title: [Serologic and clinical evidence for endemic occurrences of human granulocytic ehrlichiosis in North-Eastern Switzerland].
abstract: BACKGROUND
  Tick-borne human granulocytic ehrlichiosis (HGE) has not been diagnosed in Switzerland, although the HGE agent has been identified in ticks and animal reservoirs and human infections have been suspected on the basis of serological surveys.
  
  
  METHODS
  We retrospectively tested sera of 48 persons with antibodies to B. burgdorferi and/or tick-borne encephalitis virus for the presence of antibodies to E. phagocytophila (a surrogate marker of the agent of HGE), and reviewed their charts with regard to clinical manifestations possibly associated with a tick-borne infection. We then prospectively examined EDTA blood of 80 patients who presented with fever 7 to 21 days after a tick bite for the presence of the HGE agent (using nested PCR and microscopic examination of blood smears) and anti-E. phagocytophila antibodies. We also collected clinical data.
  
  
  RESULTS
  The retrospective study revealed 12 persons (25%) with anti-E. phagocytophila antibody titers > or = 1:80, suggesting coinfection with HGE and either Lyme Borrelia or tick-borne encephalitis virus. Among these, 7 patients presented with clinical manifestations compatible with HGE disease. The prospective investigation identified 8 patients (10%) with anti-E. phagocytophila antibody titers > or = 1:80, and 7 of these presented with signs and symptoms suggesting HGE. The HGE agent, however, was detected neither by PCR nor by microscopic examination.
  
  
  CONCLUSIONS
  Serological and clinical data suggest the occurrence of an HGE-like agent as well as of coinfections with HGE and B. burgdorferi or tick-borne encephalitis virus in Switzerland. However, the HGE agent was not identified in persons living in Switzerland.
authors.affiliation: Abteilung Infektionskrankheiten und Spitalhygiene, Departement Innere Medizin, Universitätsspital Zürich. infweb@usz.unizh.ch
authors.forename: R
authors.initials: R
authors.lastname: Weber
authors.forename: N
authors.initials: N
authors.lastname: Pusterla
authors.forename: M
authors.initials: M
authors.lastname: Loy
authors.forename: C M
authors.initials: CM
authors.lastname: Leutenegger
authors.forename: G
authors.initials: G
authors.lastname: Schär
authors.forename: D
authors.initials: D
authors.lastname: Baumann
authors.forename: C
authors.initials: C
authors.lastname: Wolfensberger
authors.forename: H
authors.initials: H
authors.lastname: Lutz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D015748:Borrelia burgdorferi Group / Q000276:immunology; D004536:Ehrlichia / Q000276:immunology; D016873:Ehrlichiosis / Q000453:epidemiology* / Q000276:immunology / Q000635:transmission; D004669:Encephalitis Viruses, Tick-Borne / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D013987:Ticks
chemical_list: D000907:Antibodies, Bacterial; D000914:Antibodies, Viral