title: Dissociation between inhibition and killing by levofloxacin in human granulocytic anaplasmosis.
abstract: Human granulocytic anaplasmosis (HGA) is a potentially fatal tick-borne infection caused by Anaplasma phagocytophilum. Treatment options are limited for this entity, with doxycycline being the drug of choice. Certain fluoroquinolones such as levofloxacin are active against A. phagocytophilum in vitro. We report a hospitalized patient with HGA who improved coincident with a 13-day course of levofloxacin therapy, but clinically and microbiologically relapsed 15 days after completion of treatment. Relapse of infection after levofloxacin therapy was reproduced in a severe combined immune-deficient (SCID) mouse infection model. Quinolone therapy should not be considered curative of HGA.
authors.affiliation: Division of Infectious Diseases, Depatment of Medicine, New York Medical College, Westcheser Medical Center, Valhalla, New York, USA. Gary_Wormser@nymc.edu
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
authors.forename: Alina
authors.initials: A
authors.lastname: Filozov
authors.forename: Sam R
authors.initials: SR
authors.lastname: Telford
authors.forename: Sandeepa
authors.initials: S
authors.lastname: Utpat
authors.forename: Russell S
authors.initials: RS
authors.lastname: Kamer
authors.forename: Dionysios
authors.initials: D
authors.lastname: Liveris
authors.forename: Guiqing
authors.initials: G
authors.lastname: Wang
authors.forename: Lois
authors.initials: L
authors.lastname: Zentmaier
authors.forename: Ira
authors.initials: I
authors.lastname: Schwartz
authors.forename: Maria E
authors.initials: ME
authors.lastname: Aguero-Rosenfeld
mesh_terms: D000368:Aged; D041081:Anaplasma phagocytophilum / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D000712:Anaplasmosis / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D064704:Levofloxacin; D008297:Male; D051379:Mice; D016513:Mice, SCID; D015242:Ofloxacin / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin