Volume 22, Number 2—February 2016
Dispatch
Anaplasmataceae-Specific PCR for Diagnosis and Therapeutic Guidance for Symptomatic Neoehrlichiosis in Immunocompetent Host
Michael Schwameis
, Julia Auer, Dieter Mitteregger, Ingrid Simonitsch-Klupp, Michael Ramharter, Heinz Burgmann, and Heimo Lagler
, Julia Auer, Dieter Mitteregger, Ingrid Simonitsch-Klupp, Michael Ramharter, Heinz Burgmann, and Heimo Lagler
Table
Clinical data at admission and primary diagnostic test results for a patient with Candidatus Neoehrlichia infection, Austria, 2013*
| Clinical variable | Finding/value |
|---|---|
| Subjective symptoms |
Malaise, diffuse muscle pain, dull headache (without signs of meningism), and tenderness in the left upper abdominal quadrant |
| Tympanic temperature |
37.8°C, while taking acetaminophen |
| Heart auscultation |
Systolic murmur (right sternal border), tachycardia (125 beats per minute) |
| Condition of skin |
No rash or signs of cutaneous exposure to arthropods |
| Laboratory testing† | |
| C-reactive protein | 5 mg/dL (<0.5) |
| Procalcitonin | 0.14 ng/mL (<0.5) |
| Leukocyte count | 3.9 × 109/L (4–10) |
| Neutrophils | 53% (50–75) |
| Lymphocytes | 27% (25–40) |
| Monocytes | 16% (0–12) |
| Fibrinogen | 480 mg/dL (180–390) |
| Serum amyloid A | 164 mg/L (<5) |
| γ-globulins | 26.2% (11.1–18.8) |
| Erythrocyte sedimentation rate | 70 mm/h (<15) |
| Platelet count | 121 × 109/L (150–350) |
| Hemoglobin |
9 g/dL (12–16) |
| Chest radiography |
No consolidations, no opacities |
| Abdominal ultrasonography |
Splenomegaly of 15.5 x 6.7 cm |
| Transesophageal echocardiography |
Normal cardiac function and valves, no evidence of vegetations |
| Cranial computed tomography |
Parasagittal meningioma, otherwise normal |
| Ophthalmologic examination |
Bilateral papilloedema |
| Cerebrospinal fluid |
Clear and colorless; absolute cell count 4/μL protein, glucose, and lactate levels within reference range |
| Abdominal ultrasonography |
Splenomegaly, 15.5 × 6.7 cm |
| Urinary dip stick and urinary cultures |
No growth |
| Blood cultures |
No growth |
| Serologic testing | |
| HIV | Negative |
| Hepatitis B and C viruses | Negative |
| Epstein-Barr virus | Negative |
| Cytomegalovirus | Negative |
| Mycoplasma spp. | Negative |
| Adenovirus | Negative |
| Enterovirus | Negative |
| Coxsackievirus | Negative |
| Influenza A,B, and C viruses | Negative |
| Parainfluenza virus | Negative |
| Anaplasma spp. | Negative |
| Rickettsia spp. | Negative |
| Tuberculous mycobacteria | Negative |
| Plasmodium spp. | Negative |
| Syphilis (VDRL, TPPA) |
Negative |
| PCR testing | |
| Leishmania spp. | Negative |
| Trypanosoma spp. | Negative |
| Plasmodium spp. |
Negative |
| Giemsa-stained thin and thick blood smears | |
| Plasmodium spp. | Negative |
*TPPA, Treponema pallidum particle agglutination assay; VDRL, Venereal Disease Research Laboratory test.
†Laboratory data are given as absolute number or percentage (reference range).
Page created: January 15, 2016
Page updated: January 15, 2016
Page reviewed: January 15, 2016
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