Neoehrlichia mikurensis-An emerging opportunistic tick-borne infection in immunosuppressed patients.

Autor: Gynthersen RMM; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Stensvold CR; Laboratory of Parasitology, Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark., Nielsen SL; Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark., Møller HJ; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Nielsen HV; Laboratory of Parasitology, Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark., Lebech AM; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Christensen JR; Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark., Mens H; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., El Fassi D; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.; Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Jazyk: angličtina
Zdroj: Journal of internal medicine [J Intern Med] 2023 Jun; Vol. 293 (6), pp. 782-790. Date of Electronic Publication: 2023 Apr 12.
DOI: 10.1111/joim.13638
Abstrakt: Background: Neoehrlichia mikurensis (N. mikurensis) is a newly discovered tick-borne pathogen that can inflict life-threatening illness in immunocompromised patients. N. mikurensis infection is only detectable by polymerase chain reaction (PCR)-based methodologies. We describe three distinct clinical manifestations of N. mikurensis infection (neoehrlichiosis) in Danish patients receiving B-lymphocyte-depleting therapy, rituximab, for underlying hematological, rheumatological, or neurological disorders. All three patients went through a protracted pre-diagnostic period.
Methods: N. mikurensis DNA was detected and confirmed using two methods. Blood was tested by specific real-time PCR targeting the groEL gene and by 16S and 18S profiling followed by sequencing. Bone marrow was analyzed by 16S and 18S profiling.
Results: N. mikurensis was detected in blood samples in all three cases and in bone marrow from one of the three. The severity of the symptoms ranged from prolonged fever lasting more than 6 months to life-threatening hyperinflammation in the form of hemophagocytic lymphohistiocytosis (HLH). Interestingly, all patients presented with splenomegaly and two with hepatomegaly. After starting doxycycline therapy, symptoms were relieved within a few days, and biochemistry and organomegaly quickly normalized.
Conclusion: We present three Danish patients recognized by the same clinician over a period of 6 months, strongly suggesting that many cases are going unrecognized. Second, we describe the first case of N. mikurensis-induced HLH and emphasize the potential severity of undetected neoehrlichiosis.
(© 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)
Databáze: MEDLINE
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