Laboratory Diagnosis of Tick-Borne Infections

Case 4

July 2010

So now let’s go on to our last case, which is a 20-year-old male from Wisconsin and on the right is shown the county of his residence which you can notice is right along the Mississippi river which separates Wisconsin and Minnesota states and this is an area known to be endemic for multiple tick borne diseases. He had previously received a kidney transplant and so he was on immunosuppressive therapy. And he now presented with fever, malaise, and headache. Lab testing showed lymphopenia and mildly elevated liver function tests, and a peripheral blood smear was negative for babesia parasites. Further testing was performed, including a serologic panel for babesiosis, anaplasmosis, and Lyme disease and these were all negative. But, the physician was still concerned about an infectious etiology given that this patient was immunosuppressed, so a tick-borne disease PCR panel was also performed.

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Jump to section:

• Introduction
• Presentation Outline
• Tick-Borne Diseases
• Advantages and Limitations of Conventional Tests
• Molecular Diagnostic Methods Potential Advantages
• Molecular Diagnostic Methods Potential Disadvantages
• Treatment and Diagnostic Recommendations
• Case 1
• Diagnostic Workup
• Representative Image Giemsa-stained Peripheral Blood Smear
• Differential Diagnosis
• Which one is Plasmodium falciparum?
• Main Morphologic Features Table
• Classic Maltese Cross
• Extracellular Forms of Babesiosis
• Side-by-Side Comparison
• Further Workup
• Malaria PCR
• Babesia microti PCR
• Advantages/Uses of PCR
• Potential Disadvantages
• Potential Disadvantages
• Case 2
• Lyme Disease: Diagnostic Approach
• Reported Cases of Lyme Disease, 2008
• Serologic Assay: Test of Choice for Diagnosis of Lyme Disease
• Case 2, Further Workup
• Potential Roles for PCR
• Which Specimens Should be Tested by PCR?
• PCR for Detection of Borrelia burgdorferi DNA in Blood
• Case 3
• Live Tick Image
• Tick Image Close Up
• IDSA Guidelines
• IDSA Guidelines, continued
• Testing of Ticks by PCR
• Case 4
• Tick-Borne PCR Panel
• Diagnostic Tests for HME and HGA
• PCR for Diagnosis of Ehrlichiosis/Anaplasmosis
• Ehrlichia and Anaplasma PCR Assay Graph
• Phylogenetic Tree
• Ehrlichia muris-like Organism
• All Patients with EML had Tick Exposure
• Prevention of Tick-Borne Diseases
• Conclusions
• Conclusions, continued
• Questions?