1
|
Hosahalli Vasanna S, Lim PPC, Khan TS, Dalal J. Secondary hemophagocytic lymphohistiocytosis associated with Rocky Mountain spotted fever in a toddler: A case report. EJHAEM 2022; 3:463-466. [PMID: 35846066 PMCID: PMC9175780 DOI: 10.1002/jha2.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
A three-year-old boy presented with fever, maculopapular rash involving palms and soles, and hyponatremia two weeks following a tick bite. Empiric doxycycline that he was on was discontinued following negative initial rickettsial serology based on the non-endemicity of Rocky Mountain spotted fever (RMSF) in Northeast Ohio. He demonstrated high inflammatory markers and met the criteria for hemophagocytic lymphohistiocytosis (HLH). With a working diagnosis of macrophage activation syndrome secondary to presumed systemic-onset juvenile idiopathic arthritis (soJIA), he received HLH-directed therapy. Rising antibody titers in convalescent sera established the diagnosis of RMSF. The patient recovered completely with HLH directed therapy and re-institution of doxycycline. This is the first pediatric case report of Rickettsia rickettsii induced HLH demonstrating a favorable outcome despite modified therapy.
Collapse
Affiliation(s)
- Smitha Hosahalli Vasanna
- Department of Pediatric Hematology‐OncologyRainbow Babies and Children's Hospital/ University HospitalsClevelandOhioUSA
| | - Peter Paul C. Lim
- Department of Pediatric Infectious DiseasesRainbow Babies and Children's Hospital/University HospitalsClevelandOhioUSA
| | - Tanya Saeeda Khan
- Department of PediatricsRainbow Babies and Childreny's Hospital/University HospitalsClevelandOhioUSA
| | - Jignesh Dalal
- Department of Pediatric Hematology‐OncologyRainbow Babies and Children's Hospital/ University HospitalsClevelandOhioUSA
| |
Collapse
|
2
|
Castro MBD, Szabó MPJ, Aquino LPCTD, Dagnoni AS, Alessi AC, Costa MT, Nakaghi ACH, Santi MD, Calchi AC, André MR, Machado RZ. Immunophenotypical and pathological changes in dogs experimentally infected with Ehrlichia canis. REVISTA BRASILEIRA DE PARASITOLOGIA VETERINARIA = BRAZILIAN JOURNAL OF VETERINARY PARASITOLOGY : ORGAO OFICIAL DO COLEGIO BRASILEIRO DE PARASITOLOGIA VETERINARIA 2022; 31:e021621. [PMID: 35416862 PMCID: PMC9901872 DOI: 10.1590/s1984-29612022020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/11/2022] [Indexed: 11/22/2022]
Abstract
Canine monocytic ehrlichiosis (CME) is one of the most important tick-borne diseases worldwide, with multisystemic presentations. Immune dysregulation has been proposed as the primary mechanism involved in its pathogenesis and in tissue injury in dogs with CME. Experimental infection of German Shepherd dogs in the present study demonstrated that CME caused marked pathological changes in their lymph nodes and spleen, and also gave rise to mononuclear infiltration in organs and tissues. Immunophenotyping of cells in lymph nodes, spleen and injured tissues highlighted differences in lymphocyte subsets, local expression of immunoglobulin subclasses and MHCII molecules between infected and control dogs. These findings suggest that the immunophenotypic and immunopathological changes in dogs with acute experimental CME are related to Th1 bias and compartmentalized immune response.
