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Anaplasmose , Linfo-Histiocitose Hemofagocítica , Linfo-Histiocitose Hemofagocítica/patologia , Linfo-Histiocitose Hemofagocítica/imunologia , Humanos , Anaplasmose/patologia , Anaplasmose/complicações , Anaplasmose/imunologia , Receptores de Antígenos de Linfócitos T gama-delta/metabolismo , Linfócitos T/patologia , Linfócitos T/imunologia , Masculino , Feminino , Pessoa de Meia-IdadeRESUMO
BACKGROUND Anaplasmosis, or human granulocytic anaplasmosis (HGA), is a tick-borne diseased caused by a gram-negative, intracellular bacterium, Anaplasma phagocytophilum. HGA usually presents with mild symptoms but can be more severe. This report describes a 67-year-old male resident of rural Pennsylvania, admitted to the hospital after a fall, who developed fatal acute respiratory distress syndrome (ARDS) associated with human granulocytic anaplasmosis (HGA) following transmission of Anaplasma phagocytophilum by a tick bite (Ixodes scapularis). CASE REPORT A 67-year-old man, resident of rural Pennsylvania, with history of diabetes mellitus, presented after falling from a 7-foot-tall ladder, sustaining right-sided hemopneumothorax, multiple right rib fractures, and unstable T12 vertebra fracture. He required tube thoracostomy and underwent T9-L2 posterior spinal fusion surgery. His initial labs showed leukopenia, thrombocytopenia, and elevated transaminase levels. His course was complicated by cardiac arrest and acute respiratory failure, consistent with severe ARDS. He received high positive end-expiratory pressure (PEEP) ventilation, prone positioning, and neuromuscular paralysis to improve refractory hypoxemia. Bronchoalveolar lavage (BAL) for bacterial, fungal, viral pathogens, Covid-19, respiratory viral panel, Mycoplasma pneumoniae, and Chlamydia pneumoniae were negative. his family withdrew medical care, knowing the patient's own wishes, and the patient died. Polymerase chain reaction (PCR) for Anaplasma DNA came back positive after the patient's death. His peripheral smear was then examined, showing morulae inside the cytoplasm of infected neutrophils. CONCLUSIONS This report describes the atypical presentation of a case of HGA and highlights that in parts of the world where tick-borne diseases are endemic, disease awareness, high index of clinical suspicion, and early diagnosis and management are required.
Assuntos
Anaplasma phagocytophilum , Síndrome do Desconforto Respiratório , Humanos , Masculino , Idoso , Síndrome do Desconforto Respiratório/etiologia , Evolução Fatal , Anaplasma phagocytophilum/isolamento & purificação , Anaplasmose/diagnóstico , Anaplasmose/complicações , Picadas de Carrapatos/complicaçõesRESUMO
INTRODUCTION: In presenting this case of tick-borne illness in a patient with known disseminated blastomycosis, we aim to discuss the clinical reasoning and decision-making process when treating a septic presentation in a complex patient with multiple exposures and risk factors, from identifying and addressing the most devastating differentials to selecting appropriate empiric anti-infective regimens. CASE PRESENTATION: We present the case of a 60-year-old male with a medical history of diastolic heart failure, cirrhosis, sarcoidosis, hypertension, splenectomy, and recently diagnosed disseminated blastomycosis, who developed sepsis following a recent tick exposure. DISCUSSION: While a review of the literature revealed a paucity of cases of coexisting fungal and tick-borne illness, each is independently well-studied. Several reported commonalities exist between Blastomyces and Anaplasma, including endemic regions and at-risk populations.
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Anaplasmose , Blastomicose , Humanos , Masculino , Blastomicose/diagnóstico , Blastomicose/complicações , Blastomicose/tratamento farmacológico , Pessoa de Meia-Idade , Anaplasmose/diagnóstico , Anaplasmose/complicações , Anaplasmose/tratamento farmacológico , Diagnóstico Diferencial , AnimaisRESUMO
This case report describes a 51-year-old female with presented to the emergency department with high-grade fever, headache, nausea, vomiting, dizziness, diffuse arthralgias, and new-onset worsened vision that had developed over 3 days.
