Chang Feng-Yee, Wang Ruo-Yu, Yen Tsai-Ying, Shu Pei-Yun, Yang Su-Lin
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
J Formos Med Assoc. 2023 Mar;122(3):286-289. doi: 10.1016/j.jfma.2022.08.018. Epub 2022 Sep 9.
Human granulocytic anaplasmosis (HGA) is a tick-borne infection caused by the bacterium Anaplasma phagocytophilum. In this study, we report an indigenous case of clinically diagnosed HGA. The patient was a 41-year-old man who experienced a tick bite and later developed fever, chills, myalgia, malaise, thrombocytopenia, leukocytosis with a left shift, elevated hepatic transaminase levels, and splenomegaly upon admission to the hospital. Immunofluorescence assays detected seroconversion against A. phagocytophilum, whereas tests for spotted fever group rickettsiae, murine typhus, scrub typhus, Q fever, and ehrlichiosis were negative. ELISA and Western blot analysis using recombinant MSP2 protein confirmed the exposure to A. phagocytophilum. Oral doxycycline and intravenous ceftriaxone were prescribed, and the patient made a full recovery. Our findings indicate the presence of HGA on the main island of Taiwan. Precautions against tick bites should be taken when engaging in outdoor activities, and HGA should be considered by physicians in the differential diagnosis.
人粒细胞无形体病（HGA）是一种由嗜吞噬细胞无形体引起的蜱传播感染。在本研究中，我们报告了一例临床诊断为HGA的本土病例。患者为一名41岁男性，曾被蜱叮咬，随后出现发热、寒战、肌痛、乏力、血小板减少、白细胞增多伴核左移、肝转氨酶水平升高及脾肿大，入院时被诊断为此病。免疫荧光检测发现针对嗜吞噬细胞无形体的血清转化，而斑点热群立克次体、鼠型斑疹伤寒、恙虫病、Q热和埃立克体病检测均为阴性。使用重组MSP2蛋白进行的ELISA和Western blot分析证实患者接触过嗜吞噬细胞无形体。给予患者口服强力霉素和静脉注射头孢曲松治疗，患者完全康复。我们的研究结果表明台湾主岛存在HGA。进行户外活动时应采取预防蜱叮咬的措施，医生在鉴别诊断时应考虑HGA。
