Tick-borne disease passed person-to-person in China 18 Nov 2008 21:00:14 GMT Source: Reuters
HONG KONG, Nov 19 (Reuters) - A tick-borne infectious disease spreading in the United States and Europe has been identified for the first time in China, where it apparently passed from person to person, Chinese researchers said.
The disease -- human granulocytic anaplasmosis (HGA) -- is marked by symptoms like fever, severe headache, muscle aches, chills and shaking.
It can lead to severe disease and opportunistic infections. Caused by the anaplasma phagocytophiluman bacteria, it is carried by ticks to humans.
In the latest issue of the Journal of the American Medical Association, researchers described the case of the first Chinese person identified with the disease and how she probably went on to infect four healthcare workers and five of her family members.
According to her family, the 50-year-old woman was apparently bitten by a tick 12 days before developing a fever and hemorrhage. She deteriorated rapidly and died five days later.
Within a period of 2 weeks after she died, nine people who had had close contact with her fell ill and were diagnosed with the same disease.
Four were healthcare workers and five were members of her family who helped clean her when she was hemorrhaging heavily from her nose and mouth, the researchers said.
"No patients had tick bites. All nine patients had contact with the index patient within 12 hours of her death ... and indicated they were unlikely to have used gloves or wash after contact," the researchers wrote.
"All nine infected patients reported contact with blood and seven had contact with respiratory secretions. Those persons with skin exposure to blood or respiratory secretions, or those with pre-existing skin lesions or injuries followed by exposure to blood were significantly more likely to be infected."
The researchers called for strict adherence to protective protocols.
"The lessons of this study remain relevant to the daily hospital and health care unit operations to prevent any additional (hospital) outbreaks of HGA," they wrote.
HGA was recognised in the United States in 1990 and in Europe in 1997, with the annual number of infections reported in the U.S. steadily increasing. (Reporting by Tan Ee Lyn; Editing by Jerry Norton)
Context Human granulocytic anaplasmosis (HGA) is an emerging tick-borne disease in China. A cluster of cases among health care workers and family members following exposure to a patient with fulminant disease consistent with HGA prompted investigation.
Objective To investigate the origin and transmission of apparent nosocomial cases of febrile illness in the Anhui Province.
Design, Setting, and Patients After exposure to an index patient whose fatal illness was characterized by fever and hemorrhage at a primary care hospital and regional tertiary care hospital's isolation ward, secondary cases with febrile illness who were suspected of being exposed were tested for antibodies against Anaplasma phagocytophilum and by polymerase chain reaction (PCR) and DNA sequencing for A phagocytophilum DNA. Potential sources of exposure were investigated.
Main Outcome Measure Cases with serological or PCR evidence of HGA were compared with uninfected contacts to define the attack rate, relative risk of illness, and potential risks for exposure during the provision of care to the index patient.
Results In a regional hospital of Anhui Province, China, between November 9 and 17, 2006, a cluster of 9 febrile patients with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels were diagnosed with HGA by PCR for A phagocytophilum DNA in peripheral blood and by seroconversion to A phagocytophilum. No patients had tick bites. All 9 patients had contact with the index patient within 12 hours of her death from suspected fatal HGA while she experienced extensive hemorrhage and underwent endotracheal intubation.
The attack rate was 32.1% vs 0% (P = .04) among contacts exposed at 50 cm or closer, 45% vs 0% (P = .001) among those exposed for more than 2 hours, 75% vs 0% (P less than .001) among those reporting contact with blood secretions, and 87.5% vs 0% (P = .004) among those reporting contact with respiratory secretions from the index patient.
Conclusion We report the identification of HGA in China and likely nosocomial transmission of HGA from direct contact with blood or respiratory secretions.
Author Affiliations: National Institute of Communicable Disease Control and Prevention, China CDC, Beijing (Drs L. Zhang, Wan, Jiang, Jing, Luan, Fu, and Xu and Mr J. Zhang); Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, China (Drs Liu, Q. Li, and Ren); Chinese Center for Diseases Prevention and Control, Beijing (Drs Ni, Yang, Wang, and Feng); Yijishan Hospital, Wuhu, Anhui Province, China (Drs Yu and Run); Department of Pathology, University of Texas Medical Branch, Galveston (Dr X. Yu); National Institute for Viral Diseases Prevention and Control, Beijing, China CDC (Drs D. Li and Liang); State Key Laboratory for Infectious Diseases Prevention and Control, Beijing, China (Drs Wan, D. Li, Liang, Jing, and Xu); and Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Dumler).
Posted by adamm (Member # 11910) on :
Is this the first report of this thing being airborne?
Posted by Melanie Reber (Member # 3707) on :
Hi Adam,
This is the first report of HGA acquired through direct contact with blood or respiratory secretions. Not sure that includes airborne, though?
HGE has been transmitted through contact with blood of fresh venison.
I was wondering what Dumler had to do with this, and why Wormser has now written an article on it.