Collapse
Affiliation(s)
| | - Matias Pablo Juan Szabó
- Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia - UFU, Uberlândia, MG, Brasil
| | | | | | - Antonio Carlos Alessi
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| | - Mirela Tinucci Costa
- Departamento de Clínica e Cirurgia Veterinária, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| | | | - Mariele De Santi
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| | - Ana Claúdia Calchi
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| | - Marcos Rogério André
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| | - Rosangela Zacarias Machado
- Departamento de Patologia, Reprodução e Saúde Única, Faculdade Ciências Agrárias e Veterinárias - FCAV, Universidade Estadual Paulista - UNESP, Jaboticabal, SP, Brasil
| |
Collapse
|
3
|
Optimization and Evaluation of a Multiplex Quantitative PCR Assay for Detection of Nucleic Acids in Human Blood Samples from Patients with Spotted Fever Rickettsiosis, Typhus Rickettsiosis, Scrub Typhus, Monocytic Ehrlichiosis, and Granulocytic Anaplasmosis. J Clin Microbiol 2020; 58:JCM.01802-19. [PMID: 32493778 DOI: 10.1128/jcm.01802-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/25/2020] [Indexed: 01/09/2023] Open
Abstract
Spotted fever group rickettsioses (SFGR), typhus group rickettsioses (TGR), scrub typhus (caused by Orientia tsutsugamushi), ehrlichiosis, and anaplasmosis often present as undifferentiated fever but are not treated by agents (penicillins and cephalosporins) typically used for acute febrile illness. Inability to diagnose these infections when the patient is acutely ill leads to excess morbidity and mortality. Failure to confirm these infections retrospectively if a convalescent blood sample is not obtained also impairs epidemiologic and clinical research. We designed a multiplex real-time quantitative PCR (qPCR) assay to detect SFGR, TGR, O. tsutsugamushi, and infections caused by Anaplasma phagocytophilum and Ehrlichia chaffeensis with the ompA, 17-kDa surface antigen gene, tsa56, msp2 (p44), and vlpt gene targets, respectively. Analytical sensitivity was ≥2 copies/μl (linear range, 2 to 2 × 105) and specificity was 100%. Clinical sensitivities for SFGR, TGR, and O. tsutsugamushi were 25%, 20%, and 27%, respectively, and specificities were 98%, 99%, and 100%, respectively. Clinical sensitivities for A. phagocytophilum and E. chaffeensis were 93% and 84%, respectively, and specificities were 99% and 98%, respectively. This multiplex qPCR assay could support early clinical diagnosis and treatment, confirm acute infections in the absence of a convalescent-phase serum sample, and provide the high-throughput testing required to support large clinical and epidemiologic studies. Because replication of SFGR and TGR in endothelial cells results in very low bacteremia, optimal sensitivity of qPCR for these rickettsioses will require use of larger volumes of input DNA, which could be achieved by improved extraction of DNA from blood and/or extraction of DNA from a larger initial volume of blood.
Collapse
|
4
|
Abstract
Human ehrlichiosis and anaplasmosis are acute febrile tick-borne infectious diseases caused by various members from the genera Ehrlichia and Anaplasma. Ehrlichia chaffeensis is the major etiologic agent of human monocytotropic ehrlichiosis (HME), while Anaplasma phagocytophilum is the major cause of human granulocytic anaplasmosis (HGA). The clinical manifestations of HME and HGA ranges from subclinical to potentially life-threatening diseases associated with multi-organ failure. Macrophages and neutrophils are the major target cells for Ehrlichia and Anaplasma, respectively. The threat to public health is increasing with newly emerging ehrlichial and anaplasma agents, yet vaccines for human ehrlichioses and anaplasmosis are not available, and therapeutic options are limited. This article reviews recent advances in the understanding of HME and HGA.
Collapse
|
5
|
Walker DH, Dumler JS. The role of CD8 T lymphocytes in rickettsial infections. Semin Immunopathol 2015; 37:289-99. [PMID: 25823954 DOI: 10.1007/s00281-015-0480-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/15/2015] [Indexed: 12/01/2022]
Abstract
Arthropod-borne obligately intracellular bacteria pose a difficult challenge to the immune system. The genera Rickettsia, Orientia, Ehrlichia, and Anaplasma evolved mechanisms of immune evasion, and each interacts differently with the immune system. The roles of CD8 T cells include protective immunity and immunopathology. In Rickettsia infections, CD8 T cells are protective mediated in part by cytotoxicity toward infected cells. In contrast, TNF-α overproduction by CD8 T cells is pathogenic in lethal ehrlichiosis by induction of apoptosis/necrosis in hepatocytes. Yet, CD8 T cells, along with CD4 T cells and antibodies, also contribute to protective immunity in ehrlichial infections. In granulocytic anaplasmosis, CD8 T cells impact pathogen control modestly but could contribute to immunopathology by virtue of their dysfunction. While preliminary evidence indicates that CD8 T cells are important in protection against Orientia tsutsugamushi, mechanistic studies have been neglected. Valid animal models will enable experiments to elucidate protective and pathologic immune mechanisms. The public health need for vaccines against these agents of human disease, most clearly O. tsutsugamushi, and the veterinary diseases, canine monocytotropic ehrlichiosis (Ehrlichia canis), heartwater (Ehrlichia ruminantium), and bovine anaplasmosis (A. marginale), requires detailed immunity and immunopathology investigations, including the roles of CD8 T lymphocytes.