Assuntos
Anaplasmose , Animais , Humanos , Anaplasmose/complicações , Anaplasmose/diagnóstico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/complicaçõesRESUMO
Due to climate change, infections from tickborne pathogens are becoming more prevalent in the Northern Hemisphere. Human granulocytic anaplasmosis, caused by the obligate intracellular gram-negative bacteria Anaplasma phagocytophilum and carried by Ixodes ticks, can lead to morbidity and mortality in select populations. Anaplasmosis is commonly accompanied by significant cytopaenia, the pathophysiology of which remains unknown. Our case report describes an uncommon meningoencephalitic presentation of anaplasmosis with substantial anaemia and thrombocytopaenia. Additionally, we propose a mechanism of bone marrow infection and suppression by A. phagocytophilum which may be responsible for the cytopaenia in anaplasmosis and provide pictographic evidence of anaplasma in peripheral blood, cerebrospinal fluid and bone marrow.
Assuntos
Anaplasma phagocytophilum , Anaplasmose , Encefalite , Ixodes , Animais , Humanos , Anaplasmose/complicações , Anaplasmose/diagnóstico , Anaplasmose/tratamento farmacológico , Medula ÓsseaRESUMO
We present a case of a 54-year-old gentleman with a history of hypertension and chronic HIV who presented with fever and epigastric pain, found to have elevated troponin-I levels and diffuse ST-segement elevations on ECG without clinical evidence of ischemia concerning for myopericarditis. Initial laboratory findings also included thrombocytopenia and elevated aminotransferases as well as computed tomography imaging revealing splenic infarcts. Given plausible exposure to ticks, this led to the eventual diagnosis of anaplasmosis confirmed on PCR assay. Cardiac MRI images confirmed myocardial involvement, which resolved with antibiotic treatment. While rare, cardiac involvement is possible sequelae of anaplasmosis infection as illustrated by this case.
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Anaplasmose , Miocardite , Pericardite , Masculino , Animais , Humanos , Pessoa de Meia-Idade , Anaplasmose/complicações , Anaplasmose/diagnóstico , Pericardite/diagnóstico , Pericardite/etiologia , Pericardite/terapia , Miocardite/diagnóstico , Miocardite/etiologia , Miocardite/terapia , Troponina IRESUMO
Human granulocytic anaplasmosis (HGA) is a bacterial infection caused by Anaplasma phagocytophilum and transmitted by the bite of the black-legged (deer tick) in North America. Its incidence is increasing. HGA can be transmitted after 24 to 48 hours of tick attachment. The incubation period is 5 to 14 days after a tick bite. Symptoms include fever, chills, headache, and myalgia. Complications include shock, organ dysfunction, and death. Mortality is less than 1% with appropriate treatment. Doxycycline is first line treatment for all ages. Start it empirically if symptoms and risk factors suggest HGA. PCR is the confirmatory test of choice.
Assuntos
Anaplasma phagocytophilum , Anaplasmose , Anaplasmose/complicações , Anaplasmose/diagnóstico , Anaplasmose/tratamento farmacológico , Animais , Doxiciclina/uso terapêutico , Humanos , Reação em Cadeia da PolimeraseAssuntos
Anaplasma phagocytophilum/isolamento & purificação , Anaplasmose/diagnóstico , Viés , COVID-19/diagnóstico , Tomada de Decisões , Anaplasmose/complicações , Tosse/etiologia , Diagnóstico Diferencial , Diarreia/etiologia , Feminino , Febre/etiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pessoa de Meia-Idade , Mialgia/etiologia , Avaliação de SintomasRESUMO
BACKGROUND: Human granulocytic anaplasmosis (HGA) is a systemic inflammatory response caused by the rickettsial bacterium Anaplasma phagocytophilum. Rhabdomyolysis and acute kidney injury (AKI) are rare complications of HGA. Here, we report a case of HGA concurrent with rhabdomyolysis and AKI in an elderly patient. CASE PRESENTATION: An 84-year old woman with a medical history of hypertension was hospitalised after two days of fever, dizziness, whole body pain, and general weakness. Laboratory investigations showed severe thrombocytopenia, leukopenia, impaired renal function, and elevated cardiac enzyme and myoglobin levels. On the day after admission, peripheral blood smear revealed morula inclusions in neutrophils, a suggestive finding of HGA. Real-time polymerase chain reaction (PCR) results indicated the presence of A. phagocytophilum. Antibiotics were de-escalated to doxycycline monotherapy. After 10 days of antibiotic treatment, laboratory tests showed complete recovery from HGA complicated with rhabdomyolysis and AKI. CONCLUSIONS: HGA can lead to serious complications in patients with associated risk factors. Therefore, in patients with HGA accompanied by rhabdomyolysis, management with antibiotics and hydration should be initiated immediately, and not delayed until diagnostic confirmation.