Posted by Melanie Reber (Member # 3707) on :
Anaplasmosis
Human Granulocytic Anaplasmosis (HGA) is caused by the bacterium Anaplasma phagocytophilum. It is contracted with the bite of infected ticks (Amblyomma americanum, Ixodes pacificus, Ixodes scapularis, Ixodes spinipalpis and Ixodes Dermacentor variabilis). It has also been documented to transmit congenitally, through blood transfusion and through direct contact with blood or respiratory secretions.
Human Granulocytic Ehrlichiosis (HGE) is caused by the bacterium Ehrlichia ewingii. It is typically contracted with the bite of infected ticks (Amblyomma americanum, Amblyomma maculatum, Ixodes scapularis, Ixodes Dermacentor variabilis and Rhipicephalus sanguineus), however, it has also been transmitted through contact with blood of fresh venison.
The Fatality rate is 2-5%.
...
Nosocomial Transmission of Human Granulocytic Anaplasmosis in China. Lijuan Zhang, MD, PhD et al. JAMA. 2008;300(19):2263-2270.
Human Granulocytic Anaplasmosis During Pregnancy: Case Series and Literature Review. Dhand A, Nadelman R et al. Clinical Infectious Diseases 2007;45:589-593.
Anaplasma phagocytophilum Transmitted Through Blood Transfusion Morbidity and Mortality Weekly Report, October 24, 2008 MMWR 57(42);1145-1148
Exposure to deer blood may be a cause of human granulocytic ehrlichiosis. Bakken JS, Krueth J, Lund T, Malkovitch D, Asanovich K, Dumler JS. Clin Infect Dis 1996; 23:198.
The human ehrlichioses in the United States.1999. McQuiston, J. H., C. D. Paddock, R. C. Holman, and J. E. Childs. Emerg. Infect. Dis. 5:635-642 (Fatality rate)
Posted by adamm (Member # 11910) on :
Do you think those two were involved in modifying the organism somehow?
Posted by Melanie Reber (Member # 3707) on :
Nosocomial Transmission of Human Granulocytic Anaplasmosis?
Peter J. Krause, MD; Gary P. Wormser, MD
JAMA. 2008;300(19):2308-2309.
In this issue of JAMA, Zhang and colleagues describe a possible nosocomial outbreak of human granulocytic anaplasmosis (HGA) in China.1 The clinical presentation of the index case, a previously healthy 50-year-old woman who developed a febrile illness with rash and massive bleeding and who died 5 days later, is consistent with many infectious etiologies including viral hemorrhagic fever (VHF) for which she was given ribavirin.2 Laboratory studies in 9 subsequent cases in family members and health care workers who had contact with the patient, however, suggested that her disease was HGA.
Human granulocytic anaplasmosis is an emerging tick-borne infectious disease caused by Anaplasma phagocytophilum that occurs in Lyme disease-endemic areas in the United States and sporadically in Europe. Clinical manifestations of HGA are usually mild to moderate and most patients promptly respond to treatment with doxycycline, which neither the index patient . . . [Full Text of this Article]
Author Affiliations: Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut (Dr Krause), and the Division of Infectious Diseases, Department of Medicine, New York Medical College, Valhalla, New York (Dr Wormser).
(this needs a subscription, so they would only provide the first 150 words. If anyone can get the full text, I would love to see it!)
Posted by Melanie Reber (Member # 3707) on :
Editorial: Nosocomial Transmission of Human Granulocytic Anaplasmosis?
Peter J. Krause, M.D., of the Yale School of Medicine, New Haven, Conn., and Gary P. Wormser, M.D., of New York Medical College, Valhalla, N.Y., write that these findings provide a reminder regarding safety precautions against disease transmission.
``What is the significance of the investigation by Zhang et al? It may represent the first report of human-to-human transmission of A phagocytophilum and the first report of human HGA infection in China. This report certainly serves to reinforce the importance of adopting standard blood and body fluid precautions for all patients and especially for those with HGA; these precautions are the accepted standard of care in the United States.
The report also should stimulate further investigation of the existence of A phagocytophilum in the region of China where this outbreak originated. In addition, it is essential to emphasize that fulfilling the case definition of HGA used for epidemiological surveillance in the United States does not provide diagnostic certainty, unless the diagnosis was established by the microbiological gold standard of culturing the microorganism. Therefore, the findings of the study by Zhang et al, while interesting and provocative, should be regarded as preliminary.''
(it figures...)
Posted by Cold Feet (Member # 9882) on :
Just wanted to bump these articles up as they are really important. Thanks for finding and posting these!
Posted by pryorka (Member # 13649) on :
So the Chinese were the ones to find out it could be spread by this method even though the infection has been in the U.S. for centuries??? Good job CDC good job....
Posted by jamescase20 (Member # 14124) on :
I keep telling you guys/gals that many TBDs are spread human to human...besides, common sense dictates this in several ways. One, is how can this bug resist ABX treatments? It can due to human to human transmission thanks to heavy human and animal ABX use, by ABX resistence.
Two, These bugs STAY alive to DAYS under a coverslip and slide on a blood smear.
Three, Bb was transmitted appearently to the discoverier of lyme via rabbit urine.
Four, saliva was discovered to contain actual KEETS!!!!