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Clinical Presentation and Outcomes of Children With Human Granulocytic Anaplasmosis
Anna M Schotthoefer1, Matthew C Hall2, Satya Vittala2,3
1Marshfield Clinic Research Institute.
Insights
Human granulocytic anaplasmosis (HGA) in children is increasing, with most cases being mild. Doxycycline is recommended due to limited data on untreated outcomes in pediatric HGA patients.
Area of Science:
- Pediatric Infectious Diseases
- Tick-Borne Illnesses
- Epidemiology
Background:
- Human granulocytic anaplasmosis (HGA) is a tick-borne disease affecting adults with potentially severe febrile illness.
- Clinical presentation and outcomes in pediatric HGA cases are not well-documented.
Purpose of the Study:
- To determine the frequency, clinical presentation, and outcomes of pediatric HGA cases.
- To analyze trends in pediatric HGA incidence in a highly endemic region of Wisconsin.
Main Methods:
- Retrospective analysis of pediatric patients (1994-2015) with suspected or confirmed HGA.
- Classification of HGA cases (confirmed, probable, suspected) based on CDC criteria.
- Statistical comparison using Fisher's exact and Wilcoxon rank-sum tests.
Main Results:
- Out of 187 identified children, 17% had confirmed or probable HGA.
- Pediatric HGA cases increased sharply in 2010 and have remained elevated.
- Concurrent HGA and Lyme disease increased hospitalization risk (OR 6.55); no life-threatening cases or deaths were reported.
Conclusions:
- The incidence of HGA in children appears to be rising.
- Most pediatric HGA cases present with mild illness.
- Doxycycline is the preferred treatment due to limited data on untreated pediatric HGA outcomes.
Background:
Adults with the tick-borne disease human granulocytic anaplasmosis (HGA) have a spectrum of acute febrile illnesses that, if untreated, might be severe. Clinical presentation and outcomes of children with HGA have been poorly described.
Methods:
A retrospective analysis was conducted to determine the frequency, presentation, and outcomes of pediatric patients with HGA between 1994 and 2015 in a region of Wisconsin in which HGA is highly endemic. Patients with related International Classification of Diseases Ninth and Tenth Revision (ICD-9 and ICD-10, respectively) codes or positive HGA laboratory test results were evaluated and classified as having had confirmed, probable, or suspected HGA on the basis of the Centers for Disease Control and Prevention (CDC) case definition. The Fisher's exact and Wilcoxon rank-sum tests were used in statistical comparisons.
Results:
Of 187 children identified with possible HGA, 17 (9%) had confirmed, 75 (40%) had probable, and 91 (49%) had suspected infections. The number of cases rose sharply in 2010 and has remained between 16 and 36 cases per year since that time. A minority of children with confirmed or probable infections had elevated liver transaminase levels (33%), leukopenia (24%), thrombocytopenia (17%), or anemia (8%); 6 (7%) of these children required hospitalization. Children with evidence of concurrent HGA and Lyme disease (27% of confirmed or probable cases) had a higher risk of hospitalization (odds ratio, 6.55 [95% confidence interval, 1.11-38.78]). None of these children had life-threatening disease or died.
Conclusions:
Evidence suggests that the frequency of HGA in children is increasing. Although most children had mild disease, doxycycline remains the treatment of choice, because outcome data for children without treatment remains limited.
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