Background

To investigate to what extent early Lyme borreliosis patients with erythema migrans are infected with Anaplasma phagocytophilum.

Methods

Three hundred ten patients from Poland with erythema migrans were included in the study. One hundred and eighty-three patients (59%) agreed to have both skin biopsy and blood samples analysed for Borrelia burgdorferi, A. phagocytophilum and ‘Candidatus Neoehrlichia mikurensis’, with PCR. Positive samples were confirmed with sequencing.

Results

B. burgdorferi DNA was detected in 49.7% of the skin samples and in 1.1% of the blood samples. A. phagocytophilum DNA was found in 7.1% blood samples, and in 8.2% of the skin biopsies. In four patients, A. phagocytophilum DNA was detected only in blood; in one case A. phagocytophilum DNA was found simultaneously in blood and skin, and additionally in this patients’ blood Borrelia DNA was detected. In four skin samples B. burgdorferi DNA was detected simultaneously with A. phagocytophilum DNA, indicative of a co-infection.

Conclusions

A. phagocytophilum may be present in early Lyme borreliosis characterized by erythema migrans and should always be considered as a differential diagnostic following a tick bite and considered in treatment schemes, as these differs (in early stage of Lyme borreliosis doxycycline, amoxicillin, cefuroxime axetil and azithromycin are recommended, while in anaplasmosis the most effective courses of treatment are doxycycline, rifampin and levofloxacin). Consequently, the role of A. phagocytophilum in erythema migrans should be further studied.

中文翻译：

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评估早期莱姆疏螺旋体病中嗜噬细胞无形体的存在，表现为游走性红斑皮肤病变。

背景

调查早期莱姆疏螺旋体病伴游走性红斑患者感染无浆体吞噬细胞的程度。

方法

该研究包括来自波兰的310名患有移行性红斑的患者。183 名患者 (59%) 同意通过 PCR对皮肤活检和血液样本进行伯氏疏螺旋体、A. phagocytophilum和 ' Candidatus Neoehrlichia mikurensis' 的分析。阳性样本通过测序确认。

结果

在 49.7% 的皮肤样本和 1.1% 的血液样本中检测到伯氏疏螺旋体DNA。A. phagocytophilum DNA 在 7.1% 的血液样本和 8.2% 的皮肤活检中被发现。在 4 名患者中，仅在血液中检测到嗜噬细胞放线菌DNA；在一个案例中，在血液和皮肤中同时发现了A. phagocytophilum DNA，另外在该患者的血液中检测到了疏螺旋体DNA。在四个皮肤样本中，同时检测到伯氏疏螺旋体DNA 和A. phagocytophilum DNA，表明存在共同感染。

结论

A. 吞噬细胞可能存在于以移行红斑为特征的早期莱姆疏螺旋体病中，应始终将其视为蜱叮咬后的鉴别诊断并在治疗方案中考虑，因为这些不同（在莱姆疏螺旋体病的早期阶段，强力霉素、阿莫西林、头孢呋辛酯和推荐使用阿奇霉素，而在无形体病中，最有效的疗程是强力霉素、利福平和左氧氟沙星）。因此，A. phagocytophilum在游走性红斑中的作用应进一步研究。