Acute Pericarditis in Co-Infection with Anaplasma phagocytophilum and Borrelia burgdorferi - a Case Report

Lajmska borelioza i krpeljni meningoencefalitis (KME) najčešće su bolesti prenosive krpeljima u Republici Hrvatskoj. Isti vektor, krpelj roda Ixodes ricinus, odgovoran je i za prijenos humane granulocitne anaplazmoze (HGA) koja se u našoj zemlji rijetko dokazuje, a prvi slučajevi su potvrđeni 1998. godine u Koprivničko-križevačkoj županiji. HGA se najčešće klinički prezentira vrućicom s leukopenijom, trombocitopenijom, povišenim aminotransferazama i CRP-om, a potvrđuje se serološki, pri čemu se povremeno dokaže koinfekcija s virusom KME i/ili bakterijom Borrelia burgdorferi. Prikazujemo slučaj 44-godišnje bolesnice koja je ambulantno liječena u Klinici za infektivne bolesti Kliničkog bolničkog centra Rijeka zbog vrućice s bicitopenijom (leukopenija, trombocitopenija) i akutnog perikarditisa. Serološkom je obradom dokazana akutna koinfekcija uzročnicima Anaplasma phagocytophilum i Borrelia burgdorferi. Liječenje je provedeno doksiciklinom i nesteroidnim antireumaticima, čime je postignut povoljan klinički odgovor.Lyme borreliosis and European tick-borne encephalitis are the most common tick-borne infections in Croatia. The common vector, Ixodes ricinus, is also responsible for the transmission of human granulocytic anaplasmosis (HGA), which, in our country is rarely detected, and the first cases were confirmed in the Koprivnica-Križevci County in 1998. HGA most commonly presents as fever with leukopenia, thrombocytopenia and altered aminotransferases and C reactive protein. The diagnosis is usually confirmed serologically and coinfection with European tick-borne encephalitis virus and Borrelia burgdorferi is rarely diagnosed. We present a 44-year-old, previously healthy patient, treated for fever with bicytopenia (leukopenia, thrombocytopenia) and acute pericarditis. Acute coinfection with Anaplasma phagocytophilum and B. burgdorferi was established serologically. The patient was treated with doxycycline and nonsteroidal noninflammatory drugs with favourable clinical outcome