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Anaplasma phagocytophilum , Anaplasmose , Rabdomiólise , Idoso , Idoso de 80 Anos ou mais , Anaplasma phagocytophilum/genética , Anaplasmose/complicações , Anaplasmose/diagnóstico , Anaplasmose/tratamento farmacológico , Animais , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Feminino , Humanos , Rabdomiólise/complicações , Rabdomiólise/tratamento farmacológicoRESUMO
The aim of this study was to analyze cases of granulocytic anaplosmosis diagnosed in 53 hunting dogs in Poland. Medical records of dogs naturally infected with Anaplasma phagocytophilum were retrospectively evaluated with regard to clinical signs and laboratory abnormalities at the time of presentation, therapy and course of disease. The most common clinical signs in A. phagocytophilum-positive dogs included in the study were lethargy (100%), inappetence (94%) and fever (92.5%). Thrombocytopenia was the most common laboratory abnormality (100%), followed by a drop in haematocrit level (79.3%) and increased AST activity (75.5%). Of the 53 infected dogs, 51 (96%) recovered and two dogs (with neurological symptoms) died. Analysis of these cases indicates that A. phagocytophilum infection must be considered in differential diagnosis in dogs living in Poland, especially in hunting dogs with thrombocyto- penia and Ixodes ricinus tick invasions.
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Anaplasmose/patologia , Doenças do Cão/microbiologia , Anaplasma phagocytophilum , Anaplasmose/complicações , Animais , Doenças do Cão/patologia , Cães , Estudos Retrospectivos , Trombocitopenia/etiologia , Trombocitopenia/veterináriaAssuntos
Anaplasmose/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Idoso , Anaplasmose/sangue , Anaplasmose/patologia , Contagem de Células Sanguíneas , Medula Óssea/patologia , Humanos , Linfo-Histiocitose Hemofagocítica/sangue , Linfo-Histiocitose Hemofagocítica/patologia , MasculinoRESUMO
BACKGROUND: Splenic rupture is a well-described complication of babesiosis but is rarely associated with anaplasmosis. CASE PRESENTATION: We report a case of a 37-year-old man with no significant past medical history who presented with malaise, myalgias, arthralgias and severe left upper quadrant pain. He was found to have splenic rupture secondary to infection by Anaplasma phagocytophilum. He reported a single tick bite the week prior to onset of his symptoms. On presentation, he was found to have left upper quadrant abdominal tenderness, pancytopenia, and splenomegaly with evidence of splenic rupture and hemoperitoneum on contrasted computed tomography. Blood smear did not demonstrate intraerythrocytic parasites or morulae. His hemoperitoneum was treated conservatively and he was empirically treated for babesiosis. Diagnosis was confirmed by a positive serum PCR for Anaplasma phagocytophilum. CONCLUSIONS: This case study adds to the small number of prior case reports and provides evidence for anaplasmosis-associated splenic rupture.
