Infection related membranoproliferative glomerulonephritis secondary to anaplasmosis:A case

BACKGROUND Anaplasmosis is a tick-borne disease with a range of clinical manifestations,from a flu-like illness with fever and myalgias to a severe systemic disease with multisystem organ failure.Although renal involvement is not a common presentation,there have been few cases reporting acute kidney injury from Anaplasmosis.CASE SUMMARY We present a 55-year-old female with anaplasmosis who developed acute kidney injury due to membranoproliferative glomerulonephritis(MPGN).The patient originally presented with cough and shortness of breath.She was admitted to the hospital with a diagnosis of community acquired pneumonia and received antibiotics.During the hospital course she developed severe acute renal failure.Initial serological work up didn’t provide any conclusive diagnosis.Hence,she underwent kidney biopsy which showed MPGN pattern suggesting autoimmune,multiple myeloma or infectious etiology.Extensive work up was undertaken which was negative for autoimmune diseases,vasculitis panel,paraproteinemias but tested positive for IgG anaplasma with high titers indicating Anaplasmosis.CONCLUSION Our case shows a unique presentation of severe acute renal failure from MPGN from tick borne illness.MPGN is usually seen with autoimmune diseases,hepatitis C virus infections,paraproteinemias.Hence,we suggest that tick borne illness should also be considered when evaluating acute renal failure cases in tick borne prevalent regions.

Aetiology of Tick-Borne Infections in an Adult Swedish Population—Are Co-Infections with Multiple Agents Common?

In Scandinavia, tick-borne infections affecting humans include Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA). Each of these infections can present with unspecific symptoms. In this prospective clinical study, we recruited patients based on two independent inclusion criteria;1) patients with unspecific symptoms, i.e. fever (≥38.0℃) or a history of feverishness and/or any combination of headache, myalgia or arthralgia and 2) patients with erythema migrans (EM), following an observed tick bite or tick exposure within one month prior to onset of symptoms. A total of 206 patients fulfilled the study. Among these, we could identify 186 cases of LB (174 with EM), 18 confirmed and two probable cases of HGA and two cases of TBE. Thirteen of the HGA cases presented without fever. Furthermore, 22 of the EM patients had a sub-clinical co-infection with Anaplasma phagocytophilum, based on serology. Both TBE cases had co-infections, one with Borrelia burgdorferi and one with Anaplasma phagocytophilum. We conclude that it is important to consider several causative agents and possible co-infections in the clinical management of infectious diseases where ticks may be suspected as vectors.

流行和在旁遮普(印度) 的奶店动物的 Anaplasma marginale 感染的 haemato 生物化学的侧面

【正】Objective:To do the systematic comparison of prevalence of anaplasmosis by PCR and Giemsa stained thin blood smear(GSTBS) based parasitological assays in dairy cattle of Punjab,which has not been reported yet.To analyse the haematobiochemical alterations in infected animals to arrive at the conclusion regarding the pathogenicity induced by Anaplasma marginale (A.marginale) in latent and patent infection.Methods:Study was conducted on 320 animals (236 cows,62 calves and 22 buffaloes) of Punjab,India.PCR on genome of A.marginale was performed by targeting msp1βgene using specific primers BAP-2/AL34S,amplifies products of size 407 bp.Questionnaires based data on the characteristics of the infected animals and management strategies of the farm were collected and correlated.Results:Higher prevalence and more significant association was observed in the PCR based molecular diagnosis(P=0.00012) as compared to that in GSTBS(P=0.028 8) based diagnosis with various regions under study.With respect to the regions,highest prevalence was recorded in Ferozepur by PCR based diagnosis, while that in Jalandhar by GSTBS examination.Similar marked significant association of the PCR based diagnosis with the age of the animals under study(P=0.00013) was observed elucidating no inverse age resistance to A.marginale in cow calves.Haematobiochemical profile of infected animals revealed marked anemia,liver dysfunction and increase globulin concentrate indicating rise in immunoglobulin level to counteract infection.Conclusions:PCR is far more sensitive in detecting the disease even in latent infection which may act as nidus for spread of anaplasmosis to susceptible animals in endemic areas.Severity of anaemia and liver dysfunction were comparable both in patent as well as latent infection indicating pathogenicity of both.

Chronic Lyme Disease Complex and Its Commonly Undiagnosed Primary and Secondary Co-Infections

Chronic Lyme disease complex describes the burden carried by patients infected with Borrelia burgdorferi as well as other co-infections or secondary co-infections (opportunistic infections). These infections can cause a significant burden on patients more so than Lyme disease alone. Along with the many underdiagnosed cases of Lyme disease throughout the world exists numerous undiagnosed co-infection and secondary co-infections leading to debilitating symptoms for many patients. The potential for co-infections varies by location as well as to the exposure to various species of ticks. Since there is potential for patients to experience several tick bites including those of different species, additional microorganisms also commonly transmitted via tick bite are included that are typically left out of the conversation of potential Borrelia burgdorferi co-infections. The most common co-infections of Lyme disease include anaplasmosis, babasiosis, bartonellosis and ehrlichiosis. Secondary co-infections or opportunistic infections commonly seen in patients with Lyme disease are also discussed. By helping to establish a comprehensive list of infections associated with Chronic Lyme disease complex may in fact help patients receive a proper diagnosis in order to administer the much needed comprehensive treatments patients deserve.