Volume 97, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Human granulocytic anaplasmosis (HGA) is a tick-borne infectious disease caused by , an obligate intracellular bacterium. Until now, the utility of tick-bite site samples for HGA diagnosis has not been reported. Using a patient's buffy coat and tick-bite site crust samples, we performed polymerase chain reaction (PCR) testing using - or -specific primers. PCR with buffy coat and crust samples obtained before doxycycline administration was positive. Six days after doxycycline administration, PCR with the buffy coat sample was negative but PCR with a crust tissue sample from the tick-bite site remained positive. This is the first case to suggest that crust tissue at the tick-bite site may be useful for early HGA diagnosis in patients who have already been treated with antibiotics such as doxycycline.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Chen SM, Dumler JS, Bakken JS, Walker DH, , 1994. Identification of a granulocytotropic Ehrlichia species as the etiologic agent of human disease. J Clin Microbiol 32: 589595. [Google Scholar]
  2. Kim KH, Yi J, Oh WS, Kim NH, Choi SJ, Choe PG, Kim NJ, Lee JK, Oh MD, , 2014. Human granulocytic anaplasmosis, South Korea, 2013. Emerg Infect Dis 20: 17081711.[Crossref] [Google Scholar]
  3. Nadelman RB, Horowitz HW, Hsieh TC, Wu JM, Aguero-Rosenfeld ME, Schwartz I, Nowakowski J, Varde S, Wormser GP, , 1997. Simultaneous human granulocytic ehrlichiosis and Lyme borreliosis. N Engl J Med 337: 2730.[Crossref] [Google Scholar]
  4. Dumler JS, Bakken JS, , 1995. Ehrlichial diseases of humans: emerging tick-borne infections. Clin Infect Dis 20: 11021110.[Crossref] [Google Scholar]
  5. Silaghi C, Kauffmann M, Passos LM, Pfister K, Zweygarth E, , 2011. Isolation, propagation and preliminary characterization of Anaplasma phagocytophilum from roe deer (Capreolus capreolus) in the tick cell line IDE8. Ticks Tick Borne Dis 2: 204208.[Crossref] [Google Scholar]
  6. Takano A, Ando S, Kishimoto T, Fujita H, Kadosaka T, Nitta Y, Kawabata H, Watanabe H, , 2009. Presence of a novel Ehrlichia sp. in Ixodes granulatus found in Okinawa, Japan. Microbiol Immunol 53: 101106.[Crossref] [Google Scholar]
  7. Oh JY, Moon BC, Bae BK, Shin EH, Ko YH, Kim YJ, Park YH, Chae JS, , 2009. Genetic identification and phylogenetic analysis of Anaplasma and Ehrlichia species in Haemaphysalis longicornis collected from Jeju Island, Korea. J Bacteriol Virol 39: 257267.[Crossref] [Google Scholar]
  8. Massung RF, Levin ML, Munderloh UG, Silverman DJ, Lynch MJ, Gaywee JK, Kurtti TJ, , 2007. Isolation and propagation of the Ap-Variant 1 strain of Anaplasma phagocytophilum in a tick cell line. J Clin Microbiol 45: 21382143.[Crossref] [Google Scholar]
  9. Levin ML, Nicholson WL, Massung RF, Sumner JW, Fish D, , 2002. Comparison of the reservoir competence of medium-sized mammals and Peromyscus leucopus for Anaplasma phagocytophilum in Connecticut. Vector Borne Zoonotic Dis 2: 125136.[Crossref] [Google Scholar]
  10. Eremeeva ME, Balayeva NM, Raoult D, , 1994. Serological response of patients suffering from primary and recrudescent typhus: comparison of complement fixation reaction, Weil-Felix test, microimmunofluorescence, and immunoblotting. Clin Diagn Lab Immunol 1: 318324. [Google Scholar]
