Nosocomial Transmission of Human Granulocytic Anaplasmosis in China

Zhang, Lijuan; Liu, Yan; Ni, Daxin; Li, Qun; Yu, Yanlin; Yu, Xue Jie; Wan, Kanglin; Li, Dexin; Liang, Guodong; Jiang, Xingran; Jing, Huaiqi; Run, Jing; Luan, Ming-chun; Fu, Xin; Zhang, Jingshan; Yang, Weizhong; Wang, Yu; Dumler, J. Stephen; Zhu, Feng; Ren, Jun; Xu, Jianguo

doi:10.1001/jama.2008.626

Cited by 161 publications

(134 citation statements)

References 39 publications

(50 reference statements)

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“…A rickettsiologist, Dr. Yu Xue-Jie, was asked by the Chinese Center for Disease Control and Prevention (China CDC) to investigate the potential etiological pathogen of the disease, which was suspected to be human anaplasmosis (HA) [1]. After careful analysis of the patients' clinical information, Dr. Yu concluded that the patients' symptoms were inconsistent with HA because most had gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, which are rarely observed in HA patients [2].…”

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confidence: 99%

An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV

Zhang

Liu

Zhao

et al. 2013

Sci. China Life Sci.

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Severe fever with thrombocytopenia syndrome (SFTS) is an emerging hemorrhagic fever in rural areas of China and is caused by a new bunyavirus, SFTSV, named after the disease. The transmission vectors and animal hosts of SFTSV are unclear. Ticks are the most likely transmission vectors and domestic animals, including goats, dogs, and cattle, are potential amplifying hosts of SFTSV. The clinical symptoms of SFTS are nonspecific, but major symptoms include fever, gastrointestinal symptoms, myalgia, dizziness, joint pain, chills, and regional lymphadenopathy. The most common abnormalities in laboratory test results are thrombocytopenia (95%), leukocytopenia (86%), and elevated levels of serum alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase. The fatality rate for SFTS is 12% on average, and the annual incidence of the disease is approximately five per 100000 of the rural population.

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confidence: 99%

An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV

Zhang

Liu

Zhao

et al. 2013

Sci. China Life Sci.

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“…Seroepidemiological data suggest that HGA infection rates in the United States are as high as 15% to 36% in some locations (7). An unusual case of nosocomial humanto-human A. phagocytophilum transmission was reported in 2006 in a regional hospital in Anhui Province, China (19). Subsequently, nationwide seroepidemiological surveys of A. phagocytophilum among high-risk agricultural groups in China demonstrated that the total seroprevalence rate of A. phagocytophilum was 13.94% (unpublished data).…”

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Rapid, Simple, and Sensitive Detection of Anaplasma phagocytophilum by Loop-Mediated Isothermal Amplification of the msp2 Gene

et al. 2011

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Anaplasma phagocytophilum is the causative agent of human granulocytic anaplasmosis, which is prevalent throughout China. In this study, we describe a rapid, simple, and sensitive loop-mediated isothermal amplification (LAMP) assay targeting the msp2 gene of A. phagocytophilum that is ideal for application in rural areas in China. This assay has the potential to detect A. phagocytophilum early in infection as an alternative to existing methods. A total of 42 suspected cases of infection with A. phagocytophilum, 15 serologically confirmed and 27 probable cases, were analyzed by the msp2 LAMP assay. To validate the accuracy of LAMP, previously established nested-PCR and real-time PCR assays were utilized. The sensitivity of LAMP was 25 copies per reaction (approximately 1,250 copies per ml blood) for A. phagocytophilum, and the assay did not detect false positives among 27 members of the order Rickettsiales and 17 common clinical pathogens. To evaluate the clinical applicability of the LAMP assay, a total of 42 clinical samples were examined. A positive LAMP result was obtained for 12 of the confirmed cases and for 14 of 27 suspected cases, while only 1 confirmed case and 3 cases (2 confirmed cases and 1 suspected case) were detected by nested PCR and real-time PCR, respectively. The LAMP assay described in this study demonstrated a high level of sensitivity comparable with that of nested PCR and real-time PCR for the detection of A. phagocytophilum. This LAMP assay is a valuable method for rapid, cost-effective, and simple detection of A. phagocytophilum in the rural areas of China.Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease caused by Anaplasma phagocytophilum, which was reported in the United States in 1990 and in Europe in 1997 (3, 6). Seroepidemiological data suggest that HGA infection rates in the United States are as high as 15% to 36% in some locations (7). An unusual case of nosocomial humanto-human A. phagocytophilum transmission was reported in 2006 in a regional hospital in Anhui Province, China (19). Subsequently, nationwide seroepidemiological surveys of A. phagocytophilum among high-risk agricultural groups in China demonstrated that the total seroprevalence rate of A. phagocytophilum was 13.94% (unpublished data). However, the greatest challenge to clinicians is the lack of a rapid, early, and accurate diagnostic method for the detection of anaplasmosis as an emerging infectious disease in China. The indirect immunofluorescence assay (IFA), the gold standard method proposed by the World Health Organization Collaborating Center for Rickettsial Reference and Research, depends on a specific, expensive fluorescence microscope and requires a pair of serum samples from both the acute and convalescent stages of the illness, which is not applicable as an early test for A. phagocytophilum infection. The utility of insensitive conventional PCR, time-consuming and easily contaminated nested PCR, and highly sensitive real-time PCR is also limited in rural areas because they require ...

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“…Nosocomial anaplasmosis transmission was reported in Anhui province, southeastern China, in 2006 (15). Following this report, A. phagocytophilum-specific DNA sequence was detected in patients from Shandong province, eastern China, in 2007 (16), and isolates were also obtained from patients in the Shandong peninsula (17).…”

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confidence: 81%

Detection of Anaplasma phagocytophilum and Anaplasma bovis in Small Wild Mammals from Taichung and Kinmen Island, Taiwan

et al. 2014

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SUMMARY: A total of 138 animals from 7 species (Apodemus agrarius, Bandicota indica, Crocidura suaveolens, Mus caroli, Mus formosanus, Rattus losea, and Suncus murinus) captured in Taichung, located in central Taiwan, and Kinmen Island, an island off the shore of China, were examined for the presence of Anaplasma phagocytophilum. The presence of the bacteria, which causes human granulocytic anaplasmosis, was examined by nested PCR targeting the16S rDNA. Twelve animals (8.7z) from M. caroli and R. losea, and 25 (18.1z) from A. agrarius, B. indica, M. caroli, and R. losea were infected with A. phagocytophilum and Anaplasma bovis, respectively. Phylogenetic analysis revealed that partial 16S rDNA sequences in the 12 aforementioned animals showed higher similarity to the sequences related to A. phagocytophilum detected in wild rodents (Rattus and Niviventer) from southeast China. The sequences of the other 25 animals belonged to the A. bovis clade. We demonstrated that small wild mammals were infected with A. phagocytophilum and A. bovis in Taichung and Kinmen Island, Taiwan.

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Nosocomial Transmission of Human Granulocytic Anaplasmosis in China

Abstract: We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions.

Cited by 161 publications

References 39 publications

An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV

An emerging hemorrhagic fever in China caused by a novel bunyavirus SFTSV

Rapid, Simple, and Sensitive Detection of Anaplasma phagocytophilum by Loop-Mediated Isothermal Amplification of the msp2 Gene

Detection of Anaplasma phagocytophilum and Anaplasma bovis in Small Wild Mammals from Taichung and Kinmen Island, Taiwan

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