title: Are patients with erythema migrans who have leukopenia and/or thrombocytopenia coinfected with Anaplasma phagocytophilum or tick-borne encephalitis virus?
abstract: Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA) are endemic in central part of Slovenia. We tested the hypothesis that patients with erythema migrans (EM) from this region, who have leukopenia and/or thrombocytopenia (typical findings in HGA and in the initial phase of TBE but not in patients with LB) are coinfected with Anaplasma phagocytophilum and/or with TBE virus, i.e. that cytopenia is a result of concomitant HGA or the initial phase of TBE. Comparison of clinical and laboratory findings for 67 patients with EM who disclosed leukopenia/thrombocytopenia with the corresponding results in sex- and age-matched patients with EM and normal blood cell counts revealed no differences. In addition, patients with typical EM and leukopenia and/or thrombocytopenia tested negative for the presence of IgM and IgG antibodies to TBE virus by ELISA as well as for the presence of specific IgG antibodies to A. phagocytophilum antigens by IFA in acute and convalescent serum samples. Thus, none of 67 patients (95% CI: 0 to 5.3%) with typical EM (the presence of this skin lesion attests for early Lyme borreliosis and is the evidence for a recent tick bite) was found to be coinfected with A. phagocytophilum or had a recent primary infection with TBE virus. The findings in the present study indicate that in Slovenia, and probably in other European countries endemic for LB, TBE and HGA, patients with early LB are rarely coinfected with the other tick-transmitted agents.
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Franc
authors: F
authors: Strle
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Petra
authors: P
authors: Bogovič
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Jože
authors: J
authors: Cimperman
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Vera
authors: V
authors: Maraspin
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Katarina
authors: K
authors: Ogrinc
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Tereza
authors: T
authors: Rojko
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Daša
authors: D
authors: Stupica
authors: Institute for Biostatistics and Medical Informatics, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors: Lara
authors: L
authors: Lusa
authors: Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors: Tatjana
authors: T
authors: Avšič-Županc
authors: Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors: Katja Strašek
authors: KS
authors: Smrdel
authors: Institute of Microbiology and Immunology, Faculty of Medicine Ljubljana, Ljubljana, Slovenia.
authors: Mateja
authors: M
authors: Jelovšek
authors: Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
authors: Stanka
authors: S
authors: Lotrič-Furlan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D041081:Anaplasma phagocytophilum / Q000302:isolation & purification; D060085:Coinfection / Q000453:epidemiology*; D016873:Ehrlichiosis / Q000150:complications / Q000453:epidemiology*; D004669:Encephalitis Viruses, Tick-Borne / Q000302:isolation & purification; D004675:Encephalitis, Tick-Borne / Q000150:complications / Q000453:epidemiology*; D015787:Erythema Chronicum Migrans / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D007970:Leukopenia / Q000150:complications / Q000453:epidemiology*; D008193:Lyme Disease / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017524:Slovenia / Q000453:epidemiology; D013921:Thrombocytopenia / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult