title: Human disease in Europe caused by a granulocytic Ehrlichia species.
abstract: Human granulocytic ehrlichiosis (HGE) was recently described in North America. It is caused by an Ehrlichia species closely related to Ehrlichia phagocytophila and Ehrlichia equi, recognized to infect mostly ruminants and horses, respectively. The vector in North America is the tick Ixodes scapularis, which is also the vector of the Lyme disease agent, Borrelia burgdorferi. Previous serologic studies in patients with a diagnosis of Lyme borreliosis indicate that HGE may exist in Europe. We report the first documented case of HGE in Europe. The diagnosis was established by seroconversion to E. equi and the HGE agent and by PCR with sequence analysis of the gene encoding the HGE agent 16S rRNA. Interestingly, the patient presented with a self-limited but moderately severe illness. Thus, European physicians need to be aware that HGE exists in Europe and that the diagnosis should be considered in febrile patients with tick bites in areas where Lyme disease is endemic.
authors.affiliation: Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Slovenia. Mirc.Petrovec@mf.uni-lj.si
authors.forename: M
authors.initials: M
authors.lastname: Petrovec
authors.forename: S
authors.initials: S
authors.lastname: Lotric Furlan
authors.forename: T A
authors.initials: TA
authors.lastname: Zupanc
authors.forename: F
authors.initials: F
authors.lastname: Strle
authors.forename: P
authors.initials: P
authors.lastname: Brouqui
authors.forename: V
authors.initials: V
authors.lastname: Roux
authors.forename: J S
authors.initials: JS
authors.lastname: Dumler
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood; D004269:DNA, Bacterial / Q000032:analysis; D004536:Ehrlichia / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D018469:Ehrlichia chaffeensis / Q000235:genetics; D016873:Ehrlichiosis / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D005260:Female; D006098:Granulocytes; D006801:Humans; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D012689:Sequence Homology, Nucleic Acid; D017524:Slovenia
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial; D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S