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Human infection with a novel tick-borne Anaplasma species in China: a surveillance study.
Lancet Infect Dis. 2015 Jun; 15(6):663-70.LI

Abstract

BACKGROUND

Anaplasma phagocytophilum and Anaplasma ovis cause human infections. We investigated the potential for human pathogenicity of a newly discovered Anaplasma species infecting goats in China.

METHODS

We collected blood samples from patients with a history of tick bite in the preceding 2 months at Mudanjiang Forestry Central Hospital of Heilongjiang Province from May 1, to June 10, 2014, to detect the novel Anaplasma species by PCR. We inoculated positive samples into cell cultures. We characterised the isolated pathogen by morphological and phylogenetic analyses. We tested serum antibodies by indirect immunofluorescence assay.

FINDINGS

28 (6%) of 477 patients assessed were infected with the novel Anaplasma species according to PCR and sequencing. We isolated the pathogen in vitro from three patients. Phylogenetic analyses of rrs, gltA, groEL, msp2, and msp4 showed that the pathogen was distinct from all known Anaplasma species. We provisionally nominate it "Anaplasma capra". 22 (92%) of 24 patients with data available had seroconversion or a four-fold increase in antibody titres. All 28 patients developed non-specific febrile manifestations, including fever in 23 (82%), headache in 14 (50%), malaise in 13 (46%), dizziness in nine (32%), myalgia in four (14%), and chills in four (14%). Additionally, ten (36%) of 28 patients had rash or eschar, eight (29%) had lymphadenopathy, eight (29%) had gastrointestinal symptoms, and three (11%) had stiff neck. Five patients were admitted to hospital because of severe disease. Six (35%) of 17 patients with data available had high hepatic aminotransferase concentrations.

INTERPRETATION

The emergence of "A capra" as a cause of human disease suggests that individuals living in or travelling to endemic regions in northern China should take precautions to reduce their risk of exposure to this novel tick-borne pathogen.

FUNDING

Natural Science Foundation of China and the US National Institutes of Health.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Li H
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Zheng YC
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Ma L
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Jia N
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Jiang BG
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Jiang RR
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Huo QB
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Wang YW
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Liu HB
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Chu YL
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Song YD
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Yao NN
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Sun T
Mudanjiang Forestry Central Hospital, Mudanjiang, Heilongjiang Province, China.
Zeng FY
Shanghai Institute of Medical Genetics, Shanghai Jiaotong University, Shanghai, China.
Dumler JS
Departments of Pathology and Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, USA.
Jiang JF
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Cao WC
State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China. Electronic address: caowc@bmi.ac.cn.

MeSH

AdolescentAdultAgedAnaplasmaAnimalsCell Culture TechniquesChildChinaEhrlichiosisEpidemiological MonitoringFemaleHumansMaleMiddle AgedPhylogenyPolymerase Chain ReactionSequence Analysis, DNATick-Borne DiseasesYoung Adult

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25833289

Citation

Li, Hao, et al. "Human Infection With a Novel Tick-borne Anaplasma Species in China: a Surveillance Study." The Lancet. Infectious Diseases, vol. 15, no. 6, 2015, pp. 663-70.
Li H, Zheng YC, Ma L, et al. Human infection with a novel tick-borne Anaplasma species in China: a surveillance study. Lancet Infect Dis. 2015;15(6):663-70.
Li, H., Zheng, Y. C., Ma, L., Jia, N., Jiang, B. G., Jiang, R. R., Huo, Q. B., Wang, Y. W., Liu, H. B., Chu, Y. L., Song, Y. D., Yao, N. N., Sun, T., Zeng, F. Y., Dumler, J. S., Jiang, J. F., & Cao, W. C. (2015). Human infection with a novel tick-borne Anaplasma species in China: a surveillance study. The Lancet. Infectious Diseases, 15(6), 663-70. https://doi.org/10.1016/S1473-3099(15)70051-4
Li H, et al. Human Infection With a Novel Tick-borne Anaplasma Species in China: a Surveillance Study. Lancet Infect Dis. 2015;15(6):663-70. PubMed PMID: 25833289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human infection with a novel tick-borne Anaplasma species in China: a surveillance study. AU - Li,Hao, AU - Zheng,Yuan-Chun, AU - Ma,Lan, AU - Jia,Na, AU - Jiang,Bao-Gui, AU - Jiang,Rui-Ruo, AU - Huo,Qiu-Bo, AU - Wang,Ya-Wei, AU - Liu,Hong-Bo, AU - Chu,Yan-Li, AU - Song,Yu-Dong, AU - Yao,Nan-Nan, AU - Sun,Tie, AU - Zeng,Fan-Yi, AU - Dumler,J Stephen, AU - Jiang,Jia-Fu, AU - Cao,Wu-Chun, Y1 - 2015/03/29/ PY - 2015/4/3/entrez PY - 2015/4/3/pubmed PY - 2015/8/4/medline SP - 663 EP - 70 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 15 IS - 6 N2 - BACKGROUND: Anaplasma phagocytophilum and Anaplasma ovis cause human infections. We investigated the potential for human pathogenicity of a newly discovered Anaplasma species infecting goats in China. METHODS: We collected blood samples from patients with a history of tick bite in the preceding 2 months at Mudanjiang Forestry Central Hospital of Heilongjiang Province from May 1, to June 10, 2014, to detect the novel Anaplasma species by PCR. We inoculated positive samples into cell cultures. We characterised the isolated pathogen by morphological and phylogenetic analyses. We tested serum antibodies by indirect immunofluorescence assay. FINDINGS: 28 (6%) of 477 patients assessed were infected with the novel Anaplasma species according to PCR and sequencing. We isolated the pathogen in vitro from three patients. Phylogenetic analyses of rrs, gltA, groEL, msp2, and msp4 showed that the pathogen was distinct from all known Anaplasma species. We provisionally nominate it "Anaplasma capra". 22 (92%) of 24 patients with data available had seroconversion or a four-fold increase in antibody titres. All 28 patients developed non-specific febrile manifestations, including fever in 23 (82%), headache in 14 (50%), malaise in 13 (46%), dizziness in nine (32%), myalgia in four (14%), and chills in four (14%). Additionally, ten (36%) of 28 patients had rash or eschar, eight (29%) had lymphadenopathy, eight (29%) had gastrointestinal symptoms, and three (11%) had stiff neck. Five patients were admitted to hospital because of severe disease. Six (35%) of 17 patients with data available had high hepatic aminotransferase concentrations. INTERPRETATION: The emergence of "A capra" as a cause of human disease suggests that individuals living in or travelling to endemic regions in northern China should take precautions to reduce their risk of exposure to this novel tick-borne pathogen. FUNDING: Natural Science Foundation of China and the US National Institutes of Health. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/25833289/full_citation DB - PRIME DP - Unbound Medicine ER -