Collapse
Affiliation(s)
- David H Walker
- Department of Pathology, Director, UTMB Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0609, USA,
| | | |
Collapse
|
6
|
Q fever and Mediterranean spotted fever associated with hemophagocytic syndrome: case study and literature review. Int J Infect Dis 2013; 17:e629-33. [PMID: 23402798 DOI: 10.1016/j.ijid.2012.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/09/2012] [Accepted: 12/13/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemophagocytosis during Q fever (QF) and Mediterranean spotted fever (MSF) is rare and only a few cases have been reported. We aimed to investigate the characteristics, outcome, and treatment of QF/MSF-associated hemophagocytosis. METHODS We retrospectively reviewed all patients with a diagnosis of QF or MSF and suspected hemophagocytic syndrome (HS), according to Henter's criteria, between 2002 and 2011, and compared the latter to patients without HS or with lymphoma-associated HS. RESULTS Seventeen patients with HS (median age 42 years, range 5-68 years; five females (29%)) with QF (n=8) and MSF (n=9) were included in this study. When comparing patients with QF- and MSF-associated HS with patients without HS (n=11), HS-associated signs (splenomegaly, ferritinemia, hypertriglyceridemia, and cytopenia) were significantly more frequent in patients with histological HS (p<0.05), along with a greater number of Henter's criteria. Despite the presence of HS-associated signs, treatment was similar in these two subgroups, including the time to recovery and the outcome. When compared to lymphoma-associated HS (n=10), the outcome in QF/MSF-associated HS was significantly different, with mortality in 70% of lymphoma patients versus none in QF- and MSF-associated HS (p<0.05). CONCLUSION Hemophagocytosis is a rare occurrence during the course of QF and MSF. The presence of profound cytopenia is quite unusual in QF and MSF and should bring to mind the presence of associated HS. Nevertheless, hemophagocytic syndrome is associated with a good outcome in this condition.
Collapse
|
7
|
Cascio A, Giordano S, Dones P, Venezia S, Iaria C, Ziino O. Haemophagocytic syndrome and rickettsial diseases. J Med Microbiol 2010; 60:537-542. [PMID: 21163825 DOI: 10.1099/jmm.0.025833-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Haemophagocytic lymphohistiocytosis is a rare but potentially fatal disease resulting from dysregulated activation and proliferation of lymphocytes. We present a case of haemophagocytic syndrome occurring in a 5-year-old Italian boy as a complication of Mediterranean spotted fever. The characteristics of this case have been analysed and contextualized among those of another 15 cases of haemophagocytic syndrome associated with rickettsial diseases found through a systematic review of the international literature.
