Case Report: Polymerase Chain Reaction Testing of Tick Bite Site Samples for the Diagnosis of Human Granulocytic Anaplasmosis

Choon-Mee Kim Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Seok Won Kim Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Dong-Min Kim Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Na-Ra Yoon Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Piyush Jha Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Sook Jin Jang Department of Laboratory Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Young-Joon Ahn Department of Medical Education, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Donghoon Lim Department of Urology, College of Medicine, Chosun University, Gwangju, Republic of Korea

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Seung Hun Lee Division of Zoonoses, Center for Immunology and Pathology, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Republic of Korea

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Seon Do Hwang Division of Zoonoses, Center for Immunology and Pathology, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Republic of Korea

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Yeong Seon Lee Division of Zoonoses, Center for Immunology and Pathology, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Republic of Korea

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Human granulocytic anaplasmosis (HGA) is a tick-borne infectious disease caused by Anaplasma phagocytophilum, 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 Ehrlichia- or Anaplasma-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.

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Author Notes

Address correspondence to Dong-Min Kim, Department of Internal Medicine, College of Medicine, Chosun University, 588 Seosuk-dong, Dong-gu, Gwangju 501-717, Republic of Korea. E-mail: drongkim@chosun.ac.kr
These authors contributed equally to this work.

Authors' addresses: Choon-Mee Kim, Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: choonmee@chosun.ac.kr. Seok Won Kim, Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: chosunns@chosun.ac.kr. Dong-Min Kim, Na-Ra Yoon, and Piyush Jha, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mails: drongkim@chosun.ac.kr, shine@chosun.ac.kr, and pjhadoc@gmail.com. Sook Jin Jang, Department of Laboratory Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: sjbjang@chosun.ac.kr. Young-Joon Ahn, Department of Medical Education, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: yjoon@Chosun.ac.kr. Donghoon Lim, Department of Urology, College of Medicine, Chosun University, Gwangju, Republic of Korea, E-mail: dhlim@chosun.ac.kr. Seung Hun Lee, Seon do Hwang, and Yeong Seon Lee, Division of Zoonoses, Center for Immunology and Pathology, Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju-si, Republic of Korea, E-mails: lee5196@nate.com, hwangsd@korea.kr, and ysleenih@korea.kr.

Financial support: This study was supported by research funds from Chosun University Hospital 2016.

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