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

� 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].
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