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Volume 22, Number 10—October 2016

Accuracy of Diagnosis of Human Granulocytic Anaplasmosis in China

Gary P. WormserComments to Author 
Author affiliation: New York Medical College, Valhalla, New York, USA

Main Article

Table 4

Selected clinical and laboratory variables of patients with an HGA diagnosis in China and the United States*

Variable China, no. (%) patients† United States, no. (%) patients‡ p value§
Number 165 44
Headache 38 (23.0) 36 (81.8) <0.0001
Myalgias 44 (26.7) 33 (75.0) <0.0001
Diarrhea 63 (38.2) 6 (13.6) 0.002
Leukopenia¶ 144/145 (99.3) 24 (54.5) <0.0001
<100,000 platelets/mm3 151 (91.5) 13 (29.5) <0.0001

*HGA, human granulocytic anaplasmosis.
†3 case series of HGA published in 2011, 2013, and 2015 (2022).
‡Case series of culture-confirmed HGA published in 2013 (4).
§Fisher exact test.
¶<4,500, <3,600, <4,000 leukocytes/mm3 for references (4), (20), and (22), respectively.

Main Article

  1. Zhang  L, Liu  Y, Ni  D, Li  Q, Yu  Y, Yu  XJ, Nosocomial transmission of human granulocytic anaplasmosis in China. JAMA. 2008;300:226370.DOIPubMedGoogle Scholar
  2. Fang  L-Q, Liu  K, Li  X-L, Liang  S, Yang  Y, Yao  HW, Emerging tick-borne infections in mainland China: an increasing public health threat. Lancet Infect Dis. 2015;15:146779.DOIPubMedGoogle Scholar
  3. Bakken  JS, Dumler  JS. Human granulocytic anaplasmosis. Infect Dis Clin North Am. 2015;29:34155.DOIPubMedGoogle Scholar
  4. Wormser  GP, Aguero-Rosenfeld  ME, Cox  ME, Nowakowski  J, Nadelman  RB, Holmgren  D, Differences and similarities between culture-confirmed human granulocytic anaplasmosis and early lyme disease. J Clin Microbiol. 2013;51:9548.DOIPubMedGoogle Scholar
  5. Krause  PJ, Wormser  GP. Nosocomial transmission of human granulocytic anaplasmosis? JAMA. 2008;300:23089.DOIPubMedGoogle Scholar
  6. Johnson  BJB, Pilgard  MA, Russell  TM. Assessment of new culture method for detection of Borrelia species from serum of lyme disease patients. J Clin Microbiol. 2014;52:7214.DOIPubMedGoogle Scholar
  7. Yu  X-J, Liang  M-F, Zhang  S-Y, Liu  Y, Li  JD, Sun  YL, Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med. 2011;364:152332.DOIPubMedGoogle Scholar
  8. Xu  B, Liu  L, Huang  X, Ma  H, Zhang  Y, Du  Y, Metagenomic analysis of fever, thrombocytopenia and leukopenia syndrome (FTLS) in Henan Province, China: discovery of a new bunyavirus. PLoS Pathog. 2011;7:e1002369.DOIPubMedGoogle Scholar
  9. Liu  Q, He  B, Huang  S-Y, Wei  F, Zhu  X-Q. Severe fever with thrombocytopenia syndrome, an emerging tick-borne zoonosis. Lancet Infect Dis. 2014;14:76372.DOIPubMedGoogle Scholar
  10. Liu  S, Chai  C, Wang  C, Amer  S, Lv  H, He  H, Systematic review of severe fever with thrombocytopenia syndrome: virology, epidemiology, and clinical characteristics. Rev Med Virol. 2014;24:90102.DOIPubMedGoogle Scholar
  11. Liu  Y, Li  Q, Hu  W, Wu  J, Wang  Y, Mei  L, Person-to-person transmission of severe fever with thrombocytopenia syndrome virus. Vector Borne Zoonotic Dis. 2012;12:15660.DOIPubMedGoogle Scholar
  12. Bao  C-J, Guo  X-L, Qi  X, Hu  JL, Zhou  MH, Varma  JK, A family cluster of infections by a newly recognized bunyavirus in eastern China, 2007: further evidence of person-to-person transmission. Clin Infect Dis. 2011;53:120814.DOIPubMedGoogle Scholar
