Human Granulocytic Anaplasmosis as a Cause of Febrile Illness in Korea Since at Least 2006

Yi, Jongyoun; Kim, Kye-Hyung; Ko, Mee Kyung; Lee, Eun Yup; Choi, Su Jin; Oh, Myoung Don

doi:10.4269/ajtmh.16-0309

Cited by 19 publications

(15 citation statements)

References 36 publications

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“…We did not observe any scrub typhus and SFTS co-infections, in contrast to a previous study 7. As our study samples were collected in 2006, and it is uncertain whether there was a sufficient concurrent epidemic of SFTS in Korea, in contrast to the presence of HGA at least since 2006 6. Another possible explanation is that there is a possibility of false negatives in few cases because laboratory detection of another gene of SFTSV, such as S segment or M segment, was not performed.…”

Section: Discussioncontrasting

confidence: 84%

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Co-Infection of Scrub Typhus and Human Granulocytic Anaplasmosis in Korea, 2006

Kim

Lee²,

Moon

et al. 2019

J Korean Med Sci

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BackgroundScrub typhus, severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are important arthropod-borne infectious diseases in Korea and share a common point that they are transmitted by arthropod bites mostly during outdoor activities and there are considerable overlaps of epidemiologic and clinical features at presentation. We investigated the co-infection of these infections.MethodsThe study subjects were patients with laboratory-confirmed scrub typhus who were enrolled retrospectively in 2006. SFTS virus (SFTSV) infection was confirmed by a reverse transcriptase polymerase chain reaction (PCR) to amplify partial L segment of SFTSV for molecular diagnosis. HGA was confirmed by a nested PCR to amplify 16S rRNA gene of Anaplasma phagocytophilum. Direct sequencing of the positive PCR products was performed. Clinical features of co-infected subjects were described.ResultsOne-hundred sixty-seven patients with scrub typhus were included in the analysis. Co-infection of A. phagocytophilum was identified in 4.2% of scrub typhus patients (7/167). The route of co-infection was uncertain. The co-infected patients had not different clinical manifestations compared to the patients with scrub typhus only. All the study subjects were negative for SFTSV.ConclusionWe found retrospective molecular evidence of the co-infection of scrub typhus and HGA in Korea. HGA may be more prevalent than expected and need to be considered as an important differential diagnosis of febrile patients in Korea.

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Section: Discussioncontrasting

confidence: 84%

“…Severe fever with thrombocytopenia syndrome (SFTS) and human granulocytic anaplasmosis (HGA) are emerging tick-borne infections in Korea 123. The emergence of both infections in Korea can be traced back to 2008 and 2006, respectively 456…”

Section: Introductionmentioning

confidence: 99%

Co-Infection of Scrub Typhus and Human Granulocytic Anaplasmosis in Korea, 2006

Kim

Lee²,

Moon

et al. 2019

J Korean Med Sci

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“…As such, it is unclear whether or not our patient had HLH. Nonetheless, since being first described in a case series of 29 patients in 2007 by Dumler et al, 25 HGA-induced HLH has been reported in New York, 42 South Korea, 43 and Greece. 44 It is essential to identify HGA and other tick-borne diseases as an inciting cause of HLH.…”

Section: Discussionmentioning

confidence: 98%

Severe Human Granulocytic Anaplasmosis With Significantly Elevated Ferritin Levels in an Immunocompetent Host in Pennsylvania: A Case Report

Camacci

Panganiban

Pattison

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Human granulocytic anaplasmosis (HGA) is a tick-borne, infectious disease caused by Anaplasma phagocytophilum that generally presents with nonspecific symptoms such as fever, chills, headache, malaise, and myalgia. If not treated immediately, HGA can cause hemophagocytic lymphohistiocytosis (HLH), a well-documented but underrecognized sequela of severe HGA. In this article, we report a case of severe HGA with hyperferritinemia in a 74-year-old male from Central Pennsylvania who initially presented with recurrent fevers, nausea, and malaise to our emergency department and was subsequently discharged home that same day. Ten days later, the patient returned with acute kidney injury, elevated liver transaminases, and profound hyperferritinemia to 5130 ng/mL. Empiric doxycycline was administered for suspected tick-borne disease and serologies eventually came back positive for anti–Anaplasma phagocytophilum antibodies. The patient returned to baseline status 15 days after discharge. Our case shows the challenges in the timely diagnosis of HGA and highlights the role of serum ferritin in aiding this diagnosis. Although our patient did not fulfill the HLH diagnostic criteria, our report demonstrates the importance of recognizing HGA as a reversible cause of HLH.

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“…Many previous studies based in Korea have focused on anaplasmosis in animals other than humans,45 indicating a long-term interest in the disease. Since the first HGA case was reported in 2013,2 few cases have been reported in Korea 6…”

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confidence: 99%

“…There are similar animal hosts between HGA and HFRS. A. phagocytophilum have been detected in ticks including H. longicornis , Ixodes nipponensis , and I. persulcatus and in wild animals such as striped field mice and the major host of Hantan virus is wild rodents ( Apodemus species) 6…”

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confidence: 99%