Infectiologic differential diagnosis of chronic Lyme disease and so ...

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- Ehrlichia chaffeensis [1] - Anaplasma phagocytophilum [2] E. chaffeensis infects monocytes; A. Phagocytophila, granulocytes. E. chaffeensis is the pathogen of human monocytic ehrlichiosis (HME), a very rare infectious disease, which occurs primarily in the USA and some regions of South America, but practically nowhere else on earth. E. phagocytophila is the pathogen of human granulocytic anaplasmosis, another extremely rare disease in the USA with an annual incidence of approximately 10 / 1 million in habitants [3]. The infection data and symptomatology are compiled in Table 22. Table 22 Human granulocytic anaplasmosis (HGA) Infection data, symptomatology, treatment Pathogen: - E. chaffeensis and Anaplasma phagocytophilum Transmission: - Ticks (I. ricinus (Europe), I. scapularis (USA)) Reservoirs: - Red deer, human beings (E. chaffeensis). White-footed mice (Anaplasma phagocytophilum) Intracellular localization Symptomatology: - Fever - Influenza-like symptoms - Headaches - Joint pains - Muscle pains - Coughing - CNS disorders - Meningitis Pathological laboratory findings: 38
� Leukopenia � Thrombocytopenia � Elevated transaminases � Anemia (rare) � Elevated creatinine (rare) Treatment: - Doxycycline The pathological importance of human monocytic ehrlichiosis (HME) and human granulocytic anaplasmosis (HGA) was discovered in 1986 and 1994, respectively [35, 36]. The two infectious diseases resemble each other clinically and with regard to laboratory findings. The pathogens develop in monocytes (HME) or in granulocytic leukocytes (HGA). Thus, their localization is exclusively intracellular. The pathogens are transmitted by ticks, in the United States primarily via Ixodes scapularis, in Europe, via I. ricinus. Important reservoirs: deer (HME); wood mice (HGA) In addition, other modes of transmission are being discussed: mother-child transmission, blood transfusions, direct contact with infected animals, transmission form person to person [37, 38, 41, 42, 43, 44]. Scientific reports on illnesses due to HGA in Europe are rarities [4]. However, studies in Northern Italy showed that 24% of the ticks (I. ricinus) were infected by E. chaffeensis or A. phagocytophilum. Similar figures have been substantiated in the Netherlands and in Poland, whereas in Germany they are at approximately 2% [5 - 10]. The figures for the East Coast of the United States were higher; approximately of the order of 30% - 40% [11, 12]. In patients with Lyme disease the seroprevalence for A. phagocytophilum in Europe is approximately 10% [13 - 15]. Similar figures were also obtained in the USA [16]. 39
Page 1 and 2: Infectiologic differential diagnosi
Page 3 and 4: 3 Anamnistically, one has to consid
Page 5 and 6: Table 2 LD coinfections (not tick-b
Page 7 and 8: Table 5 Bartonellosis’ infection
Page 9 and 10: Table 6 Main disease manifestations
Page 11 and 12: 11 Fig. 1. Erythrocytes infected wi
Page 13 and 14: 13 Bartonellae are localized in ery
Page 15 and 16: ESR und CRP elevated Hypercalcemia
Page 18 and 19: Table 9 Antibiotic treatment of bar
Page 20 and 21: antibiosis is that the antibiotic i
Page 22 and 23: The laboratory diagnostics for Chla
Page 24 and 25: The arthritis occurs in 1% of the u
Page 26 and 27: In the differential diagnosis of Ly
Page 28 and 29: Late phase: - Reactive arthritis -
Page 30 and 31: the depiction of chronic yersiniosi
Page 32 and 33: In Yersinia-PCR-positive patients,
Page 34 and 35: - Incubation period 3 weeks - Atypi
Page 36 and 37: system, of the skin and other organ
Page 40 and 41: Since seroprevalence merely express
Page 42 and 43: B. microti is the predominant patho
Page 44 and 45: epresent a major health hazard and
Page 46 and 47: The decisive diagnostic information
Page 48 and 49: Probable: IFA IgG 1:1024 and one of
Page 50 and 51: The main manifestation of the Campy
Page 52 and 53: The term “reactive arthritis” i
Page 54 and 55: In the diagnosis of a “reactive a
Page 56 and 57: Table 27 Disease manifestations of
Page 58 and 59: addition, other pathogens discussed
Page 60 and 61: [8] Schouls LM, Van De Pol I, Rijpk
Page 62 and 63: [25] Hermanowska-Szpakowicz T, Skot
Page 64 and 65: [43] Bakken JS, Krueth JK, Lund T,
Page 66 and 67: [60] Fox LM, Wingerter S, Ahmed A e
Page 68 and 69: [80] Marra CM. Neurologic complicat
Page 70 and 71: [100] Pulliainen AT, Dehio C. Barto
Page 72 and 73: [118] Bass JW, Freitas BC, Freitas
Page 74 and 75: [137] Gaydos CA, Roblin PM, Hammers
Page 76 and 77: [155] Cover TL, Aber RC. Yersinia e
Page 78 and 79: multi-organ donors for the presence
Page 80 and 81: [190] Straubinger RK, Straubinger A
Page 82 and 83: [208] Bitnun A, Ford-Jones E, Blase
Page 84 and 85: patients with reactive and undiffer
Page 86 and 87: [242] Appelbaum PC, Gillespie SH, B
Page 88 and 89:
pneumoniae infection associated wit
Page 90 and 91:
[276] Thomas NH, Collins JE, Robb S
Page 92 and 93:
[294] File TM Jr, Segreti J, Dunbar
Page 94 and 95:
[310] Sorvillo FJ, Lieb LE, Waterma
Page 96 and 97:
henselae Isolates Collected from Ca
Page 98 and 99:
[345] Raoult D, Levy PY, Harlé JR,
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