I got this via email this evening. Keep your CS close!
Annie
ANAPLASMOSIS - USA: (WISCONSIN)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 7 Sep 2009
Source: LaCrossetribune.com [edited]
<http://www.lacrossetribune.com/news/article_ded7b774-9b65-11de-9e68-001cc4c002e0.html>
La Crosse area health officials are seeing more cases of a new
tick-borne infection carried by the same deer tick that causes Lyme
disease. Gundersen Lutheran researchers have been monitoring
anaplasmosis the last 3 years and report 50 human cases in the La
Crosse area. The researchers have developed a test for the disease
and have been testing blood samples in Gundersen Lutheran Medical
Foundation's microbiology laboratories at the La Crosse Health Science Center.
"It is an emerging infection in this area," said Dean Jobe,
researcher and supervisor of Gundersen Lutheran's laboratories. "In
collecting ticks, we have found it in 10 to 15 percent of the ticks."
Only a few years ago, the disease was rare in the La Crosse area, he
said. "It is mimicking early Lyme," Jobe said. "We used to say we
couldn't find ticks with Lyme south of I-90, and now we see plenty of
ticks, and the same is happening with anaplasmosis." Unlike Lyme,
anaplasmosis is an infection of the white blood cells, he said. Lyme
disease is primarily a skin infection that gets into the bloodstream
and spreads into the joints, Jobe said.
"We've seen an increase in anaplasmosis over the last couple years,
but particularly more this year [2009]," said Dr. Todd Kowalski, a
Gundersen Lutheran physician specializing in infectious diseases.
"It's been on our radar for 15 years or more with cases in northern
Wisconsin, but the last few years, it has been emerging in our area."
Kowalski said symptoms are similar to Lyme, such as fever, headache
and body aches, but people don't get a rash with anaplasmosis. "It's
not a subtle disease," Kowalski said. "Most people feel worse, and
it's a little bit more abrupt than Lyme with perhaps a higher fever
and more severe headache and body aches. "With anaplasmosis, patients
don't wait as long to see their physician or go to urgent care or the
ER," he said. "But it is a very treatable disease."
Kowalski said anaplasmosis is treated the same way as Lyme, with a
tetracycline antibiotic. "What's rewarding is when patients are put
on antibiotics, within 24 to 36 hours they feel a lot better," he
said. He also said prevention measures and the tick season from early
spring to late fall are the same for both diseases. Kowalski said the
same person can get the 2 infections at the same time. He said most
La Crosse area primary care, urgent care and emergency medicine
physicians are aware of anaplasmosis.
Gundersen Lutheran has conducted research on the disease and
developed an accurate molecular test which detects a gene unique to
the organism, and it can be done rapidly, Jobe said. He said
Gundersen Lutheran also is studying the best time to use the test in
the course of the disease.
Jobe said the number of Lyme cases has continued to rise every year
due to a bigger deer population and mild winters. "We have a huge
deer population that supports ticks, and I think anaplasmosis has
established itself in the area," Jobe said. "It's a little too early
to say if anaplasmosis will be as common as Lyme, but there is a
growing concern it could become problematic," he said.
[Byline: Terry Rindfleisch]
--
Communicated by:
ProMED-mail Rapporteur Susan Baekeland
[The following was extracted from Mod.ML's comments in ProMED post
Anaplasmosis, nosocomial transmission - China: (AH) 20081120.3661:
"The cause of anaplasmosis is _Anaplasma phagocytophilum_, a
rickettsia-like microorganism that was previously referred to as
_Ehrlichia phagocytophila_. _A. phagocytophilum_ is an obligate
intracellular bacterium that infects granulocytes. (Anaplasmosis was
previously called human granulocytic ehrlichiosis, and is now also
called human granulocytic anaplasmosis or HGA.) In the USA,
anaplasmosis is found primarily in the New England, North Central,
and Pacific States. _A. phagocytophilum_ is transmitted by _Ixodes
scapularis_ in the Northeastern and upper Midwest United States, _I.
pacificus_ in the Western United States, _I. ricinus_ in Europe, and
probably _I. persulcatus_ in parts of Asia. These vectors can also
transmit Lyme disease, babesiosis, and, in Europe and Asia,
tick-borne encephalitis. Because of a common tick vector, a patient
infected with any one of these pathogens in the USA and Europe, and
possibly elsewhere in the world, may be co-infected with other
pathogens that the tick vector may be concurrently carrying.
The tick nymph, which is primarily responsible for transmission of
Lyme disease, anaplasmosis, or babesiosis, is less than 3 mm long,
even when fully engorged with blood. Because of its small size, the
bite of a nymph might not be noticed and consequently not be removed
before disease transmission occurs. Indeed, patients frequently do
not recall a tick bite. Nymphs typically feed more actively in May
and June resulting in a peak of clinical illness in July.
