目的:提高对新出现的蜱传病原体米库伦病新埃希氏菌感染的各种临床表现的认识。
方法:在10年期间(2013-2023年)在瑞典诊断为米库伦奈瑟氏球菌感染的所有患者均接受了人口学因素调查,危险因素,合并症,临床症状和体征,和实验室结果。使用“对潜在结构的正交投影-判别分析”生成多变量模型,以确定与mikurensis感染相关的临床和免疫参数。
结果:在10年期间,134例患者被诊断为米库伦奈瑟菌感染,其中102人被纳入本研究。大多数患者(79%)受到免疫抑制。主要合并症是恶性B细胞淋巴瘤,多发性硬化症,和类风湿性关节炎。利妥昔单抗治疗(59%)和脾切除术(14%)表现突出。所有患者都居住在瑞典南部蜱病流行地区,然而,其中三分之一是在冬季蜱虫不活跃时被诊断出来的。确定了两名无症状感染的献血者,但未确认输血传播的感染。C反应蛋白水平升高,口腔软骨,血清总IgM与新氏体病有关。以前未报告的症状,如踝关节水肿,颈部疼痛,麻木,在一些患者中发现了突发性耳聋。1例再生障碍性贫血在根除感染后部分好转。
结论:新氏病是一种多面性新发传染病。
OBJECTIVE: To increase knowledge about the varied clinical manifestations of human infection with the emerging
tick-borne pathogen Neoehrlichia mikurensis.
METHODS: All patients diagnosed in Sweden with N. mikurensis infection during a 10-year period (2013-2023) were investigated regarding their demographic factors, risk factors, comorbidities, clinical signs and symptoms, and laboratory results. Multivariate models were generated using \"Orthogonal Projections to Latent Structures-Discriminant Analysis\" to identify clinical and immune parameters associated with N. mikurensis infection.
RESULTS: During the 10-year period, 134 patients were diagnosed with N. mikurensis infection, 102 of whom were included in this study. Most of the patients (79%) were immunosuppressed. The main comorbidities were malignant B-cell lymphomas, multiple sclerosis, and rheumatoid arthritis. Rituximab therapy (59%) and splenectomy (14%) featured prominently. All patients resided in the southern
tick-endemic part of Sweden, yet one-third of them were diagnosed in wintertime when ticks are inactive. Two asymptomatically infected blood donors were identified but transfusion-transmitted infection was not confirmed. Increased levels of C-reactive protein, orosomucoid, and total IgM in serum were associated with neoehrlichiosis. Previously unreported symptoms such as ankle edema, neck pain, numbness, and sudden deafness were detected in some patients. One case of aplastic anemia partially improved after eradication of the infection.
CONCLUSIONS: Neoehrlichiosis is a multi-faceted emerging infectious disease.