  13. Kim  WY, Choi  W, Park  S-W, Wang  EB, Lee  WJ, Jee  Y, Nosocomial transmission of severe fever with thrombocytopenia syndrome in Korea. Clin Infect Dis. 2015;60:16813.DOIPubMedGoogle Scholar
  14. Tang  X, Wu  W, Wang  H, Du  Y, Liu  L, Kang  K, Human-to-human transmission of severe fever with thrombocytopenia syndrome bunyavirus through contact with infectious blood. J Infect Dis. 2013;207:7369.DOIPubMedGoogle Scholar
  15. Gai  Z, Liang  M, Zhang  Y, Zhang  S, Jin  C, Wang  SW, Person-to-person transmission of severe fever with thrombocytopenia syndrome bunyavirus through blood contact. Clin Infect Dis. 2012;54:24952.DOIPubMedGoogle Scholar
  16. Chen  H, Hu  K, Zou  J, Xiao  J. A cluster of cases of human-to-human transmission caused by severe fever with thrombocytopenia syndrome bunyavirus. Int J Infect Dis. 2013;17:e2068.DOIPubMedGoogle Scholar
  17. Jiang  XL, Zhang  S, Jiang  M, Bi  ZQ, Liang  MF, Ding  SJ, A cluster of person-to-person transmission cases caused by SFTS virus in Penglai, China. Clin Microbiol Infect. 2015;21:2749.DOIPubMedGoogle Scholar
  18. Wormser  GP. Human granulocytic anaplasmosis and Lyme disease. JAMA. 2016;316:989.DOIPubMedGoogle Scholar
  19. Liu  Y, Yu  X-J. Human granulocytic anaplasmosis and Lyme disease–reply. JAMA. 2016;316:99.DOIPubMedGoogle Scholar
  20. Zhang  L, Wang  G, Liu  Q, Chen  C, Li  J, Long  B, Molecular analysis of Anaplasma phagocytophilum isolated from patients with febrile diseases of unknown etiology in China. PLoS One. 2013;8:e57155.DOIPubMedGoogle Scholar
  21. Jiao  X-Y, Fan  Z-C, Li  Y-Z, Tang  Y-T, Ke  C-W. Clinical and laboratory features parameters of human granulocytic anaplasmosis (HGA) in patients admitted to hospital in Guangdong Province, China. Trop Doct. 2015;45:20913.DOIPubMedGoogle Scholar
  22. Li  H, Zhou  Y, Wang  W, Guo  D, Huang  S, Jie  S. The clinical characteristics and outcomes of patients with human granulocytic anaplasmosis in China. Int J Infect Dis. 2011;15:e85966.DOIPubMedGoogle Scholar
  23. Sun  X-F, Zhao  L, Wen  H-L, Luo  L-M, Yu  X-J. Anaplasma species in China. Lancet Infect Dis. 2015;15:12634.DOIPubMedGoogle Scholar
  24. Li  H, Zheng  Y-C, Ma  L, Jia  N, Jiang  BG, Jiang  RR, Human infection with a novel tick-borne Anaplasma species in China: a surveillance study. Lancet Infect Dis. 2015;15:66370.DOIPubMedGoogle Scholar
  25. Chapman  AS, Bakken  JS, Folk  SM, Paddock  CD, Bloch  KC, Krusell  A, ; Tickborne Rickettsial Diseases Working Group; CDC. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. 2006;55(RR-4):127.PubMedGoogle Scholar
  26. Aguero-Rosenfeld  ME, Donnarumma  L, Zentmaier  L, Jacob  J, Frey  M, Noto  R, Seroprevalence of antibodies that react with Anaplasma phagocytophila, the agent of human granulocytic ehrlichiosis, in different populations in Westchester County, New York. J Clin Microbiol. 2002;40:26125.DOIPubMedGoogle Scholar
  27. Zhang  S, Hai  R, Li  W. Li G, Lin G, He J et al. Seroprevalance of human granulocytic anaplasmosis in central and southeastern China. Am J Trop Med Hyg. 2009;81:293–5.
  28. Xie  Y-T, Lai  D-H, Liu  G-Y, Zhou  J-L, Lun  Z-R. Severe fever with thrombocytopenia syndrome in China. Lancet Infect Dis. 2015;15:145.DOIPubMedGoogle Scholar

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Page updated: September 26, 2016
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