Grzeszczuk Anna, Ziarko Sławomir, Kovalchuk Oksana, Stańczak Joanna
Department of Infectious Diseases, Medical University of Białystok, Zurawia 14 St., PL-15-540 Białystok, Poland.
Int J Med Microbiol. 2006 May;296 Suppl 40:242-9. doi: 10.1016/j.ijmm.2006.01.007. Epub 2006 Mar 10.
Febrile tick-borne diseases can be caused by different pathogens. The study objective was to prospectively determine the etiology of infection among adults exposed to tick bite and to detect acute human granulocytic anaplasmosis (HGA), a recently emerging infection, in north-eastern Poland. We evaluated 68 patients (34 males and 34 females, mean age 44.2+/-15 years) who had fever within 4 weeks after a tick bite. Paired sera were tested for antibodies against tick-borne encephalitis virus, Borrelia burgdorferi and Anaplasma phagocytophilum. Microscopic examination of EDTA whole blood and nested PCR targeting A. phagocytophilum 16S rDNA gene fragment were carried out at enrolment. Tick-borne infections were diagnosed in 57 individuals (84%). Sixty-four patients were hospitalised. Tick-borne encephalitis (TBE) was revealed in 49 cases; in 39 patients as a single infection, in three patients concurrent with erythema migrans or other Lyme borreliosis symptoms, in five patients concurrent with probable or possible Lyme borreliosis, and in two patients concurrent with A. phagocytophilum infection. Diagnosis of HGA was confirmed in one patient by PCR and in another one by seroconversion. In two further individuals, A. phagocytophilum infection was confirmed by immunofluorescence (antibody titers > or = 1:128), which, however, does not fulfil the ESCAR (European Society of Clinical Microbiology and Infectious Diseases Study Group on Coxiella, Anaplasma, Rickettsia, and Bartonella) criteria for HGA case definition. Lyme borreliosis was diagnosed in 16 patients; in six of them as a single infection. Both confirmed HGA cases and seropositive individuals had A. phagocytophilum infection concurrent either with Lyme borreliosis (two cases) or with TBE (two cases). The clinical course was severe in three and moderate to mild in the remaining TBE cases, as well as in all Lyme borreliosis and HGA cases. TBE was found the most prevalent disease among adults with febrile illnesses occurring after a tick bite in north-eastern Poland. Concurrent tick-borne infections were frequent with multiple pathogens involved. Two confirmed acute HGA cases (fulfilling the European case definition criteria defined by ESCAR) were detected for the first time in a prospective manner in Poland.
发热性蜱传疾病可由不同病原体引起。本研究的目的是前瞻性地确定蜱叮咬后成年感染者的感染病因，并在波兰东北部检测一种新出现的感染——急性人类粒细胞无形体病（HGA）。我们评估了68例患者（34例男性和34例女性，平均年龄44.2±15岁），他们在蜱叮咬后4周内出现发热症状。对配对血清检测抗蜱传脑炎病毒、伯氏疏螺旋体和嗜吞噬细胞无形体的抗体。在入组时对乙二胺四乙酸（EDTA）全血进行显微镜检查，并对嗜吞噬细胞无形体16S rDNA基因片段进行巢式聚合酶链反应（PCR）。57例个体（84%）诊断为蜱传感染。64例患者住院治疗。49例患者确诊为蜱传脑炎（TBE）；39例为单一感染，3例同时伴有游走性红斑或其他莱姆病疏螺旋体病症状，5例同时伴有可能的莱姆病疏螺旋体病，2例同时伴有嗜吞噬细胞无形体感染。1例患者通过PCR确诊为HGA，另1例通过血清学转换确诊。另外2例个体通过免疫荧光法（抗体滴度≥1:128）确诊为嗜吞噬细胞无形体感染，然而，这不符合欧洲临床微生物学和传染病学会无形体、立克次体和巴尔通体研究组（ESCAR）关于HGA病例定义的标准。16例患者诊断为莱姆病疏螺旋体病；其中6例为单一感染。确诊的HGA病例和血清学阳性个体均同时感染嗜吞噬细胞无形体，其中2例同时伴有莱姆病疏螺旋体病，2例同时伴有TBE。其余TBE病例以及所有莱姆病疏螺旋体病和HGA病例的临床病程，3例严重，其余为中度至轻度。在波兰东北部，TBE被发现是蜱叮咬后发热疾病成年患者中最常见的疾病。蜱传感染常并发多种病原体。波兰首次前瞻性地检测到2例确诊的急性HGA病例（符合ESCAR定义的欧洲病例标准）。