  11. Tabara K, Arai S, Kawabuchi T, Itagaki A, Ishihara C, Satoh H, Okabe N, Tsuji M, , 2007. Molecular survey of Babesia microti, Ehrlichia species and Candidatus neoehrlichia mikurensis in wild rodents from Shimane Prefecture, Japan. Microbiol Immunol 51: 359367.[Crossref] [Google Scholar]
  12. Brouqui P, Bacellar F, Baranton G, Birtles RJ, Bjoërsdorff A, Blanco JR, Caruso G, Cinco M, Fournier PE, Francavilla E, Jensenius M, Kazar J, Laferl H, Lakos A, Lotric Furlan S, Maurin M, Oteo JA, Parola P, Perez-Eid C, Peter O, Postic D, Raoult D, Tellez A, Tselentis Y, Wilske B, , 2004. Guidelines for the diagnosis of tick-borne bacterial diseases in Europe. Clin Microbiol Infect 10: 11081132.[Crossref] [Google Scholar]
  13. Jin H, Wei F, Liu Q, Qian J, , 2012. Epidemiology and control of human granulocytic anaplasmosis: a systematic review. Vector Borne Zoonotic Dis 12: 269274.[Crossref] [Google Scholar]
  14. Hamburg BJ, Storch GA, Micek ST, Kollef MH, , 2008. The importance of early treatment with doxycycline in human ehrlichiosis. Medicine (Baltimore) 87: 5360.[Crossref] [Google Scholar]
  15. Eiscenstein BI, , 1990. The polymerase chain reaction. A new method of using molecular genetics for medical diagnosis. N Engl J Med 323: 178183. [Google Scholar]
  16. Watthanaworawit W, Turner P, Turner C, Tanganuchitcharnchai A, Richards AL, Bourzac KM, Blacksell SD, Nosten F, , 2013. A prospective evaluation of real-time PCR assays for the detection of Orientia tsutsugamushi and Rickettsia spp. for early diagnosis of rickettsial infections during the acute phase of undifferentiated febrile illness. Am J Trop Med Hyg 89: 308310.[Crossref] [Google Scholar]
  17. Denison AM, Amin BD, Nicholson WL, Paddock CD, , 2014. Detection of Rickettsia rickettsii, Rickettsia parkeri, and Rickettsia akari in skin biopsy specimens using a multiplex real-time polymerase chain reaction assay. Clin Infect Dis 59: 635642.[Crossref] [Google Scholar]
  18. Reppert E, Galindo RC, Ayllón N, Breshears MA, Kocan KM, Blouin EF, de la Fuente J, , 2014. Studies of Anaplasma phagocytophilum in sheep experimentally infected with the human NY-18 isolate: characterization of tick feeding sites. Ticks Tick Borne Dis 5: 744752.[Crossref] [Google Scholar]
  19. Granquist EG, Aleksandersen M, Bergström K, Dumler SJ, Torsteinbø WO, Stuen S, , 2010. A morphological and molecular study of Anaplasma phagocytophilum transmission events at the time of Ixodes ricinus tick bite. Acta Vet Scand 52: 43.[Crossref] [Google Scholar]
  20. Kim DM, Kim HL, Park CY, Yang TY, Lee JH, Yang JT, Shim SK, Lee SH, , 2006. Clinical usefulness of eschar polymerase chain reaction for the diagnosis of scrub typhus: a prospective study. Clin Infect Dis 43: 12961300.[Crossref] [Google Scholar]
  21. Reppert E, Galindo RC, Ayllón N, Breshears MA, Kocan KM, Blouin EF, de la Fuente J, , 2014. Studies of Anaplasma phagocytophilum in sheep experimentally infected with the human NY-18 isolate: characterization of tick feeding sites. Ticks Tick Borne Dis 5: 744752.[Crossref] [Google Scholar]

Data & Media loading...

Supplemental Figure

  • Received : 13 Jul 2016
  • Accepted : 13 Mar 2017
  • Published online : 08 May 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error