A walk through the tall grass: A case of transaminitis, thrombocytopenia, and leukopenia resulting from an emerging zoonotic infection in Nova Scotia

Tick born zoonotic infections spread by Ixodes scapularis are on the rise in Canada. Tick-borne illnesses have a large constellation of symptoms associated with them which can often overlap and cloud diagnostic certainty. Human granulocytic anaplasmosis (HGA) is an emerging infectious disease in Canada, with tick carriage rates as high as 15% in some parts of the country. The majority of cases are associated with fever, headache, myalgia and malaise, thrombocytopenia, and transaminitis. The diagnosis is made through indirect fluorescent antibody titres, examination of peripheral smear, or polymerase chain reaction. Here we present the case of an otherwise health 71-year-old male presenting with fevers, thrombocytopenia, leukopenia, and a mixed transaminitis following a tick bite. He was subsequently diagnosed as the first case of HGA in Nova Scotia confirmed by indirect fluorescent antibody titre.