VZL 2009, 78(4):143-149

Human Granulocytic Ehrlichiosis - a New Tick-Borne Zoonosis by Us

Petr Knížek1,2, Jiří Kobliha3, František Sedláček1
1 Pardubická krajská nemocnice, infekční oddělení, Pardubice
2 Univerzita Pardubice, Fakulta zdravotnických studií, Pardubice
3 Zdravotní ústav Ostrava, pobočka Bruntál

Lidská granulocytární ehrlichióza (HGE) je nová klíštětem přenosná zoonóza. HGE je způsobena obligátně intracelulární baktérií Anaplasma phagocytophila. Přenašečem této infekce v Evropě je klíště Ixodes ricinus. K typickým klinickým projevům patří horečka, únava, bolesti hlavy a svalů. Při těžším průběhu bývá zasažen trakt gastrointestinální, respirační nebo nervový. Charakteristickými laboratorními nálezy jsou leukopenie, trombocytopenie a zvýšení jaterních transamináz. Onemocnění lze prokázat vzestupem titru protilátek (metoda nepřímé imunofluorescence), mikroskopickou identifikací původce v granulocytech krevního nátěru, případně stanovením specifické DNA polymerázovou řetězovou reakcí (PCR). V terapii jsou účinné tetracykliny, chinolony a rifampicin. Naše populace je poměrně často exponována ehrlichiové infekci. Je třeba na tuto diagnózu myslet zejména u imunodeficitních pacientů, u kterých včasné nasazení léčby může zabránit komplikovanému průběhu nemoci.

Keywords: Lidská granulocytární ehrlichióza (HGE); Anaplasma phagocytophila; Klinické projevy; Laboratorní diagnostika

Human granulocytic ehrlichiosis (HGE) is a new tick-borne zoonosis. HGE is caused by intracellular bakteria Anaplasma phagocytophila. The vector for this infection in Europe is the tick Ixodes ricinus. Typical clinical manifestations include fever, malaise, headache and myalgia. In more serious case gastrointestinal tract or respiratory and nervous systems may be affected. Characteristic laboratory abnormalities are leucopenia, thrombocytopenia and elevated liver transaminases. This disease can by confirmed by increasing of antibody titre (indirect immunofluorescence assay), microscopic identification of patogen in granulocytes from blood smear, eventually by means of specific DNA by polymerase change reaction (PCR). Tetracyclines, quinolones and rifampicin are effective therapeutically. The Czech population is relatively often exposed to Ehrlichia infections. We should consider this diagnosis, especially in immunodeficient patiens, where early treatment may prevent complicated course of the disease.

Keywords: Human granulocytic ehrlichiosis (HGE); Anaplasma phagocytophila; Clinical manifestations; Laboratory diagnosis

