Frequency of co-seropositivities for certain pathogens and their relationship with clinical and histopathological changes and parasite load in dogs infected with Leishmania infantum

In canine leishmaniosis caused by the protozoan Leishmania infantum, little is known about how co-infections with or co-seropositivities for other pathogens can influence aggravation of this disease. Therefore, the objectives of this study were to evaluate the frequency of co-infections with or co-seropositivities for certain pathogens in dogs seropositive for L. infantum and their relationship with clinical signs, histological changes and L. infantum load. Sixty-six L. infantum-seropositive dogs were submitted to clinical examination, collection of blood and bone marrow, culling, and necropsy. Antibodies against Anaplasma spp., Borrelia burgdorferi sensu lato, Ehrlichia spp. and Toxoplasma gondii and Dirofilaria immitis antigens were investigated in serum. Samples from different tissues were submitted to histopathology and immunohistochemistry for the detection of Leishmania spp. and T. gondii. Quantitative real-time PCR was used to assess the L. infantum load in spleen samples. For detection of Coxiella burnetii, conventional PCR and nested PCR were performed using bone marrow samples. All 66 dogs tested positive for L. infantum by qPCR and/or culture. Fifty dogs (76%) were co-seropositive for at least one pathogen: T. gondii (59%), Ehrlichia spp., (41%), and Anaplasma spp. (18%). Clinical signs were observed in 15 (94%) dogs monoinfected with L. infantum and in 45 (90%) dogs co-seropositive for certain pathogens. The L. infantum load in spleen and skin did not differ significantly between monoinfected and co-seropositive dogs. The number of inflammatory cells was higher in the spleen, lung and mammary gland of co-seropositive dogs and in the mitral valve of monoinfected dogs. These results suggest that dogs infected with L. infantum and co-seropositive for certain pathogens are common in the region studied. However, co-seropositivities for certain pathogens did not aggravate clinical signs or L. infantum load, although they were associated with a more intense inflammatory reaction in some organs.

Associations between clinical canine leishmaniosis and multiple vector-borne co-infections: a case-control serological study

BACKGROUND

Dogs that have clinical leishmaniosis (ClinL), caused by the parasite Leishmania infantum, are commonly co-infected with other pathogens, especially vector-borne pathogens (VBP). A recent PCR-based study found that ClinL dogs are more likely to be additionally infected with the rickettsial bacteria Ehrlichia canis. Further information on co-infections in ClinL cases with VBP, as assessed by serology, is required. The research described in this report determined if dogs with ClinL are at higher risk of exposure to VBP than healthy control dogs using a case-control serology study.

RESULTS

Of the 47 dogs with ClinL, anti-E. canis/ Ehrlichia ewingii antibodies were detected in 17 (36.2%), anti-Anaplasma phagocytophilum/Anaplasma platys antibodies in 5 (10.6%) and antigen for Dirofilaria immitis in 2 (4.3%). Of the 87 control dogs, anti-E. canis/E. ewingii antibodies were detected in 14 (16.1%) and anti-A. phagocytophilum/A. platys antibodies in 2 (2.3%). No anti-Borrelia burgdorferi antibody tests were positive. No statistical differences between the ClinL dogs and control dogs regarding lifestyle or use of ectoparasitic prevention, were identified. The ClinL was significantly associated with anti-E. canis/E. ewingii antibodies (odds ratio = 2.9, 95% confidence interval: 1.3-6.7, P = 0.010) compared to controls by both multivariable logistic regression and structural equation modelling.

CONCLUSIONS

It was demonstrated that an increased risk for E. canis/E. ewingii seropositivity is present in dogs with ClinL compared to clinically healthy control dogs, despite similar ectoparasitic prevention use and lifestyle. Based on these findings it is suggested that dogs with ClinL should not only be tested for E. canis co-infection using PCR but also serologically for E. canis/E. ewingii.

