Volume 22, Number 2—February 2016
Dispatch
Anaplasmataceae-Specific PCR for Diagnosis and Therapeutic Guidance for Symptomatic Neoehrlichiosis in Immunocompetent Host
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).