{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:06:05Z","timestamp":1789538765621,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Neoehrlichia mikurensis<\/jats:italic> (<jats:italic>N. mikurensis<\/jats:italic>) is a newly discovered tick\u2010borne pathogen that can inflict life\u2010threatening illness in immunocompromised patients. <jats:italic>N. mikurensis<\/jats:italic> infection is only detectable by polymerase chain reaction (PCR)\u2010based methodologies. We describe three distinct clinical manifestations of <jats:italic>N. mikurensis<\/jats:italic> infection (neoehrlichiosis) in Danish patients receiving B\u2010lymphocyte\u2010depleting therapy, rituximab, for underlying hematological, rheumatological, or neurological disorders. All three patients went through a protracted pre\u2010diagnostic period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p><jats:italic>N. mikurensis<\/jats:italic> DNA was detected and confirmed using two methods. Blood was tested by specific real\u2010time PCR targeting the <jats:italic>groEL<\/jats:italic> gene and by 16S and 18S profiling followed by sequencing. Bone marrow was analyzed by 16S and 18S profiling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:italic>N. mikurensis<\/jats:italic> was detected in blood samples in all three cases and in bone marrow from one of the three. The severity of the symptoms ranged from prolonged fever lasting more than 6 months to life\u2010threatening hyperinflammation in the form of hemophagocytic lymphohistiocytosis (HLH). Interestingly, all patients presented with splenomegaly and two with hepatomegaly. After starting doxycycline therapy, symptoms were relieved within a few days, and biochemistry and organomegaly quickly normalized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We present three Danish patients recognized by the same clinician over a period of 6 months, strongly suggesting that many cases are going unrecognized. Second, we describe the first case of <jats:italic>N. mikurensis<\/jats:italic>\u2010induced HLH and emphasize the potential severity of undetected neoehrlichiosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.13638","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T06:12:21Z","timestamp":1680588741000},"page":"782-790","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["<i>Neoehrlichia mikurensis<\/i>\u2014An emerging opportunistic tick\u2010borne infection in immunosuppressed patients"],"prefix":"10.1111","volume":"293","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2493-2147","authenticated-orcid":false,"given":"Rosa M. M.","family":"Gynthersen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen Rune","family":"Stensvold","sequence":"additional","affiliation":[{"name":"Laboratory of Parasitology, Department of Bacteria Parasites, and Fungi, Statens Serum Institut  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Signe Ledou","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Pathology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger Jon","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus 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