholson WL, Massung RF (1997) PCR amplification and comparison of nucleotide sequences from the groESL heat shock operon of Ehrlichia species. J Clin Microbiol 35: 2087–2092PubMedGoogle Scholar
  13. Lotric-Furlan S, Petrovec M, Avsic-Zupanc T, Strle F (2003) Human granulocytic ehrlichiosis in Slovenia. Ann NY Acad Sci 990: 279–284PubMedCrossRefGoogle Scholar
  14. Cizman M, Avsic-Zupanc T, Petrovec M, Ruzić-Sabljić E, Pokorn M (2000) Seroprevalence of ehrlichiosis, Lyme borreliosis and tick-borne encephalitis infections in children and young adults in Slovenia. Wien Klin Wochenschr 112: 842–845PubMedGoogle Scholar
  15. Rojko T, Ursic T, Avsic-Zupanc T, Petrovec M, Strle F, Lotric-Furlan S (2005) Prevalence and incidence of infection with Anaplasma phagocytophilum among Slovene forestry workers during the period of tick activity. Ann NY Acad Sci (in press)Google Scholar
  16. Bakken JS, Dumler JS (2000) Human granulocytic ehrlichiosis. Clin Infect Dis 31: 554–560CrossRefPubMedGoogle Scholar
  17. Remy V, Hansmann Y, De Martino S, Christmann D, Brouqui P (2003) Human anaplasmosis presenting as atypical pneumonitis in France. Clin Infect Dis 37: 846–848CrossRefPubMedGoogle Scholar
  18. Karlsson U, Bjoersdorff A, Massung RF, Christensson B (2001) Human granulocytic ehrlichiosis – a clinical case in Scandinavia. Scand J Infect Dis 33: 73–74CrossRefPubMedGoogle Scholar
  19. van Dobbenburgh A, van Dam AP, Fikrig E (1999) Human granulocytic ehrlichiosis in western Europe (letter). N Engl J Med 340: 1214–1216CrossRefPubMedGoogle Scholar
  20. Aquero-Rosenfeld M, Horowitz HW, Wormser GP, McKenna DF, Nowakowski J, Munoz J, et al (1996) Human granulocytic ehrlichiosis: a case series from a medical center in New York State. Ann Intern Med 125: 904–908Google Scholar
  21. Wormser GP, Horowitz HW, Dumler JS, Schwartz I, Aquero-Rosenfeld M (1996) False-positive Lyme disease in human granulocytic ehrlichiosis. Lancet 347: 981–982CrossRefPubMedGoogle Scholar
  22. Lotric-Furlan S, Petrovec M, Avsic-Zupanc T, Strle F (2005) Concomitant tickborne encephalitis and human granulocytic ehrlichiosis. Emerg Infect Dis 11: 485–488PubMedGoogle Scholar
  23. Cimperman J, Maraspin V, Lotric-Furlan S, Ruzić-Sabljić E, Avsic-Zupanc T, Strle F (2002) Double infection with tick-borne encephalitis virus and Borrelia burgdorferi sensu lato. Wien Klin Wochenschr 114: 620–622PubMedGoogle Scholar
  24. Lotric-Furlan S, Avsic-Zupanc T, Petrovec M, Nicholson WL, Sumner JW, Childs JE, Strle F (2001) Clinical and serological follow-up of patients with human granulocytic ehrlichiosis in Slovenia. Clin Diagn Lab Immunol 8: 899–903CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Stanka Lotrič-Furlan
    • 1
  • Tereza Rojko
    • 1
  • Miroslav Petrovec
    • 2
  • Tatjana Avšič-Županc
    • 2
  • Franc Strle
    • 1
  1. 1.Department of Infectious DiseasesUniversity Medical Center Ljubljana, University of LjubljanaSlovenia
  2. 2.Institute of Microbiology and Immunology, Medical FacultyUniversity of LjubljanaSlovenia

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