The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Borrelia miyamotoi Infection Presenting as Human Granulocytic Anaplasmosis: A Case Report

Hanumara Ram Chowdri, MD; Joseph L. Gugliotta, MD; Victor P. Berardi; Heidi K. Goethert, ScD; Philip J. Molloy, MD; Sherri L. Sterling, MBA, MLS; and Sam R. Telford III, ScD
[+] Article, Author, and Disclosure Information

From Hawthorn Medical Associates and St. Luke's Hospital, New Bedford, Massachusetts; Hunterdon Medical Center, Flemington, New Jersey; Robert Wood Johnson Medical School, New Brunswick, New Jersey; IMUGEN, Norwood, Massachusetts; and Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts.

Grant Support: By National Institutes of Health (R41 AI 078631 and R21 AI 082436) and the Evelyn Lilly Lutz Foundation.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0290.

Reproducible Research Statement: Study protocol and statistical code: Not applicable. Data set: Available from Dr. Telford (e-mail, sam.telford@tufts.edu).

Requests for Single Reprints: Sam R. Telford III, ScD, Department of Infectious Disease and Global Health, Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536; e-mail, sam.telford@tufts.edu.

Current Author Addresses: Dr. Chowdri: Hawthorn Medical Associates, 275 Allen Street, New Bedford, MA 02740.

Dr. Gugliotta: Hunterdon Medical Center, 1100 Wescott Drive, Flemington, NJ 08822.

Mr. Berardi, Dr. Molloy, and Ms. Sterling: Reference Diagnostic Division, IMUGEN, Inc., 315 Norwood Park South, Norwood, MA 02062.

Drs. Goethert and Telford: Department of Infectious Disease and Global Health, Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536.

Author Contributions: Conception and design: J.L. Gugliotta, V.P. Berardi, H.K. Goethert, S.R. Telford.

Analysis and interpretation of the data: H.R. Chowdri, J.L. Gugliotta, V.P. Berardi, H.K. Goethert, P.J. Molloy, S.R. Telford.

Drafting of the article: H.K. Goethert, P.J. Molloy, S.R. Telford.

Critical revision of the article for important intellectual content: H.R. Chowdri, V.P. Berardi, H.K. Goethert.

Final approval of the article: H.R. Chowdri, J.L. Gugliotta, V.P. Berardi, H.K. Goethert, P.J. Molloy, S.L. Sterling, S.R. Telford.

Provision of study materials or patients: H.R. Chowdri, J.L. Gugliotta.

Obtaining of funding: S.R. Telford, V.P. Berardi.

Administrative, technical, or logistic support: V.P. Berardi, H.K. Goethert, P.J. Molloy, S.L. Sterling.

Collection and assembly of data: H.R. Chowdri, V.P. Berardi, H.K. Goethert, S.L. Sterling.

Ann Intern Med. 2013;159(1):21-27. doi:10.7326/0003-4819-159-1-201307020-00005
Text Size: A A A

Chinese translation

Background: The diverse tickborne infections of the northeastern United States can present as undifferentiated flu-like illnesses. In areas endemic for Lyme and other tickborne diseases, patients presenting with acute febrile illness with myalgia, headache, neutropenia, thrombocytopenia, and elevated hepatic aminotransferase levels are presumptively diagnosed as having human granulocytic anaplasmosis (HGA).

Objective: To assign a cause for illness experienced by 2 case patients who were initially diagnosed with HGA but did not rapidly defervesce with doxycycline treatment and had no laboratory evidence of Anaplasma phagocytophilum infection.

Design: Case report.

Setting: 2 primary care medical centers in Massachusetts and New Jersey.

Patients: 2 case patients acutely presenting with fever.

Measurements: Identification of the causative agent by polymerase chain reaction and DNA sequencing.

Results: Molecular diagnostic assays detected Borrelia miyamotoi in the peripheral blood of both patients. There was no evidence of infection with other tickborne pathogens commonly diagnosed in the referral areas.

Limitation: One of the case patients may have had concurrent Lyme disease.

Conclusion: The presence of B. miyamotoi DNA in the peripheral blood and the patients’ eventual therapeutic response to doxycycline are consistent with the hypothesis that their illness was due to this newly recognized spirochete. Samples from tick-exposed patients acutely presenting with signs of HGA but who have a delayed response to doxycycline therapy or negative confirmatory test results for HGA should be analyzed carefully for evidence of B. miyamotoi infection.

Primary Funding Source: National Institutes of Health and the Evelyn Lilly Lutz Foundation.


Grahic Jump Location

Phylogenetic analysis of portions of the flagellin (top) and GlpQ (bottom) genes amplified from case patients 1 and 2, showing placement of the presumptive causative agent within the North American clade of Borrelia miyamotoi.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Related Point of Care
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.