@article{3108228,
    title = "Fatal human anaplasmosis associated with macrophage activation syndrome in Greece and the Public Health response",
    author = "Tsiodras, S. and Spanakis, N. and Spanakos, G. and Pervanidou, D. and Georgakopoulou, T. and Campos, E. and Petra, T. and Kanellopoulos, P. and Georgiadis, G. and Antalis, E. and Kontos, V. and Giannopoulos, L.A. and Tselentis, Y. and Papa, A. and Tsakris, A. and Saroglou, G.",
    journal = "Journal of Infection and Public Health",
    year = "2017",
    volume = "10",
    number = "6",
    pages = "819-823",
    publisher = "Elsevier Ireland Ltd",
    issn = "1876-0341",
    doi = "10.1016/j.jiph.2017.01.002",
    keywords = "chaperonin 60;  ferritin, adult;  Anaplasma phagocytophilum;  Article;  case report;  clinical article;  clinical feature;  disease surveillance;  fatality;  ferritin blood level;  gene amplification;  Greece;  hematological parameters;  human;  human granulocytic anaplasmosis;  insomnia;  irritability;  kidney failure;  macrophage activation syndrome;  male;  middle aged;  outcome assessment;  pancytopenia;  priority journal;  pyrexia idiopathica;  respiratory failure;  sore throat;  anaplasmosis;  animal;  complication;  dog;  fatality;  isolation and purification;  macrophage activation syndrome;  pathology;  public health service, Anaplasma phagocytophilum;  Anaplasmosis;  Animals;  Dogs;  Fatal Outcome;  Greece;  Humans;  Macrophage Activation Syndrome;  Male;  Middle Aged;  Public Health Administration",
    abstract = "Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum that has the potential to spread in new geographical areas. The first fatal case of HGA in Greece is presented. Fever of unknown origin, renal and respiratory insufficiency and development of macrophage activation syndrome characterized the clinical presentation. Amplification and sequencing of a fragment of the groEL gene revealed the presence of A. phagocytophilum. The epidemiological and clinical features were collected during an epidemiological investigation. Public health measures were instituted by the Hellenic Centre for Disease Control and Prevention. The Public Health intervention required the collaboration of epidemiologists, veterinarians and microbiologists. Emphasis was given to communication activities and misconceptions concerning canines and their role in the disease. The emergence of human anaplasmosis in a new geographical area highlights the importance of disease awareness and of the need for continued support for tick and tick-borne disease surveillance networks. © 2017 The Authors"
}