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Anaplasma phagocytophilum , Anaplasmose , Pancitopenia , Ruptura Esplênica , Adulto , Anaplasmose/complicações , Anaplasmose/diagnóstico , Humanos , Masculino , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Esplenomegalia/etiologiaAssuntos
Anaplasmose/complicações , Neurite do Plexo Braquial/etiologia , Idoso , Humanos , MasculinoRESUMO
The Anaplasmataceae family is composed of obligatory intracellular Gram-negative bacteria transmitted by arthropod vectors. In Brazil, with the exception of Anaplasma marginale, little is known about the occurrence of other Anaplasma and Ehrlichia species infecting cattle. The present study aimed at investigating the occurrence of Anaplasma spp. and Ehrlichia spp. in beef cattle (Bos indicus) sampled in the Brazilian Pantanal, an area prone to periodic flooding and endemic for bovine trypanosomiasis. Blood samples from 400 cattle were collected and screened by PCR assays based on rrs and dsb genes from Anaplasma spp. and Ehrlichia spp., respectively. Positive samples for Anaplasma spp. were subjected to qPCR assays based on the msp-2 gene and nPCR based on the groEL gene. As a result, 4.75% (19/400) and 48.12% (167/347) were positive for Anaplasma platys and Ehrlichia minasensis, respectively. Besides, positivity of 56.75% (227/400) for A. marginale and seropositivity of 90.75% (363/400) for Trypanosoma vivax were found. A high rate of co-infection was observed (67.25%), from which the co-infection by A. marginale and E. minasensis was more frequently found in calves than cows. Interestingly, none of the animals presenting co-infection showed anemia or other clinical signs. The present study showed, for the first time, the occurrence of A. platys and E. minasensis in beef cattle in the southern Pantanal, as well as a high rate of co-infection by A. marginale, E. minasensis and T. vivax in the sampled animals.
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Anaplasmose/epidemiologia , Anemia/veterinária , Coinfecção/veterinária , Ehrlichiose/veterinária , Anaplasma/fisiologia , Anaplasma marginale/fisiologia , Anaplasmose/complicações , Anaplasmose/microbiologia , Anemia/complicações , Anemia/epidemiologia , Anemia/etiologia , Animais , Brasil/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/microbiologia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Ehrlichia/fisiologia , Ehrlichiose/complicações , Ehrlichiose/epidemiologia , Ehrlichiose/microbiologiaRESUMO
Anaplasmosis is an emerging infection in the United States and remains under-recognized in many areas including Pennsylvania. Presenting signs and symptoms are often nonspecific, but fulminant infection can occur in vulnerable populations. We present two cases of severe anaplasmosis that progressed to secondary hemophagocytic lymphohistiocytosis (HLH). This severe immune dysregulation syndrome has an extremely high mortality, but anaplasmosis represents one of the few treatable underlying etiologies. It is imperative for physicians to recognize this complication and start empiric doxycycline, as early treatment improves mortality. We also present a case of anaplasmosis-induced HLH successfully treated with a combination of doxycycline, steroids, and anakinra (an IL-1 receptor antagonist), highlighting that this primarily immune-mediated complication is amenable to treatment with both antibiotics and immune suppression.
Assuntos
Anaplasmose/complicações , Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Linfo-Histiocitose Hemofagocítica/terapia , Esteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Pennsylvania , Resultado do TratamentoRESUMO
PURPOSE: Tick-borne co-infections are a serious epidemiological and clinical problem. Only a few studies aimed to investigate the effect of tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA) co-infection in the course of the inflammatory process and the participation of chemokines in the pathomechanism of these diseases. The aim of the study was to evaluate CCL-4, CCL-17, CCL-20, and IL-8 serum concentrations in patients with HGA, TBE and HGAâ¯+â¯TBE co-infection. METHODS: Eighty-seven patients with HGA (nâ¯=â¯20), TBE (nâ¯=â¯49) and HGAâ¯+â¯TBE (nâ¯=â¯18) were included to the study. The control group (CG) consisted of 20 healthy people. Concentrations of cytokines were measured in serum using commercial ELISA assays. In patients with TBE and HGAâ¯+â¯TBE inflammatory markers were assessed during the acute and convalescent period. The results were analyzed using non-parametric tests with pâ¯<â¯0.05 considered as significant. RESULTS: Before treatment, significantly higher concentrations of IL-8, CCL-4 and CCL-20 were observed in HGA patients. CCL-4 and CCL-20 concentrations were significantly higher in TBE patients compared to CG. Concentrations of IL-8, CCL-4, and CCL-20 were significantly higher in HGAâ¯+â¯TBE than in CG. After treatment, a significant reduction of IL-8, CCL-4, and CCL-20 concentrations in TBE patients and IL-8 in HGAâ¯+â¯TBE co-infection was observed. CCL-4 concentration was higher in HGAâ¯+â¯TBE co-infection in comparison to patients with TBE after treatment. CONCLUSIONS: Our study confirms that concentrations of IL-8, CCL-4, and CCL-20 are increased in the course of HGA and TBE. Their concentrations in serum may be used to monitor the course of TBE and HGA, as well as possibly detect co-infections with the diseases.
