title: Fatal human anaplasmosis associated with macrophage activation syndrome in Greece and the Public Health response.
abstract: Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum that has the potential to spread in new geographical areas. The first fatal case of HGA in Greece is presented. Fever of unknown origin, renal and respiratory insufficiency and development of macrophage activation syndrome characterized the clinical presentation. Amplification and sequencing of a fragment of the groEL gene revealed the presence of A. phagocytophilum. The epidemiological and clinical features were collected during an epidemiological investigation. Public health measures were instituted by the Hellenic Centre for Disease Control and Prevention. The Public Health intervention required the collaboration of epidemiologists, veterinarians and microbiologists. Emphasis was given to communication activities and misconceptions concerning canines and their role in the disease. The emergence of human anaplasmosis in a new geographical area highlights the importance of disease awareness and of the need for continued support for tick and tick-borne disease surveillance networks.
authors.affiliation: 4th Department of Internal Medicine, University General Hospital "Attikon", National & Kapodistrian University of Athens Medical School, Athens, Greece; The Hellenic Centre for Disease Control and Prevention, Athens, Greece. Electronic address: tsiodras@med.uoa.gr.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
authors.affiliation: Department of Microbiology, National and Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Spanakis
authors.affiliation: The Hellenic Centre for Disease Control and Prevention, Athens, Greece.
authors.forename: Gregory
authors.initials: G
authors.lastname: Spanakos
authors.affiliation: The Hellenic Centre for Disease Control and Prevention, Athens, Greece.
authors.forename: Danai
authors.initials: D
authors.lastname: Pervanidou
authors.affiliation: The Hellenic Centre for Disease Control and Prevention, Athens, Greece.
authors.forename: Theano
authors.initials: T
authors.lastname: Georgakopoulou
authors.affiliation: Metropolitan Hospital, Athens, Greece.
authors.forename: Elsa
authors.initials: E
authors.lastname: Campos
authors.affiliation: Metropolitan Hospital, Athens, Greece.
authors.forename: Theofania
authors.initials: T
authors.lastname: Petra
authors.affiliation: Metropolitan Hospital, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Kanellopoulos
authors.affiliation: Metropolitan Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Georgiadis
authors.affiliation: 4th Department of Internal Medicine, University General Hospital "Attikon", National & Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Antalis
authors.affiliation: Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece.
authors.forename: Vassileios
authors.initials: V
authors.lastname: Kontos
authors.affiliation: The Hellenic Centre for Disease Control and Prevention, Athens, Greece.
authors.forename: Lambros A
authors.initials: LA
authors.lastname: Giannopoulos
authors.affiliation: Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographic Medicine, WHO Collaborating Center for Mediterranean Zoonoses, University of Crete, Heraklion, Crete, Greece.
authors.forename: Yiannis
authors.initials: Y
authors.lastname: Tselentis
authors.affiliation: Department of Microbiology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Papa
authors.affiliation: Department of Microbiology, National and Kapodistrian University of Athens Medical School, Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
authors.affiliation: Metropolitan Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Saroglou
mesh_terms: D041081:Anaplasma phagocytophilum / Q000302:isolation & purification*; D000712:Anaplasmosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D000818:Animals; D004285:Dogs; D017809:Fatal Outcome; D006115:Greece; D006801:Humans; D055501:Macrophage Activation Syndrome / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011635:Public Health Administration
keywords: Anaplasma; Anaplasma phagocytophilum; Granulocytic anaplasmosis; Greece