Mild clinical picture of human granulocytic anaplasmosis

Abstract

A. phagocytophilum je uzročnik humane granulocitne anaplazmoze (HGA). U najvećem dijelu Europe, uključujući i Hrvatsku, glavni vektor za A. phagocytophilim je Ixodes ricinus, a rezervoar su šumski sisavci. Najčešće HGA prolazi asimptomatski, eventualno uz kratkotrajni febrilitet. Ukoliko se bolest razvije, može poprimiti različite oblike, od lakih do izrazito teških. Simptomi su uglavnom nespecifični: febrilitet, mialgije, artralgije, zimice, mučnina, povraćanje i glavobolja. Osip se javlja rijetko. U jednog dijela bolesnika se mogu javiti neurološki simptomi. Može se prezentirati i kao vrućica nepoznata porijekla u trajanju i do dva mjeseca. U radu je prikazan blagi oblik HGA u šezdestšestogodišnje bolesnice u koje pored febriliteta, općeg algičkog sindroma s izraženom jakom glavoboljom i početnom smušenošću nema drugih vodećih simptoma bolesti. U laboratorijskim nalazima kod dolaska registrirana je blago povišena vrijednost CRP-a, blaža jetrena lezija, leukopenija, trombocitopenija, povišena vrijednost LDH i diselektrolitemija. Dijagnoza je postavljena serološki nakon što je bolesnica otpuštena iz bolnice. Tijekom hospitalizacije, bolesnica je liječena simptomatski. U centralnoj i sjeverozapadnoj Hrvatskoj je moguće očekivati pojavu infekcija A. phagocytophilum i posljedično razvoj HGA te na ovu bolest treba misliti u diferencijalnoj dijagnostici bolesti koje se prenose krpeljima.A. phagocytophilum is the causative agent of human granulocytic anaplasmosis (HGA). In most of Europe, including Croatia, the main vector for the A.phagocytophilim is Ixodes ricinus, and reservoirs are forest mammals. HGA is usually asymptomatic, possibly with short-term fever. If the disease develops, it can take different forms, ranging from mild to severe. Symptoms are usually nonspecific: fever, myalgia, arthralgia, chills, nausea, vomiting and headache. The rash occurs rarely. Some of the patients may experience neurological symptoms. It may present as fever of unknown origin lasting up to two months. Here we present a mild form of HGA in a 66-year old female patient. Besides fever, algic syndrome with severe headache and expressed initial disorientation, no other leading symptoms were recorded. The laboratory findings registered on admission were: slightly elevated CRP levels, a mild liver lesion, leucopenia, thrombocytopenia, elevated LDH value and electrolyte disorders. The diagnosis was based on serology after the patient was discharged from the hospital. During hospitalization, the patient was treated symptomatically. In central and northwestern Croatia, we can expect the occurrence of A. phagocytophilum infection and subsequent development of the HGA, and the disease should be considered in the differential diagnosis of diseases transmitted by ticks