title: Disease-specific diagnosis of coinfecting tickborne zoonoses: babesiosis, human granulocytic ehrlichiosis, and Lyme disease.
abstract: To determine whether a unique group of clinical and laboratory manifestations characterize certain major deer tick-transmitted human pathogens in North America, we compared the symptoms, short-term complications, and laboratory test results of New England residents who became ill due to > or =1 of these pathogens. Patients completed a uniformly structured questionnaire and submitted blood samples for serologic and polymerase chain reaction (PCR) testing after developing symptoms of Lyme disease, human babesiosis, or human granulocytic ehrlichiosis (HGE). Complete blood count with thin blood smear, PCR, and immunoglobulin M antibody tests helped differentiate the acute manifestations of these diseases. Physicians should consider use of tests designed to diagnose babesiosis and HGE in patients with Lyme disease who experience a prolonged flulike illness that fails to respond to appropriate antiborrelial therapy.
authors.affiliation: Department of Pediatrics, Medicine, Clinical Microbiology, Genetics, and Developmental Biology, and the Center for Microbial Pathogenesis, University of Connecticut School of Medicine, Farmington, CT, USA. PKrause@CCMCKIDS.org
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Krause
authors.forename: Kathleen
authors.initials: K
authors.lastname: McKay
authors.forename: Charles A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sikand
authors.forename: Ronald
authors.initials: R
authors.lastname: Lentz
authors.forename: Timothy
authors.initials: T
authors.lastname: Lepore
authors.forename: Linda
authors.initials: L
authors.lastname: Closter
authors.forename: Diane
authors.initials: D
authors.lastname: Christianson
authors.forename: Sam R
authors.initials: SR
authors.lastname: Telford
authors.forename: David
authors.initials: D
authors.lastname: Persing
authors.forename: Justin D
authors.initials: JD
authors.lastname: Radolf
authors.forename: Andrew
authors.initials: A
authors.lastname: Spielman
mesh_terms: D000328:Adult; D001404:Babesiosis / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D001772:Blood Cell Count; D019411:Clinical Laboratory Techniques; D003937:Diagnosis, Differential; D016873:Ehrlichiosis / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D006098:Granulocytes; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D008137:Longitudinal Studies; D008193:Lyme Disease / Q000175:diagnosis* / Q000276:immunology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D017282:Tick-Borne Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D015047:Zoonoses / Q000382:microbiology / Q000469:parasitology
chemical_list: D007075:Immunoglobulin M