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First documented case of human granulocytic ehrlichiosis in Austria

Erster nachgewiesener Fall von Humaner Granulozytärer Ehrlichiose in Österreich

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Zusammenfassung

Wir beschreiben den ersten Fall von Humaner Granulozytärer Ehrlichiose, in Österreich, wobei die Infektion wahrscheinlich durch einen Zeckenstich in der Nähe von Arzl im Bezirk Innsbruck Land (Nordtirol) erfolgte. Die Krankheit verlief biphasisch: 8 Tage nach dem Zeckenstich begann die Patientin an fronto-occipitalen Kopfschmerzen, diffusen Arthralgien. Myalgien, allgemeinem Unwohlsein und subfebrilen Temperaturen zu leiden, nach 3 beschwerdefreien Tagen setzte am 20. Tag akut Fieber bis 39,5°C ein, das vier Tage später eine stationäre Aufnahme notwendig machte. Die klinischen und labormedizinischen Befunde entsprachen den Beobachtungen bei anderen erwachsenen europäischen Patienten, allerdings wurden auch transiente Antikörper gegen Thrombozyten nachgewiesen.

Bei der stationären Aufnahme wies die Patientin hohe Antikörpertiter gegenanaplasma phagocytophilum auf (IgG 1∶1024, IgM 1∶640), 6 Wochen später war der IgG-Titer auf 1∶2048 gestiegen, die IgM-Konzentration war auf <1∶40 abgesunken.

Auch in Österreich sollte bei febrilen Thrombozytopenien die Humane Granulozytäre Ehrlichiose bedacht werden, besonders, wenn ein Zeckenstich in der Anamnese eruierbar ist.

Summary

We report the first documented case of human granulocytic ehrlichiosis (HGE) in Austria. The infection was acquired near Arzl in the surroundings of Innsbruck in northern Tyrol. Except for a biphasic course of illness, presentation in this 33-year-old female patient was comparable to clinical findings observed in other European adults with high fever, transient thrombocytopenia, elevated levels of CRP and LDH, arthralgias, myalgias, fatigue and subfebrile temperature. Flu-like symptoms started about seven days after a tick bite and lasted for ten days, followed by an asymptomatic interval of three days and an acute onseet of fever up to 39.5°C on day 20. On admission, the patient showed high antibody titres againstAnaplasma phagocytophilum (IgG 1∶1024, IgM 1∶640); six weeks later the IgG-titre had risen to 1∶2048, and IgM-levels had fallen below 1∶40. The demonstration of anti-platelet antibodies in acute-phase serum was noteworthy.

We conclude that also in Austria HGE should be considered in patients with febrile thrombocytopenia, especially when the medical history reveals recent tick exposure.

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Authors and Affiliations

  1. Institut für Hygiene und Sozialmedizin, Universität Innsbruck, Innsbruck, Austria

    Gernot Walder, Barbara Falkensammer, Johannes Aigner, Gerhard Tiwald, Manfred P. Dierich & Reinhard Würzner

  2. Abteilung für Innere Medizin, Bezirkskrankenhaus Lienz, Lienz, Austria

    Gernot Walder & Peter Lechleitner

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  1. Gernot Walder
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  2. Barbara Falkensammer
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  3. Johannes Aigner
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  4. Gerhard Tiwald
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  5. Manfred P. Dierich
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  7. Peter Lechleitner
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Correspondence to Gernot Walder.

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Walder, G., Falkensammer, B., Aigner, J. et al. First documented case of human granulocytic ehrlichiosis in Austria. Wien Klin Wochenschr 115, 263–266 (2003). https://doi.org/10.1007/BF03040326

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  • DOI: https://doi.org/10.1007/BF03040326

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