Nosocomial transmission of human granulocytic anaplasmosis in China

Lijuan Zhang, Yan Liu, Daxin Ni, Qun Li, Yanlin Yu, Xue Jie Yu, Kanglin Wan, Dexin Li, Guodong Liang, Xiugao Jiang, Huaiqi Jing, Jing Run, Mingchun Luan, Xiuping Fu, Jingshan Zhang, Weizhong Yang, Yu Wang, J. Stephen Dumler, Zijian Feng, Jun Ren & 1 others Jianguo Xu

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish (US)
Pages (from-to)2263-2270
Number of pages8
JournalJournal of the American Medical Association
Volume300
Issue number19
DOIs
StatePublished - Nov 19 2008

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Anaplasmosis
China
Fever
Polymerase Chain Reaction
Anaplasma phagocytophilum
Tick-Borne Diseases
Tick Bites
Hemorrhage
Intratracheal Intubation
DNA
Leukopenia
Tertiary Healthcare
Transaminases
DNA Sequence Analysis
Tertiary Care Centers
Thrombocytopenia
Primary Health Care
Outcome Assessment (Health Care)
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Zhang, L., Liu, Y., Ni, D., Li, Q., Yu, Y., Yu, X. J., ... Xu, J. (2008). Nosocomial transmission of human granulocytic anaplasmosis in China. Journal of the American Medical Association, 300(19), 2263-2270. https://doi.org/10.1001/jama.2008.626

Nosocomial transmission of human granulocytic anaplasmosis in China. / Zhang, Lijuan; Liu, Yan; Ni, Daxin; Li, Qun; Yu, Yanlin; Yu, Xue Jie; Wan, Kanglin; Li, Dexin; Liang, Guodong; Jiang, Xiugao; Jing, Huaiqi; Run, Jing; Luan, Mingchun; Fu, Xiuping; Zhang, Jingshan; Yang, Weizhong; Wang, Yu; Dumler, J. Stephen; Feng, Zijian; Ren, Jun; Xu, Jianguo.

In: Journal of the American Medical Association, Vol. 300, No. 19, 19.11.2008, p. 2263-2270.

Research output: Contribution to journalArticle

Zhang, L, Liu, Y, Ni, D, Li, Q, Yu, Y, Yu, XJ, Wan, K, Li, D, Liang, G, Jiang, X, Jing, H, Run, J, Luan, M, Fu, X, Zhang, J, Yang, W, Wang, Y, Dumler, JS, Feng, Z, Ren, J & Xu, J 2008, 'Nosocomial transmission of human granulocytic anaplasmosis in China', Journal of the American Medical Association, vol. 300, no. 19, pp. 2263-2270. https://doi.org/10.1001/jama.2008.626
Zhang, Lijuan ; Liu, Yan ; Ni, Daxin ; Li, Qun ; Yu, Yanlin ; Yu, Xue Jie ; Wan, Kanglin ; Li, Dexin ; Liang, Guodong ; Jiang, Xiugao ; Jing, Huaiqi ; Run, Jing ; Luan, Mingchun ; Fu, Xiuping ; Zhang, Jingshan ; Yang, Weizhong ; Wang, Yu ; Dumler, J. Stephen ; Feng, Zijian ; Ren, Jun ; Xu, Jianguo. / Nosocomial transmission of human granulocytic anaplasmosis in China. In: Journal of the American Medical Association. 2008 ; Vol. 300, No. 19. pp. 2263-2270.
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abstract = "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",
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AU - Zhang, Lijuan

AU - Liu, Yan

AU - Ni, Daxin

AU - Li, Qun

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AU - Yu, Xue Jie

AU - Wan, Kanglin

AU - Li, Dexin

AU - Liang, Guodong

AU - Jiang, Xiugao

AU - Jing, Huaiqi

AU - Run, Jing

AU - Luan, Mingchun

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AU - Zhang, Jingshan

AU - Yang, Weizhong

AU - Wang, Yu

AU - Dumler, J. Stephen

AU - Feng, Zijian

AU - Ren, Jun

AU - Xu, Jianguo

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N2 - 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

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