评估由游走性红斑皮肤损害表现的早期莱姆病中嗜吞噬细胞无形体的存在。

Assessment of Anaplasma phagocytophilum presence in early Lyme borreliosis manifested by erythema migrans skin lesions.

机构信息

Department of Infectious Diseases and Neuroinfections Medical University in Białystok, Żurawia 14, 15-540, Białystok, Poland.

出版信息

Travel Med Infect Dis. 2020 Jul-Aug;36:101648. doi: 10.1016/j.tmaid.2020.101648. Epub 2020 Apr 1.

DOI:10.1016/j.tmaid.2020.101648

PMID:32247015

Abstract

BACKGROUND

To investigate to what extent early Lyme borreliosis patients with erythema migrans are infected with Anaplasma phagocytophilum.

METHODS

Three hundred ten patients from Poland with erythema migrans were included in the study. One hundred and eighty-three patients (59%) agreed to have both skin biopsy and blood samples analysed for Borrelia burgdorferi, A. phagocytophilum and 'Candidatus Neoehrlichia mikurensis', with PCR. Positive samples were confirmed with sequencing.

RESULTS

B. burgdorferi DNA was detected in 49.7% of the skin samples and in 1.1% of the blood samples. A. phagocytophilum DNA was found in 7.1% blood samples, and in 8.2% of the skin biopsies. In four patients, A. phagocytophilum DNA was detected only in blood; in one case A. phagocytophilum DNA was found simultaneously in blood and skin, and additionally in this patients' blood Borrelia DNA was detected. In four skin samples B. burgdorferi DNA was detected simultaneously with A. phagocytophilum DNA, indicative of a co-infection.

CONCLUSIONS

A. phagocytophilum may be present in early Lyme borreliosis characterized by erythema migrans and should always be considered as a differential diagnostic following a tick bite and considered in treatment schemes, as these differs (in early stage of Lyme borreliosis doxycycline, amoxicillin, cefuroxime axetil and azithromycin are recommended, while in anaplasmosis the most effective courses of treatment are doxycycline, rifampin and levofloxacin). Consequently, the role of A. phagocytophilum in erythema migrans should be further studied.

摘要

背景

为了研究患有游走性红斑的早期莱姆病患者感染嗜吞噬细胞无形体的程度。

方法

本研究纳入了来自波兰的 310 名患有游走性红斑的患者。其中 183 名患者（59%）同意同时进行皮肤活检和血液样本分析，以检测伯氏疏螺旋体、嗜吞噬细胞无形体和“候选新立克次体”，采用 PCR 方法。阳性样本通过测序进行确认。

结果

在 49.7%的皮肤样本和 1.1%的血液样本中检测到伯氏疏螺旋体 DNA。在 7.1%的血液样本和 8.2%的皮肤活检中发现了嗜吞噬细胞无形体 DNA。在 4 名患者中，仅在血液中检测到嗜吞噬细胞无形体 DNA；在 1 例患者中，同时在血液和皮肤中检测到嗜吞噬细胞无形体 DNA，并且在该患者的血液中还检测到了伯氏疏螺旋体 DNA。在 4 个皮肤样本中同时检测到伯氏疏螺旋体 DNA 和嗜吞噬细胞无形体 DNA，提示存在合并感染。

结论

嗜吞噬细胞无形体可能存在于以游走性红斑为特征的早期莱姆病中，在被蜱叮咬后应始终将其视为鉴别诊断，并考虑将其纳入治疗方案，因为在早期莱姆病中，推荐使用多西环素、阿莫西林、头孢呋辛酯和阿奇霉素，而在无形体病中，最有效的治疗方案是多西环素、利福平和平氟沙星。因此，嗜吞噬细胞无形体在游走性红斑中的作用应进一步研究。