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Anaplasmose/sangue , Quimiocina CCL17/sangue , Quimiocina CCL20/sangue , Quimiocina CCL4/sangue , Encefalite Transmitida por Carrapatos/sangue , Interleucina-8/sangue , Adolescente , Adulto , Idoso , Anaplasmose/líquido cefalorraquidiano , Anaplasmose/complicações , Coinfecção , Encefalite Transmitida por Carrapatos/líquido cefalorraquidiano , Encefalite Transmitida por Carrapatos/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Tick-borne encephalitis virus (TBEV) is a zoonotic pathogen which may cause tick-borne encephalitis (TBE) in humans and animals. More than 10,000 cases of TBE are reported annually in Europe and Asia. However, the knowledge on TBE in animals is limited. Co-infection with Anaplasma phagocytophilum and louping ill virus (LIV), a close relative to TBEV, in sheep has been found to cause more severe disease than single LIV or A. phagocytophilum infection. The aim of this study was to investigate TBEV infection and co-infection of TBEV and A. phagocytophilum in lambs. A total of 30 lambs, aged five to six months, were used. The experiment was divided into two. In part one, pre- and post-infection of TBEV and A. phagocytophilum was investigated (group 1 to 4), while in part two, co-infection of TBEV and A. phagocytophilum was investigated (group 5 and 6). Blood samples were drawn, and rectal temperature was measured daily. Lambs inoculated with TBEV displayed no clinical symptoms, but had a short or non-detectable viremia by reverse transcription real-time PCR. All lambs inoculated with TBEV developed neutralizing TBEV antibodies. Our study is in accordance with previous studies, and indicates that TBEV rarely causes symptomatic disease in ruminants. All lambs inoculated with A. phagocytophilum developed fever and clinical symptoms of tick-borne fever, and A. phagocytophilum was present in the blood samples of all infected lambs, shown by qPCR. Significantly higher mean TBEV titer was detected in the group co-infected with TBEV and A. phagocytophilum, compared to the groups pre- or post-infected with A. phagocytophilum. These results indicate that co-infection with TBEV and A. phagocytophilum in sheep stimulates an increased TBEV antibody response.
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Anaplasmose/patologia , Coinfecção/patologia , Encefalite Transmitida por Carrapatos/patologia , Doenças dos Ovinos/patologia , Anaplasma phagocytophilum/patogenicidade , Anaplasmose/complicações , Anaplasmose/microbiologia , Anaplasmose/virologia , Animais , Coinfecção/microbiologia , Coinfecção/virologia , Vírus da Encefalite Transmitidos por Carrapatos/patogenicidade , Encefalite Transmitida por Carrapatos/complicações , Encefalite Transmitida por Carrapatos/microbiologia , Encefalite Transmitida por Carrapatos/virologia , Feminino , Masculino , Ovinos , Doenças dos Ovinos/microbiologia , Doenças dos Ovinos/virologiaRESUMO
Tick-borne illnesses are a growing problem in the United States. Human granulocytic anaplasmosis (HGA), carried by the Ixodes scapularis tick, is caused by Anaplasma phagocytophilum. While the clinical manifestations of HGA may be protean, ranging from asymptomatic infection to life-threatening multiorgan failure, renal involvement is uncommon. We report a case of a 64-year-old man presenting with a febrile illness and acute nephritis in the setting of HGA infection. The patient's kidney biopsy was characterized by a membranoproliferative glomerulonephritis pattern and acute interstitial inflammation. After appropriate antibiotic treatment and high-dose steroids, the patient had a marked improvement in kidney function, although a subsequent recrudescence of nephritis required a 6-month course of additional steroids. As the prevalence of tick-borne diseases continues to spread across the United States, raising awareness of the potential for atypical presentations is important, particularly because early diagnosis and treatment can be curative and prevent further complications.
