• • Anaplasma phagocytophilum
    • Obligate intracellular Gram-negative
    • Recognized in early 1990s in Wisconsin and Minnesota – acute febrile tick-borne illness similar to ehrlichiosis
    • Replicate in host granulocytes (versus monocytes for Ehrlichiosis)
  
  

  Posted 08/15/16 09:17:28 AM by Matthew Cummings

• • Reservoir – small mammals (mice, rats)
    • Transmitted by Ixodes tick sp. --> same vector sp. as Lyme, Babesiosis
    • Cases occur year-round, peak in summer months
    • Highest annual incidence in New England, Mid-Atlantic and Upper Midwest States
  
  

  Posted 08/15/16 09:18:11 AM by Matthew Cummings

• • Similar clinical presentation to ehrlichiosis, RMSF 
    • Acute febrile, flu-like illness (headache, myalgia, fatigue, cough, nausea/vomiting, abd pain, diarrhea)
    • Labs -- important diagnostic clues: 
      • Leukopenia
      • Thrombocytopenia 
      • Transaminitis
      • Rash less common than ehrlichiosis and RMSF
  
  

  Posted 08/15/16 09:19:11 AM by Matthew Cummings

• • Anaplasmosis diagnosis
    • Whole-blood PCR --> Sensitivity 60-90% prior to antimicrobials
    • Blood smear review for intra-cytoplasmic morulae (Wright, Giemsa stains) --> Sensitivity 25-75%, highest within 1 week of illness onset
    • Anaplasmosis-specific IgM and IgG --> May take 4-6 weeks to develop serologic positivity
  
  

  Posted 08/15/16 09:20:15 AM by Matthew Cummings

• • Anaplasmosis treatment
    • As a rule – treat empirically if clinical picture suspicious PRIOR to confirmatory testing
    • Doxycycline drug of choice --  100mg twice daily --> also covers Ehrlichia sp. and RMSF 
    • Often see RAPID clinical response in 24-48 hrs
    • Duration: Usually 10d or at least 3d after last fever
    • If persistent fever > 48 hrs s/p doxy – reconsider diagnosis, ?Babesia co-infection
  
  

  Posted 08/15/16 09:34:40 AM by Matthew Cummings

• For further reading...

  Lyme, Babesia, Anaplasmosis IDSA Clinical Practice Guidelines (CID)
  Diagnosis and Management of Tickborne Rickettsial Diseases (MMWR)
  Clinical Presentation, Diagnosis, Management of Ehrlichia and Anaplasma (CID)
  
  
  
  

  Posted 08/15/16 09:38:54 AM by Matthew Cummings

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