Human (Granulocytic) Anaplasmosis (HGA ... - Allina Health

More documents

Recommendations

Info

Infection with Babesia The merozoites escape by causing rupture of the host erythrocyte, and are then free to invade other red cells. Multiplication of the parasites and rupture (hemolysis) of the red cells are responsible for the clinical manifestations of the disease. For practical purposes, humans are dead-end hosts; there is thought to be little, if any, subsequent transmission from infected humans to feeding ticks (although human to human transmission has been reported in the setting of transfusion of cellular blood products (see below), and possibly during pregnancy/ delivery). Other infecting species (MO-1, B. duncani) have been reported in the western United States, thought to be transmitted by the western black-legged tick Ixodes pacificus. In Europe, infection of humans by B. divergens, transmitted by the sheep tick Ixodes ricinus, has been reported. In Minnesota in 2010, a record number of confirmed or probable cases (56, or 1.1 per 100,000 population) were reported, compared to 31 cases the year before. 59% of reported patients were male, with median age 61 years (range 5-84 years). Onset of illness was elevated from June through August with a peak in July comprising 40% of cases. 46% of patients were hospitalized (range: 2 days – more than one month). One patient died. 14% of patients also had confirmed Lyme disease, and a different 14% had confirmed or probable <strong>HGA</strong>. Symptom onset after infection is usually 1-4 weeks (usually 1-9 weeks after infection resulting from transfusion). The spectrum of disease ranges from latent/subclinical to fulminant with hemolysis, multiorgan failure and death. The most severely affected tend to be those individuals who are asplenic, elderly or immunocompromised (i.e., HIV positive, underlying malignancy, corticosteroid treatment). 6
Infected individuals may be asymptomatic. Symptoms/signs of the disease may include hemolysis, high fever, chills, muscle aches/arthralgias, headache, fatigue, loss of appetite, nausea and vomiting. More extreme expressions of disease include hypotension, hepatic dysfunction, renal failure, disseminated intravascular coagulation, multiorgan failure and death. Supportive laboratory findings may include hemolysis, thrombocytopenia, and elevated LFTs. Treatment: According to the CDC, most patients who are asymptompatic do not require treatment. Early diagnosis and treatment of symptomatic patients may reduce the length of illness and severity of disease. CDC recommendations include assistance from infectious disease specialists and antimicrobial drugs: Atovaquone + azithromycin for mild to moderate cases or Clindamycin + quinine for severe cases, usually for 7-10 days, although repeat treatment or monitoring of parasitemia may be necessary for some patients (immunocompromised, for example). Please see CDC or MDH web sites for dosing recommendations. Additionally, those patients with severe illness may require or benefit from supportive care such as: vasopressors, antipyretics, blood transfusions, exchange transfusions, dialysis, and mechanical ventilation. Laboratory Diagnosis: Bear in mind that some patients may be simultaneously infected with more than one tickborne infection. 7
Page 1 and 2: July 2012 Human (Granulocytic) Anap
Page 3 and 4: Morules in neutrophils indicated by
Page 5: BABESIOSIS Babesiosis (originally c
Page 9 and 10: TRANSFUSION-TRANSMITTED DISEASE Cas
Page 11: REFERENCES K. Annen, D.O., et al. T

Human (Granulocytic) Anaplasmosis (HGA ... - Allina Health

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?