Severe Anaplasmosis presenting as possible CVA: Case report and 3-year Anaplasma infection diagnosis data is based on PCR testing and serology

Abstract

Introduction Anaplasmosis is a tick-borne illness caused by Anaplasma phagocytophilum . A review of CDC reports showed an increase in Anaplasmosis, with 1,193 cases reported in 2009 compared to 5,672 cases reported in 2017, with the majority of cases between May and October. Neurologic manifestations are uncommon. Case A 72-year-old male presented in August with acute left-sided weakness. Patient was found to have an acute kidney injury (creatinine 5.3 mg/dL), thrombocytopenia (platelet count 25,000/mL), and rhabdomyolysis (CPK 25,000 units/L). Workup for an acute stroke was negative. Peripheral blood smears showed Anaplasma neutrophil inclusions in >30 % of the buffy coat prep. PCR testing was positive for Anaplasmosis. He was treated with doxycycline for 10 days, with improvement within 48 h. He was discharged home after a 13-day hospital course with no residual neurological deficits. A review of our medical system between January 1st, 2016 and December 31st, 2018 revealed 20 cases of Anaplasmosis. All cases presented between May and December and had fever of unclear etiology, but only our case presented with stroke-like symptoms. All cases involved people living in heavily wooded areas, with a mean age of 70 years. Discussion The typical presentation of Anaplasmosis is a nonspecific febrile illness with leukopenia and thrombocytopenia. Although headache is common, stroke-like symptoms are a rare but known complication. Elderly and immunocompromised patients living in heavily wooded areas are at higher risk for Anaplasmosis. Delayed diagnosis was common (55 % of case review) and associated with worse prognosis.

Redox Imbalance and Its Metabolic Consequences in Tick-Borne Diseases

“…The incidence of HGA cases in the USA has increased steadily since the disease became reportable from 348 cases in 2000 to 5,655 cases in 2019. The number of annually reported HGA cases in Europe is lower; however, there is insufficient epidemiological data as the disease is underdiagnosed or underreported (Matei et al, 2019;Eldaour et al, 2021). Ticks are vectors of a wide variety of viruses, also known as tick-borne viruses or tiboviruses (TBV).…”

Human Granulocytic Anaplasmosis—A Systematic Review of Published Cases

“…Of 110 patients, 58 (52.7%) were male, and 9 (8.2%) did not have a gender reported [ 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , …”

“…Uncommon presentations included: myocarditis, seizures, short-term memory impairment, orchitis, glomerulonephritis, myositis with severe rhabdomyolysis, peripheral neuropathy at the site of a tick bite, cerebral infarct, Sweet syndrome, and hemophagocytic lymphohistiocytosis (HLH) [ 35 , 38 , 39 , 63 , 81 , 86 , 90 , 91 ].…”

An Atypical Presentation of a Severe Case of Anaplasma Phagocytophilum

“…Approximately 7% to 17% of patients require intensive care [ 3 , 8 ]. The fatality rate has been reported to be 1.2% among those 20 to 39 years of age [ 10 ], in which delayed diagnosis and treatment were risk factors [ 8 ]. Three percent may develop life-threatening complications [ 3 ] requiring hospitalization and ICU admission, including acute respiratory distress syndrome (ARDS), acute renal failure, coagulopathy, rhabdomyolysis, myocarditis, and hemorrhage.…”

“…Using antibiotics other than doxycycline increases the risk of severe illness and patient death. Observational reports indicate that delay in treatment is associated with a poor outcome and increased length of hospital stay [ 10 , 13 ]. Our patient has been treated with doxycycline 100 mg twice daily for 14 days.…”