Detection of Dirofilaria immitis antigen and antibodies against Anaplasma phagocytophilum, Borrelia burgdorferi and Ehrlichia canis in dogs from ten provinces of China

Despite the fact vector-borne diseases (VBDs) have been increasingly reported in dogs worldwide, there are only limited reports on VBDs in dogs in China with most being based on molecular detection of active infections. To provide further data on the exposure of dogs in China to VBD agents, we used commercial immunochromatographic assays to test plasma from 637 apparently healthy indoor and breeding colony dogs from 21 veterinary clinics in 10 provinces in China and a commercial dog breeding facility for circulating antigen of Dirofilaria immitis, and for circulating antibodies against Ehrlichia spp., Anaplasma spp., and Borrelia burgdorferi. Overall, we found only low levels of exposure to Ehrlichia spp. (4.7%; 30/637), Anaplasma spp. (1.4%; 9/637), B. burgdorferi (0.9%; 6/637) and D. immitis (0.2%; 1/637) with most of the positive animals coming from the commercial breeding colony (26/103; 25.2%) where ectoparasites were most commonly noted. At least one vector-borne agent was found in dogs from 6 of the 10 provinces investigated. Our results confirm exposure of dogs from around China to a variety of VBDs, even indoor pets seldom observed to harbor ectoparasites.

A novel Ehrlichia species in blood and Ixodes ornithorhynchi ticks from platypuses (Ornithorhynchus anatinus) in Queensland and Tasmania, Australia

Worldwide, Ehrlichia spp. are emerging infectious organisms of domestic animals and people, however, most Ehrlichia spp. naturally infect wildlife reservoirs causing mainly asymptomatic infections. Australian ecosystems have been under-explored for these potentially pathogenic organisms, and recent studies have identified a range of novel Ehrlichia, and their sister genera, Anaplasma and 'Candidatus Neoehrlichia' species, from native Australian ticks. We used bacterial 16S rRNA (16S) next-generation sequencing and genus-specific PCR to profile the bacterial communities in platypus (Ornithorhynchus anatinus) blood samples and platypus ticks (Ixodes ornithorhynchi), and identified a high prevalence of Ehrlichia sequences. We also observed Ehrlichia-like intra-neutrophilic inclusions (morulae) in PCR-positive stained platypus blood films that were consistent in morphology with other Ehrlichia spp. Bayesian phylogenetic analysis of 16S (1343 bp), gltA (1004 bp), and groEL (1074 bp) gene sequences group the platypus Ehrlichia with 'Candidatus Ehrlichia khabarensis' from far-eastern Russia, and demonstrate that the platypus Ehrlichia is clearly distinct from all other Ehrlichia spp. Enough genetic divergence exists to delineate this platypus Ehrlichia as a separate species that we propose to designate 'Candidatus Ehrlichia ornithorhynchi'. There is no evidence that 'Candidatus Ehrlichia ornithorhynchi' causes disease in wild platypuses, however, the organism does seem to be widespread in Australia, being found in both Queensland and Tasmania. 'Candidatus Ehrlichia ornithorhynchi' is the second native Australian Ehrlichia described and adds to the rapidly growing diversity of recently described native Australian tick-borne bacteria.

Evaluation of NF-κB concentration in patients with tick-borne encephalitis, neuroborreliosis, anaplasmosis and Anaplasma phagocythophilum with tick-borne encephalitis virus co-infection

OBJECTIVES

The aim of the study was the evaluation of NF-κB concentration in serum and cerebrospinal fluid (CSF) of patients with diagnosis of tick-borne diseases: tick-borne encephalitis (TBE), neuroborreliosis (NB), anaplasmosis (ANA) and patients co-infected with tick-borne encephalitis virus and Anaplasma phagocythophilum (TBE+ANA). Additionally NF-κB concentration during acute and convalescent period was compared.

METHODS

Sixty-seven patients with diagnosis of tick-borne diseases were included in the study. The control group (CG) consisted of 18 patients hospitalized because of headaches and had lumbar puncture performed. The NF-κB was measured by human inhibitory subunit of NF-κB ELISA Kit during acute and convalescent period.

RESULTS

In serum the significant differences were observed only in patients with TBE+ANA co-infection. In CSF the concentration of NF-κB was significantly higher in patients with TBE, TBE+ANA co-infection, and patients with NB than in CG. Receiver operating characteristic (ROC) curves analysis showed that NF-κB concentration in CSF differentiated patients with NB with CG; patients co-infected with TBE and ANA with CG and patients with TBE with CG. NF-κB concentration in serum differentiated patients co-infected with TBE and ANA with NB and with ANA, with TBE and with CG. In TBE group the serum NF-κB concentration significantly decreased in convalescent period, while in NB and TBE groups significant CSF decrease of NF-κB concentration was observed.

