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Volume 22, Number 2—February 2016

Anaplasmataceae-Specific PCR for Diagnosis and Therapeutic Guidance for Symptomatic Neoehrlichiosis in Immunocompetent Host

Michael SchwameisComments to Author , Julia Auer, Dieter Mitteregger, Ingrid Simonitsch-Klupp, Michael Ramharter, Heinz Burgmann, and Heimo LaglerComments to Author 
Author affiliations: Medical University of Vienna, Vienna, Austria

Main Article


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)
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)
PCR testing
Leishmania spp. Negative
Trypanosoma spp. Negative
Plasmodium spp.
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).

Main Article

Page created: January 15, 2016
Page updated: January 15, 2016
Page reviewed: January 15, 2016
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