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Clin Infect Dis. 2014 Jun;58(12):1716-22. doi: 10.1093/cid/ciu189. Epub 2014 Mar 18.

Infections with the tick-borne bacterium "Candidatus Neoehrlichia mikurensis" mimic noninfectious conditions in patients with B cell malignancies or autoimmune diseases.

Author information

1
Department of Clinical Microbiology/Infectious Diseases, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg.
2
Department of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg.
3
Department of Internal Medicine, Karlstad Hospital, Karlstad.
4
Department of Rheumatology, Sahlgrenska University Hospital, Göteborg.
5
Department of Medicine, Kungälv Hospital, Kungälv, Sweden.
6
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
7
Laboratory for Molecular Diagnostics, CHAMBON Laboratories, Prague, Czech Republic.
8
Mikrobiologische Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
9
Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.
10
Department of Clinical Microbiology/Infectious Diseases, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg Department of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg.

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 Both published (6) and unpublished cases (5) were included.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.

KEYWORDS:

B-cell malignancies; human; infection, Neoehrlichia; tick-borne

Comment in

PMID:
24647019
DOI:
10.1093/cid/ciu189
[Indexed for MEDLINE]
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