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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 and Author 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
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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.

Figures

Grahic Jump Location
Figure.

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

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