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1.
Clin Infect Dis ; 73(7): e2372-e2378, 2021 10 05.
Article in English | MEDLINE | ID: mdl-32818961

ABSTRACT

BACKGROUND: Candidatus (Ca.) Neoehrlichia (N.) mikurensis is an emerging tick-borne pathogen of humans that is closely related to Ehrlichia and Anaplasma species. This strict intracellular bacterium escapes detection by routine microbiologic diagnostic methods such as blood culture, leading to considerable under-diagnosis of the infectious disease it causes, neoehrlichiosis. METHODS: Here, we describe the vascular and thromboembolic events afflicting a series of 40 patients diagnosed with neoehrlichiosis in Sweden during a 10-year period (2009-2019). RESULTS: The majority of the patients (60%) developed vascular events ranging from repeated thrombophlebitis, deep vein thrombosis, pulmonary embolism, transitory ischemic attacks, to arteritis. Younger age was a risk factor for vascular complications. In contrast, there was no difference in the incidence of vascular events between immunosuppressed and immunocompetent patients. However, there were qualitative differences, such that deep vein thrombosis exclusively afflicted the immunosuppressed patients, whereas arteritis was restricted to the immunocompetent persons. We also present the case histories of two patients who developed vasculitis mimicking polyarteritis nodosa and giant cell arteritis. Both were cured by doxycycline treatment. CONCLUSIONS: Ca. N. mikurensis infection should be considered in patients living in tick-endemic areas of Europe and northern Asia who present with atypical vascular and/or thromboembolic events. Early diagnosis and antibiotics targeting this emerging infectious agent can eradicate the infection and prevent the development of new vascular events.


Subject(s)
Anaplasmataceae Infections , Anaplasmataceae , Ixodes , Vasculitis , Anaplasmataceae Infections/epidemiology , Animals , Cohort Studies , Humans , Sweden/epidemiology
3.
Clin Infect Dis ; 58(12): 1716-22, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24647019

ABSTRACT

BACKGROUND: Candidatus Neoehrlichia mikurensis is a newly discovered noncultivatable bacterium spread among ticks and rodents in Europe and Asia that can infect humans, particularly immunocompromised patients. METHODS: We compiled clinical and laboratory data from 11 patients with hematological malignances or autoimmune diseases who were diagnosed with Candidatus N. mikurensis infection in Europe 2010-2013. Both published (6) and unpublished cases (5) were included. RESULTS: The patients had a median age of 67, were mostly male (8/11), and resided in Sweden, Switzerland, Germany, and the Czech Republic. All but one had ongoing or recent immune suppressive treatment and a majority were splenectomized (8/11). Less than half of them recalled tick exposure. The most frequent symptoms were fever (11/11), localized pain afflicting muscles and/or joints (8/11), vascular and thromboembolic events (6/11), that is, deep vein thrombosis (4), transitory ischemic attacks (2), pulmonary embolism (1), and arterial aneurysm (1). Typical laboratory findings were elevated C-reactive protein, leukocytosis with neutrophilia, and anemia. Median time from onset of symptoms to correct diagnosis was 2 months. In at least 4 cases, the condition was interpreted to be due to the underlying disease, and immunosuppressive therapy was scheduled. All patients recovered completely when doxycycline was administered. CONCLUSIONS: Candidatus N. mikurensis is an emerging tick-borne pathogen that may give rise to a systemic inflammatory syndrome in persons with hematologic or autoimmune diseases that could be mistaken for recurrence of the underlying disease and/or unrelated arteriosclerotic vascular events. Awareness of this new pathogen is warranted among rheumatologists, hematologists, oncologists, and infectious disease specialists.


Subject(s)
Anaplasmataceae Infections/diagnosis , Autoimmune Diseases/microbiology , Hematologic Neoplasms/microbiology , Tick-Borne Diseases/diagnosis , Aged , Anaplasmataceae Infections/complications , Anaplasmataceae Infections/drug therapy , Aneurysm/microbiology , Anti-Bacterial Agents/therapeutic use , C-Reactive Protein/metabolism , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/microbiology , DNA, Bacterial/blood , Delayed Diagnosis , Female , Fever/microbiology , Humans , Ischemic Attack, Transient/microbiology , Male , Middle Aged , Musculoskeletal Pain/microbiology , Pulmonary Embolism/microbiology , Splenectomy , Tick-Borne Diseases/complications , Tick-Borne Diseases/drug therapy , Tick-Borne Diseases/microbiology , Venous Thrombosis/microbiology
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