Marshfield Clinic Research Institute.
Marshfield Clinic, Marshfield, Wisconsin.
J Pediatric Infect Dis Soc. 2018 May 15;7(2):e9-e15. doi: 10.1093/jpids/pix029.
Adults with the tick-borne disease human granulocytic anaplasmosis (HGA) have a spectrum of acute febrile illnesses that, if untreated, might be severe. Clinical presentation and outcomes of children with HGA have been poorly described.
A retrospective analysis was conducted to determine the frequency, presentation, and outcomes of pediatric patients with HGA between 1994 and 2015 in a region of Wisconsin in which HGA is highly endemic. Patients with related International Classification of Diseases Ninth and Tenth Revision (ICD-9 and ICD-10, respectively) codes or positive HGA laboratory test results were evaluated and classified as having had confirmed, probable, or suspected HGA on the basis of the Centers for Disease Control and Prevention (CDC) case definition. The Fisher's exact and Wilcoxon rank-sum tests were used in statistical comparisons.
Of 187 children identified with possible HGA, 17 (9%) had confirmed, 75 (40%) had probable, and 91 (49%) had suspected infections. The number of cases rose sharply in 2010 and has remained between 16 and 36 cases per year since that time. A minority of children with confirmed or probable infections had elevated liver transaminase levels (33%), leukopenia (24%), thrombocytopenia (17%), or anemia (8%); 6 (7%) of these children required hospitalization. Children with evidence of concurrent HGA and Lyme disease (27% of confirmed or probable cases) had a higher risk of hospitalization (odds ratio, 6.55 [95% confidence interval, 1.11-38.78]). None of these children had life-threatening disease or died.
Evidence suggests that the frequency of HGA in children is increasing. Although most children had mild disease, doxycycline remains the treatment of choice, because outcome data for children without treatment remains limited.
患有蜱传性人粒细胞无形体病（HGA）的成年人会出现一系列急性发热性疾病，如果不治疗，可能会很严重。儿童 HGA 的临床表现和结局描述甚少。
对 1994 年至 2015 年威斯康星州一个 HGA 高度流行地区的 HGA 儿科患者的发生频率、表现和结局进行了回顾性分析。具有相关国际疾病分类第九和第十版（分别为 ICD-9 和 ICD-10）编码或 HGA 实验室检测阳性结果的患者，根据疾病预防控制中心（CDC）的病例定义，评估并分类为确诊、可能或疑似 HGA。统计比较采用 Fisher 确切概率法和 Wilcoxon 秩和检验。
在 187 例可能患有 HGA 的儿童中，17 例（9%）为确诊病例，75 例（40%）为可能病例，91 例（49%）为疑似病例。2010 年病例数急剧增加，此后每年保持在 16 至 36 例之间。少数确诊或可能感染的儿童存在肝转氨酶升高（33%）、白细胞减少（24%）、血小板减少（17%）或贫血（8%）；其中 6 例（7%）需要住院治疗。有合并 HGA 和莱姆病证据的儿童（确诊或可能病例的 27%）住院风险更高（比值比，6.55[95%置信区间，1.11-38.78]）。这些儿童均无危及生命的疾病或死亡。
有证据表明儿童 HGA 的发病率正在增加。尽管大多数儿童的疾病较轻，但多西环素仍然是治疗的首选，因为没有治疗的儿童的结局数据仍然有限。
