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Serological reactivity to Anaplasma phagocytophilum in neoehrlichiosis patients

Journal article
Authors Linda Wass
Anna Grankvist
M. Mattsson
H. Gustafsson
K. Krogfelt
B. Olsen
K. Nilsson
A. Martensson
H. Quarsten
A. J. Henningsson
Christine Wennerås
Published in European Journal of Clinical Microbiology & Infectious Diseases
Volume 37
Issue 9
Pages 1673-1678
ISSN 0934-9723
Publication year 2018
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 1673-1678
Language en
Links dx.doi.org/10.1007/s10096-018-3298-...
Keywords human granulocytic ehrlichiosis, borrelia-burgdorferi, mikurensis, tick, infections, sweden, seroprevalence, humans, norway, europe, Infectious Diseases, Microbiology
Subject categories Infectious Medicine

Abstract

The tick-borne bacterium Candidatus (Ca.) Neoehrlichia (N.) mikurensis is a cause of "fever of unknown origin" because this strict intracellular pathogen escapes detection by routine blood cultures. Case reports suggest that neoehrlichiosis patients may display serological reactivity to Anaplasma (A.) phagocytophilum. Since Anaplasma serology is part of the diagnostic work-up of undetermined fever in European tick-exposed patients, we wanted to investigate (1) the prevalence of A. phagocytophilum seropositivity among neoehrlichiosis patients, (2) the frequency of misdiagnosed neoehrlichiosis patients among A. phagocytophilum seropositive patients, and (3) the frequency of A. phagocytophilum and Ca. N. mikurensis co-infections. Neoehrlichiosis patients (n = 18) were analyzed for A. phagocytophilum IgM and IgG serum antibodies by indirect immunofluorescence assay. Serum samples from suspected anaplasmosis patients (n = 101) were analyzed for bacterial DNA contents by singleplex PCR specific for A. phagocytophilum and Ca. N. mikurensis, respectively. One fifth of the neoehrlichiosis patients (4/18) were seropositive for IgM and/or IgG to A. phagocytophilum at the time of diagnosis. Among the patients with suspected anaplasmosis, 2% (2/101) were positive for Ca. N. mikurensis by PCR whereas none (0/101) had detectable A. phagocytophilum DNA in the serum. To conclude, patients with suspected anaplasmosis may in fact have neoehrlichiosis. We found no evidence of A. phagocytophilum and Ca. N. mikurensis co-infections in humans with suspected anaplasmosis or confirmed neoehrlichiosis.

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