Collapse
Affiliation(s)
- Antonio Cascio
- AILMI (Associazione Italiana per la Lotta contro le Malattie infettive) Universit� di Messina, Messina, Italy.,Dipartimento di Patologia Umana, Università di Messina, Messina, Italy
| | - Salvatore Giordano
- Unità Operativa Complessa Malattie Infettive, ARNAS 'Civico, Di Cristina, Benfratelli', Palermo, Italy
| | - Piera Dones
- Unità Operativa Complessa Malattie Infettive, ARNAS 'Civico, Di Cristina, Benfratelli', Palermo, Italy
| | - Silvia Venezia
- Unità Operativa Complessa Oncoematologia Pediatrica, ARNAS 'Civico, Di Cristina, Benfratelli', Palermo, Italy
| | - Chiara Iaria
- Dipartimento di Malattie Infettive e Tropicali, Università 'La Sapienza', Roma, Italy.,AILMI (Associazione Italiana per la Lotta contro le Malattie infettive) Universit� di Messina, Messina, Italy
| | - Ottavio Ziino
- Unità Operativa Complessa Oncoematologia Pediatrica, ARNAS 'Civico, Di Cristina, Benfratelli', Palermo, Italy
| |
Collapse
|
8
|
Abstract
Human ehrlichiosis and anaplasmosis are acute febrile tick-borne diseases caused by various members of the genera Ehrlichia and Anaplasma (Anaplasmataceae). Human monocytotropic ehrlichiosis has become one of the most prevalent life-threatening tick-borne disease in the United States. Ehrlichiosis and anaplasmosis are becoming more frequently diagnosed as the cause of human infections, as animal reservoirs and tick vectors have increased in number and humans have inhabited areas where reservoir and tick populations are high. Ehrlichia chaffeensis, the etiologic agent of human monocytotropic ehrlichiosis (HME), is an emerging zoonosis that causes clinical manifestations ranging from a mild febrile illness to a fulminant disease characterized by multiorgan system failure. Anaplasma phagocytophilum causes human granulocytotropic anaplasmosis (HGA), previously known as human granulocytotropic ehrlichiosis. This article reviews recent advances in the understanding of ehrlichial diseases related to microbiology, epidemiology, diagnosis, pathogenesis, immunity, and treatment of the 2 prevalent tick-borne diseases found in the United States, HME and HGA.
Collapse
|
9
|
Chapes SK, Ganta RR. Defining the immune response to Ehrlichia species using murine models. Vet Parasitol 2008; 158:344-59. [PMID: 19028013 DOI: 10.1016/j.vetpar.2008.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 09/06/2008] [Accepted: 09/09/2008] [Indexed: 01/01/2023]
Abstract
Pathogenic bacteria belonging to the family Anaplasmataceae include species of the genera Ehrlichia and Anaplasma. Ehrlichia chaffeensis, first known as the causative agent of human monocytic ehrlichiosis, also infects several vertebrate hosts including white-tailed deer, dogs, coyotes and goats. E. chaffeensis is transmitted from the bite of an infected hard tick, such as Amblyomma americanum. E. chaffeensis and other tick-transmitted pathogens have adapted to both the tick and vertebrate host cell environments. Although E. chaffeensis persists in both vertebrate and tick hosts for long periods of time, little is known about that process. Immunological studies will be valuable in assessing how the pathogen persists in nature in both vertebrate and invertebrate hosts. Understanding the host immune response to the pathogen originating from dual host backgrounds is also important to develop effective methods of diagnosis, control and treatment. In this paper, we provide our perspective of the current understanding of the immune response against E. chaffeensis in relation to other related Anaplasmataceae pathogens.
Collapse
Affiliation(s)
- Stephen K Chapes
- Division of Biology, College of Arts and Sciences, Kansas State University, Manhattan, KS 66506, USA
| | | |
Collapse
|
10
|
Molecular Pathology of Rickettsial Lung Infections. MOLECULAR PATHOLOGY LIBRARY 2008. [PMCID: PMC7147442 DOI: 10.1007/978-0-387-72430-0_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rickettsial infections of humans comprise a diverse group of infections caused by pathogens that are obligate intracellular bacteria with a genetic relationship, including the genera Rickettsia, Orientia, Ehrlichia, and Anaplasma. The host cells of these pathogens largely belie the systemic clinical manifestations, because Rickettsia and Orientia infect endothelial cells, and Ehrlichia and Anaplasma infect circulating leukocytes (monocytes and neutrophils, respectively). Thus, the predominant manifestations (fever, headache, myalgia, with or without rash) do not usually focus attention on the respiratory system; however, the underlying pathogenesis of these infections involves degrees of vascular compromise either by direct injury and inflammation or by the action of vasoactive proinflammatory molecules such as cytokines, chemokines, and prostaglandins. Given that the lung possesses the largest vascular bed in the human body, it is not surprising that pulmonary involvement is periodically identified and, when severely affected, is considered a potentially life-threatening complication.1,2
Collapse
|