First case of human "Candidatus Neoehrlichia mikurensis" infection in a febrile patient with chronic lymphocytic leukemia

Abstract

An immunocompromised patient presented with febrile episodes, an erysipelas-like rash, and thromboembolic complications. Amplification of 16S rRNA gene sequences from blood and sequence analysis revealed "Candidatus Neoehrlichia mikurensis." We report the first case of human disease caused by "Ca. Neoehrlichia mikurensis."

FIG. 1.

Laboratory-determined parameters (solid lines; left y axis) and body temperature (dotted line; right y axis) in relation to administration of antibiotics during the second period of hospitalization, 10 to 21 August, and several days following discharge. Antibiotics: CLOX, cloxacillin administered i.v.; FLOX, oral floxacillin; MEM, meropenem administered i.v.; and LOR, oral loracarbef. Units of measurements for parameters are as follows: serum sodium level (S-sodium), millimoles per liter; hemoglobin, grams per liter; C-reactive protein, milligrams per liter; and WBC count, cells (10⁹) per liter.

FIG. 2.

Laboratory-determined parameters (solid lines; left y axis) and body temperature (dotted line; right y axis) in relation to antibiotic treatment taken by the patient at home and administered during the third period of hospitalization (22 September to 5 October) and during subsequent polyclinical visits. Antibiotics: CLI, oral clindamycin; CLOX, cloxacillin administered i.v.; TZP, piperacillin-tazobactam administered i.v.; MEM, meropenem administered i.v.; and DOX, oral doxycycline. Units of measurement for parameters are as given in the legend to Fig. 1.