Assuntos
Injúria Renal Aguda/etiologia , Anaplasmose/complicações , Glucocorticoides/administração & dosagem , Rim/patologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/tratamento farmacológico , Anaplasma phagocytophilum/isolamento & purificação , Anaplasmose/diagnóstico , Anaplasmose/tratamento farmacológico , Antibacterianos/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Water buffalo is important livestock in several countries in the Latin American and Caribbean regions. This buffalo species can be infected by tick-borne hemoparasites and remains a carrier of these pathogens which represent a risk of infection for more susceptible species like cattle. Therefore, studies on the epidemiology of tick-borne hemoparasites in buffaloes are required. In this study, the prevalence of Babesia bovis, Babesia bigemina, and Anaplasma marginale were determined in water buffalo herds of western Cuba. To this aim, a cross-sectional study covering farms with large buffalo populations in the region was performed. Eight buffalo herds were randomly selected, and blood samples were collected from 328 animals, including 63 calves (3-14 months), 75 young animals (3-5 years), and 190 adult animals (> 5 years). Species-specific nested PCR and indirect ELISA assays were used to determine the molecular and serological prevalences of each hemoparasite, respectively. The molecular and serological prevalence was greater than 50% for the three hemoparasites. Differences were found in infection prevalence among buffalo herds, suggesting that local epidemiological factors may influence infection risk. Animals of all age groups were infected, with a higher molecular prevalence of B. bigemina and A. marginale in young buffalo and calves, respectively, while a stepwise increase in seroprevalence of B. bovis and B. bigemina from calves to adult buffaloes was found. The co-infection by the three pathogens was found in 12% of animals, and when analyzed by pair, the co-infections of B. bovis and B. bigemina, B. bigemina and A. marginale, and B. bovis and A. marginale were found in 20%, 24%, and 26%, respectively, underlying the positive interaction between these pathogens infecting buffaloes. These results provide evidence that tick-borne pathogen infections can be widespread among water buffalo populations in tropical livestock ecosystems. Further studies should evaluate whether these pathogens affect the health status and productive performance of water buffalo and infection risk of these pathogens in cattle cohabiting with buffalo.
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Anaplasma marginale , Anaplasmose/complicações , Babesia , Babesiose/parasitologia , Búfalos/parasitologia , Anaplasmose/epidemiologia , Animais , Babesiose/complicações , Babesiose/epidemiologia , Bovinos , Coinfecção , Estudos Transversais , Cuba/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Filogenia , Reação em Cadeia da Polimerase , Estudos Soroepidemiológicos , CarrapatosRESUMO
Human granulocytic anaplasmosis (HGA) is a tickborne rickettsial disease caused by the bacterium Anaplasma phagocytophilum. Reported cases have increased with the highest incidence in the Northeast. To our knowledge, this is the first report of anaplasmosis associated with an inflammatory arthritis. A 64-year-old man, with a history of Crohn's disease controlled on budesonide, presented to the emergency room in August 2017 with a week history of headache, sore throat, fever, myalgias, rash, and joint pain. There was no clinical evidence of active Crohn's disease. He lives in Nassau County and participates in outdoor activities. His exam was notable for a maculopapular rash over the trunk, arms, and thighs as well as synovitis of several proximal interphalangeal joints. Lab tests revealed transaminitis and elevated inflammatory markers. When evaluated by rheumatology, he had marked polyarthritis of wrists and hands as well as extremely painful motion of the shoulders, elbows, hips, knees, and ankles despite ibuprofen. Prednisone 20 mg daily resulted in significant improvement in his arthritis. Because of an Anaplasma phagocytophilum IgM of 1:320 (normal < 1:20; IgG < 1:64; normal < 1:64) that returned few weeks after presentation, he was prescribed 4 weeks of doxycycline. Convalescent Anaplasma serologies revealed negative IgM and IgG > 1:320. He fully recovered and was able to discontinue steroids. HGA presents acutely with a spectrum of manifestations ranging from a flu-like illness to severe complications such as respiratory failure. Myalgias and arthralgias are common, but an inflammatory arthritis has not been described.