Anaplasmosis: Human Granulocytotropic Anaplasmosis

Human Granulocytotropic Anaplasmosis (HGA) is caused by A. phagocytophilum. In 2006 more than 3257 cases of HGA were reported to the CDC, Atlanta. The distribution of cases is similar to that for Lyme disease because of the shared Ixodes scapularis tick vector. Most of the cases were reported from upper midwestern and northeastern United States. White-tailed deer & white footed mice in the United States and red deer in Europe are natural reservoirs.

Signs and symptoms: The incubation period of Human Granulocytotropic Anaplasmosis is 4-8 days. After the incubation period the following symptoms like fever, malaise, myalgia (muscle pain) and headache appear. Some patients may develop nausea, vomiting, confusion and rash.

Severe complications like adult respiratory distress syndrome (ARDS), a toxic shock syndrome, and opportunistic infections, which may be life-threatening, can develop. Case fatality rate is very less about 0.5% and up to 7% patients may require intensive care.

Diagnosis: PCR testing of blood from patients with active disease before initiation of therapy is sensitive and specific. Other non specific findings like thrombocytopenia, leukopenia, or elevation in serum alanine or aspartate aminotransferase are seen.

Treatment: Doxycycline 100 mg orally twice daily is the drug of choice for treatment of HGA. Rifampin can be used successfully in children and pregnant women. Most of the patients respond within 24 to 48 hours.

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