Anaplasmosis Information for Health Professionals
Anaplasmosis, formerly known human granulocytic ehrlichiosis (HGE), is a bacterial disease transmitted to humans by Ixodes scapularis (blacklegged tick or deer tick), the same tick that transmits Lyme disease. The etiologic agent of anaplasmosis is Anaplasma phagocytophilum, a rickettsial bacterium.
The disease was first recognized during 1993 in several patients from Minnesota and western Wisconsin. Human ehrlichiosis, a similar disease, is caused by Ehrlichia chaffeensis and is found throughout much of southeastern and south-central United States. Human ehrlichiosis is not a common vector-borne disease in Minnesota at this time, but a small number of cases have been reported.
Another related form of ehrlichiosis caused by the Ehrlichia muris-like agent was identified in Minnesota and Wisconsin patients in 2009. Since then, low numbers of cases have been reported in both states.
Onset of illness occurs 5 to 21 days after exposure to an infected tick. Common signs and symptoms include fever (often over 102°F), chills, headache, and myalgias. Nausea, vomiting, anorexia, acute weight loss, abdominal pain, cough, diarrhea, and change in mental status are reported less frequently. Highly suggestive laboratory findings include leukopenia (WBC< 4,500/mm³), thrombocytopenia (platelets <150,000/mm³), and increased aminotransferase levels. Unusual presentations may be the result of coinfections with Borrelia burgdorferi (Lyme disease agent) and/or Babesia microti (babesiosis agent), as a single feeding tick may transmit multiple disease agents.
Cases of anaplasmosis acquired through blood transfusions have been documented. Include anaplasmosis in the rule-out for patients who develop a febrile illness with thrombocytopenia following blood transfusion. Suspected transfusion-associated anaplasmosis should be reported to MDH and the supplying blood center.
Any two of the following three tests for evidence of infection with Anaplasma phagocytophilum are recommended.
- Polymerase chain reaction (PCR) assays are recommended, particularly for acute cases, to detect bacterial DNA and distinguish between Ehrlichia and Anaplasma species.
- An indirect immunofluorescence assay (IFA) is the principal test use to detect anaplasmosis infection. Acute and convalescent phase serum samples can be evaluated to look for a four-fold change in antibody titer to A. phagocytophilum.
- Intracellular inclusions (morulae) also may be visualized in granulocytes on Wright- or Giemsa- stained blood smears.
Anaplasmosis patients typically respond dramatically to doxycycline therapy (100 mg twice daily until the patient is afebrile for at least 3 days). Other tetracycline drugs also are likely to be effective. In general patients with suspect anaplasmosis and unexplained fever after a tick exposure should receive empiric doxycycline therapy while diagnostic tests are pending, particularly if they experience leukopenia and/or thrombocytopenia.
- CDC: Tickborne Diseases of the United States: A Reference Manual for Health Care Providers (PDF)
- CDC:Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever, Ehrlichiosis, and Anaplasmosis - United States
Morbidity and Mortality Weekly Report: A Practical Guide for Physicians and Other Health-Care and Public Health Professionals
- IDSA: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
Clinical Practice Guidelines by the Infectious Diseases Society of America.
Minnesota Rules Governing Communicable Diseases require health care providers to report confirmed or suspected cases of anaplasmosis to the Minnesota Department of Health (MDH) within 1 working day.
MDH staff also are available to provide clinical consultation regarding diagnosis and treatment of anaplasmosis and other tick-borne diseases. Call 651-201-5414 for a clinical consultation.