In the USA, the usual insect vector for ehrlichiosis, also called
human monocytic ehrlichiosis, is _Amblyomma americanum_, the lone
star tick, which, along with the white-tailed deer, maintains
_Ehrlichiae_ in nature. As a result, ehrlichiosis is mainly found in
the southeastern and south-central US, where the lone star tick is
commonly found. Because of different tick vectors, patients with
ehrlichiosis are unlikely to be co-infected with either Lyme disease
or babesiosis.
Wright stain of peripheral blood smears or buffy-coat preparations
demonstrate stained cytoplasmic inclusions consisting of vacuolar
microcolonies of _A. phagocytophilum_ within neutrophils in 20 to 80
percent of patients with anaplasmosis, unlike the rarity of
visualizing organisms within circulating mononuclear cells in
ehrlichiosis (Weinberg G: Laboratory diagnosis of ehrlichiosis and
babesiosis. Pediat Infect Dis J 2001; 20: 435-7.)
Because _A. phagocytophilum_ is disseminated in the blood stream, it
is not surprising that infected blood could serve as a vehicle for
person-to-person transmission. Indeed, _A. phagocytophilum_ can
survive in refrigerated blood, and anaplasmosis has been transmitted
through blood transfusion (Centers for Disease Control and
Prevention. _Anaplasma phagocytophilum_ Transmitted Through Blood
Transfusion -- Minnesota, 2007. MMWR 2008; 57: 1145-8. October 2008
[date cited] Available from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5742a1.htm>).
In anaplasmosis, non-specific symptoms, which normally occur within
1-2 weeks following the bite of an infected tick, may vary from mild
to severe and include fever, chills, malaise, headache, muscle aches
and pain, and absence of skin rash. Laboratory findings include
anemia, leukopenia, thrombocytopenia, and elevated serum
transaminases. Half the symptomatic patients require hospitalization,
which is associated with older age, higher neutrophil counts, lower
lymphocyte counts, anemia, the presence of morulae in leukocytes, or
underlying immune suppression. Severe complications include a septic
or toxic shock-like syndrome, coagulopathy, acute respiratory
distress syndrome, acute abdominal syndrome, rhabdomyolysis,
myocarditis, acute renal failure, hemorrhage, brachial plexopathy,
demyelinating polyneuropathy, cranial nerve palsies, and
opportunistic infections. Approximately 5 to 7 percent of patients
require intensive care, and the disease can be fatal.
Anaplasmosis should be suspected in patients with the acute onset of
unexplained fever, chills, and headache, often in association with
thrombocytopenia, leukopenia, and/or increased liver enzyme levels
with a history of tick exposure within the prior 3 weeks. The
diagnosis of anaplasmosis can be confirmed by a 4-fold increase in
antibody titer by IFA [indirect immunofluorescent assay] in acute and
convalescent phase serum samples, PCR [polymerase chain reaction]
amplification of anaplasma DNA in a clinical specimen, immunostaining
of _A. phagocytophilum_ antigen in a tissue sample, or isolation of
_A. phagocytophilum_ from a clinical specimen in cell culture
(Centers for Disease Control and Prevention.
Ehrlichiosis/Anaplasmosis 2008 Case definition. September 2008 [date
cited] Available at
<http://www.cdc.gov/ncphi/disss/nndss/casedef/ehrlichiosis_2008.htm>).
Treatment with doxycycline 100 mg twice daily orally or intravenously
for 10 days for all symptomatic patients suspected of having
anaplasmosis is recommended for a minimal total course of 10 days.
This treatment regimen should be adequate therapy for patients with
anaplasmosis alone and for patients who are co-infected with Lyme
disease, but is not effective therapy for patients who are
co-infected with babesiosis."
La Crosse, a city of about 50 000, is located on the western border
of the midsection of Wisconsin, along the east side of the
Mississippi River. The state of Wisconsin can be located on the
HealthMap/ProMED-mail interactive map of the USA at
<http://healthmap.org/r/00CW>.
Additional information on ticks, including pictures, is available at
<http://www.lib.uiowa.edu/haRDIN/MD/cdc/ticks.html>. - Mod.ML]
[see also:
2008
----
Anaplasmosis, nosocomial transmission - China: (AH) 20081120.3661
Anaplasmosis, human granulocytic - USA: (MN), ex transfusion 2007 20081024.3362
Anaplasmosis, human granulocytic - Canada: 1st rep., (AB) 20080731.2352
2007
----
Ehrlichiosis, fatal - USA (MO) 20070607.1849
2003
----
Ehrlichiosis, human granulocytic - USA (MA) 20030903.2211
Ehrlichiosis, human monocytic - USA (NC) 20030625.1571
1999
----
Ehrlichiosis, human - Mexico 19990713.1173
1998
----
Ehrlichiosis, human granulocytic - USA (Connecticut) 19980713.1318
Ehrlichiosis, human granulocytic - Sweden 19980418.0719
1995
----
Human granulocytic ehrlichiosis (5) 19950802.0625
Human granulocytic ehrlichiosis - Europe? 19950723.0581]
....................................................ml/msp/dk
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