Received: August 5, 2009; Published: December 1, 2009  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Knížek, P., Kobliha, J., & Sedláček, F. (2009). Human Granulocytic Ehrlichiosis - a New Tick-Borne Zoonosis by Us. Vojenské Zdravotnické Listy, 78(4), 143-149
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. BAKKEN, JS. - KRUETH, J. - WILSON, C., et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA, 1996, vol. 275, no. 3, p. 199-205. Go to original source...
    2. BLANCO, JR. - OTEO, JA. Human granulocytic ehrlichiosis in Europe. Clin. Microbiol. Infect., 2002, vol. 8, no. 12, p. 763-772. Go to original source... Go to PubMed...
    3. BROUQUI, P. - SALVO, E. - DUMLER, JS., et. al. Diagnosis of granulocytic ehrlichiosis in humans by immunofluorescence assay. Clin. Diagn. Lab. Immunol., 2001, vol. 8, no. 1, p. 199-202. Go to original source... Go to PubMed...
    4. BROUQUI, P., et. al. Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin. Microbiol. Infect., 2004, vol. 29, no. 10, p. 1108-1132. Go to original source... Go to PubMed...
    5. DAVSON, JE. - ANDERSON, BE. - FISHBEIN, DB., et al. Isolation and characterisation of an Ehrlichia sp. From a patient diagnose with human ehrlichiosis. J. Clin. Microbiol., 1991, vol. 29., no. 12, p. 2741-2745. Go to original source... Go to PubMed...
    6. DUMLER, JS. - BAKKEN, JS. Ehrlichial diseases of humans: emerging tick-borne infections. Clin. Infect. Dis., 1995, vol. 20, no. 5, p. 1102-1110. Go to original source... Go to PubMed...
    7. DUMLER, JS. - BARBET, AF. - BROKER, CPJ., et al. Reorganozation of genera in the families Ricketsiaceae and Anaplasmataceae in the order Rickettsiales: unification of sam species of Ehrlichia with Anaplasma, Cowdia with Ehrlichia, and Ehrlichia with Neorickettsia, designation of six new species combinations and designation of Ehrlichia equi anf "HGE agent" as subjective synonym of Ehrlichia phagocytophila. Int. J. Syst. Evol. Bacteriol., 2001, vol. 51, no. 6, p. 2145-2165. Go to original source... Go to PubMed...
    8. EDELMAN, DC. - DUMLER, JS. Evaluation of an improved PCR diagnostic assay for human granulocytic ehrlichiosis. Mol. Diagn., 1996, vol. 1., no. 1., p. 41-49. Go to original source... Go to PubMed...
    9. FUKUDA, T. - KUTAO, T. - KEYDA, Y. Studies on the kausativ agent of Hyuganetsu dissease. Isolation of the agent and its inoculation trial in human beings. Med. Biol., 1954, vol. 32, p. 200-209.
    10. HARDALO, C. - QUAGLIARELLO, V. - DUMLER, JS. Human granulocytic ehrlichiosis in Connecticut: report of a fatal case. Clin. Infet. Dis., 1995, vol. 21, no. 7, p. 910-914. Go to original source... Go to PubMed...
    11. HOROWITZ, HW. - KILCHEVSKY, E. - HABER, S., et. al. Perinatal transmission of the agent of human granulocytic ehrlichiosis. N. Engl. Med., 1998, vol. 339, no. 5, p. 365-378. Go to original source... Go to PubMed...
    12. HUML, O. - ČADA, F. - BÖHM, K., et al. Granulocytární ehrlichióza u psa. Veterinářství, 1996, roč. 46, č. 11, s. 464-466.
    13. CHEN, SM. - DUMLER, JS. - BAKKEN, JS., et al. Identification of a granulocytotropic Ehrlichia species as the etiologic agent of human disease. J. Clin. Microbiol., 1994, vol. 32, no. 3, p. 589-595. Go to original source... Go to PubMed...
    14. LÁSIKOVÁ, S. - PÍCHA, D. - MORAVCOVÁ, L. Sérové HGE protilátky u pacientů s lymeskou boreliózou v České republice. Klin. Mikrob. Inf. Lék., 2000, roč. 6, č. 4, s. 112-115.
    15. LEPIDI, H. - BUNNELL, JE. - MARTIN, ME., et al. Comperative patology and immunohistology associated with clinical illness after Ehrlichia phagocytophila-group infections. Am. Trop. Med. Hyg, 2000, vol. 62, no. 1, p. 29-37. Go to original source... Go to PubMed...
    16. LOTRIC-FURLAN, S. - AVSIC-ZUPANC, T. - PETROVEC, M., et. al. Clinical and serological follow-up of patiens with human granulocytic ehrlichiosis in Slovenia. Clin. Diagn. Lab. Immunol., 2001, vol. 8, no. 5, p. 899-903. Go to original source... Go to PubMed...
    17. MAEDA, K. - MARKOWITZ, N. - HALLEY, RC., et al. Human infection with Ehlichia Cannes, a leukocyt Rickettsia. N. Engl. J. Med., 1987, vol. 316, no. 11, p. 853-756. Go to original source... Go to PubMed...
    18. PETROVEC, M. - LOTRIC, LS. - ZUPANC, TA., et al. Human disease in Europe cause by granulocytic Ehrlichia species. J. Clin. Microbiol., 1997, vol. 35, no. 4. p. 1556-1559. Go to original source... Go to PubMed...
    19. TAN, HP. - DUMLER, JS. - MALEY, JR., et. al. Human monocytic ehrlichiosis: An emerging pathogen in transplantation. Transplantation, 2001, vol. 71, no. 11, p. 1678-1680. Go to original source... Go to PubMed...
    20. ZEMAN, P. - PAZDIORA, P. - RÉBL, K., et al. Výskyt protilátek proti granulocytárním ehrlichiím u západočeské a středočeské populace. Epidemiol. Mikrobiol. Imunol., 2002, roč. 4, č. 1, s. 13-18.
    21. ZEMAN, P. - PAZDIORA, P. Současné poznatky o ehrlichióze. Prakt. Lékař, 2004, roč. 84, č. 12, s. 714-717.

    Return to the content