TY - JOUR
T1 - Prevalence of tick-borne neoehrlichia mikurensis in individuals undergoing B-cell depleting therapy in Denmark
T2 - A prospective cohort study 2023-2024
AU - Mens, Helene
AU - Gynthersen, Rosa
AU - Christensen, Jeppe Romme
AU - Blinkenberg, Morten
AU - Sellebjerg, Finn
AU - El Fassi, Daniel
AU - Glintborg, Bente
AU - Jensen, Dorte Vendelbo
AU - Jensen, Jørgen Skov
AU - Lebech, Anne Mette
N1 - Publisher Copyright:
© 2025 The Authors.
PY - 2025
Y1 - 2025
N2 - Background Neoehrlichia mikurensis is an emerging tick-borne pathogen posing a particular risk to individuals undergoing B-cell depleting therapy (BCDT). Objective To establish a rational testing strategy for N. mikurensis among individuals on BCDT. Methods We conducted a prospective cohort study between January 2023 and December 2024 on Adults receiving BCDT, in the Capital Region of Denmark. A digital questionnaire covered tick exposure and symptoms. Blood was tested for N. mikurensis DNA by real-time PCR. Results Of 1211 eligible individuals, 443 (37%) were enrolled. The median age was 54 years, and 62% were female. PCR testing was performed on 389 participants, detecting N. mikurensis DNA in 1.0% (4/389; 95% CI: 0.4-2.6). All infected individuals reported prolonged symptoms (e.g., fatigue, fever, unintended weight loss) and responded rapidly to doxycycline therapy. Notably, only one of the four cases exhibited elevated CRP. Symptom-based screening yielded a high likelihood ratio of 25 for identifying positive cases. Conclusions Our results indicate that employing a symptom-based testing strategy for N. mikurensis is a rational approach for individuals undergoing BCDT.
AB - Background Neoehrlichia mikurensis is an emerging tick-borne pathogen posing a particular risk to individuals undergoing B-cell depleting therapy (BCDT). Objective To establish a rational testing strategy for N. mikurensis among individuals on BCDT. Methods We conducted a prospective cohort study between January 2023 and December 2024 on Adults receiving BCDT, in the Capital Region of Denmark. A digital questionnaire covered tick exposure and symptoms. Blood was tested for N. mikurensis DNA by real-time PCR. Results Of 1211 eligible individuals, 443 (37%) were enrolled. The median age was 54 years, and 62% were female. PCR testing was performed on 389 participants, detecting N. mikurensis DNA in 1.0% (4/389; 95% CI: 0.4-2.6). All infected individuals reported prolonged symptoms (e.g., fatigue, fever, unintended weight loss) and responded rapidly to doxycycline therapy. Notably, only one of the four cases exhibited elevated CRP. Symptom-based screening yielded a high likelihood ratio of 25 for identifying positive cases. Conclusions Our results indicate that employing a symptom-based testing strategy for N. mikurensis is a rational approach for individuals undergoing BCDT.
KW - B-cell depleting therapy
KW - Infection risk
KW - Neoehrlichia mikurensis
KW - Tick-borne diseases
U2 - 10.1016/j.ijid.2025.108069
DO - 10.1016/j.ijid.2025.108069
M3 - Journal article
C2 - 40972815
AN - SCOPUS:105022742753
SN - 1201-9712
VL - 161
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
M1 - 108069
ER -