title: Co-infection with Anaplasma platys, Bartonella henselae and Candidatus Mycoplasma haematoparvum in a veterinarian.
abstract: BACKGROUND
  During a two year period, a 27-year-old female veterinarian experienced migraine headaches, seizures, including status epilepticus, and other neurological and neurocognitive abnormalities. Prior to and during her illness, she had been actively involved in hospital-based work treating domestic animals, primarily cats and dogs, in Grenada and Ireland and anatomical research requiring the dissection of wild animals (including lions, giraffe, rabbits, mongoose, and other animals), mostly in South Africa. The woman reported contact with fleas, ticks, lice, biting flies, mosquitoes, spiders and mites and had also been scratched or bitten by dogs, cats, birds, horses, reptiles, rabbits and rodents. Prior diagnostic testing resulted in findings that were inconclusive or within normal reference ranges and no etiological diagnosis had been obtained to explain the patient's symptoms.
  
  
  METHODS
  PCR assays targeting Anaplasma sp. Bartonella sp. and hemotopic Mycoplasma sp. were used to test patient blood samples. PCR positive amplicons were sequenced directly and compared to Gen Bank sequences. In addition, Bartonella alpha Proteobacteria growth medium (BAPGM) enrichment blood culture was used to facilitate bacterial growth and Bartonella spp. serology was performed by indirect fluorescent antibody testing.
  
  
  RESULTS
  Anaplasma platys, Bartonella henselae and Candidatus Mycoplasma haematoparvum DNA was amplified and sequenced from the woman's blood, serum or blood culture samples. Her serum was variably seroreactive to several Bartonella sp. antigens. Despite symptomatic improvement, six months of doxycycline most likely failed to eliminate the B. henselae infection, whereas A. platys and Candidatus M. haematoparvum DNA was no longer amplified from post-treatment samples.
  
  
  CONCLUSIONS
  As is typical of many veterinary professionals, this individual had frequent exposure to arthropod vectors and near daily contact with persistently bacteremic reservoir hosts, including cats, the primary reservoir host for B. henselae, and dogs, the presumed primary reservoir host for A. platys and Candidatus Mycoplasma haematoparvum. Physicians caring for veterinarians should be aware of the occupational zoonotic risks associated with the daily activities of these animal health professionals.
authors.affiliation: Department of Clinical Sciences, Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.
authors.forename: Ricardo G
authors.initials: RG
authors.lastname: Maggi
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Mascarelli
authors.forename: Lauren N
authors.initials: LN
authors.lastname: Havenga
authors.forename: Vinny
authors.initials: V
authors.lastname: Naidoo
authors.forename: Edward B
authors.initials: EB
authors.lastname: Breitschwerdt
mesh_terms: D000328:Adult; D000709:Anaplasma / Q000302:isolation & purification*; D000818:Animals; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D001431:Bacteriological Techniques; D018416:Bartonella henselae / Q000302:isolation & purification*; D060085:Coinfection / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D004199:Disease Vectors; D005260:Female; D019425:Grenada; D006801:Humans; D007494:Ireland; D009174:Mycoplasma / Q000302:isolation & purification*; D016273:Occupational Exposure; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013019:South Africa; D018634:Veterinarians