CONCLUSIONS

Countrywide serological evaluation of canine prevalence for Anaplasma spp., Borrelia burgdorferi (sensu lato), Dirofilaria immitis and Ehrlichia canis in Mexico

BACKGROUND

Canine vector-borne diseases (CVBD) have become a major concern for canine and human public health. The aim of the study described here is to add epidemiological data regarding four pathogens responsible for CVBD, namely anaplasmosis, borreliosis, dirofilariosis and ehrlichiosis in a national survey conducted in Mexico.

METHODS

Seventy-four veterinary centres located in 21 federal Mexican states were asked to test dogs with clinical signs suspect for CVBD and healthy dogs, for detection of Dirofilaria immitis antigen and antibodies against Anaplasma spp., Borrelia burgdorferi (sensu lato) and Ehrlichia canis using the SNAP® 4DX® from IDEXX® Laboratories.

RESULTS

A total of 1706 dogs were tested, including 943 apparently healthy and 722 CVBD-suspect dogs. Infected dogs were 36.7 %. The highest percentages of infection with E. canis (51.0 %) and Anaplasma spp. (16.4 %) were obtained in the northwestern region, while D. immitis was most frequently found in the northeastern region of the country (8.9 %). Four dogs from the northwestern, northeastern, eastern and southeastern regions, respectively, were positive for B. burgdorferi (sensu lato). Northcentral regions showed lowest overall prevalence of infection (2.4 %). Co-infections were detected in 8.8 % of the dogs tested. Statistically significant lower positivity was found among dogs aged less than one year (23.2 %) and small-sized dogs (27.6 %), while higher prevalence of infection was found in dogs living outdoors (42.0 %), dogs with detectable tick infestation (43.3 %) and dogs that received treatment for tick-transmitted infections (58.8 %). Seropositivity was a risk factor for the presence of clinical signs as follows: Anaplasma spp. (OR = 2.63; 95 % CI: 1.88-3.67; P < 0.0001), D. immitis (OR = 2.52; 95 % CI: 1.61-3.95; P < 0.0001), E. canis (OR = 3.58; 95 % CI: 2.88-4.45; P < 0.0001), mixed infections (OR = 4.08; 95 % CI: 2.79-5.96; P < 0.0001), one or more agents (OR = 3.58; 95 % CI: 2.91-4.42; P < 0.0001).

CONCLUSIONS

Canine serological evidence supports that dogs from Mexico are at risk of acquiring Anaplasma spp., D. immitis and/or E. canis, while B. burgdorferi (sensu lato) transmission is minimal in the country. Practitioners play a fundamental role in the detection and control of these diseases to protect dogs and humans.

Mutations in Ehrlichia chaffeensis Causing Polar Effects in Gene Expression and Differential Host Specificities

Ehrlichia chaffeensis, a tick-borne rickettsial, is responsible for human monocytic ehrlichiosis. In this study, we assessed E. chaffeensis insertion mutations impacting the transcription of genes near the insertion sites. We presented evidence that the mutations within the E. chaffeensis genome at four genomic locations cause polar effects in altering gene expressions. We also reported mutations causing attenuated growth in deer (the pathogen’s reservoir host) and in dog (an incidental host), but not in its tick vector, Amblyomma americanum. This is the first study documenting insertion mutations in E. chaffeensis that cause polar effects in altering gene expression from the genes located upstream and downstream to insertion sites and the differential requirements of functionally active genes of the pathogen for its persistence in vertebrate and tick hosts. This study is important in furthering our knowledge on E. chaffeensis pathogenesis.

The epidemiology of tick-borne haemoparasites as determined by the reverse line blot hybridization assay in an intensively studied cohort of calves in western Kenya

The development of sensitive surveillance technologies using PCR-based detection of microbial DNA, such as the reverse line blot assay, can facilitate the gathering of epidemiological information on tick-borne diseases, which continue to hamper the productivity of livestock in many parts of Africa and elsewhere. We have employed a reverse line blot assay to detect the prevalence of tick-borne parasites in an intensively studied cohort of indigenous calves in western Kenya. The calves were recruited close to birth and monitored for the presence of infectious disease for up to 51 weeks. The final visit samples from 453 calves which survived for the study period were analyzed by RLB. The results indicated high prevalences of Theileria mutans (71.6%), T. velifera (62.8%), Anaplasma sp. Omatjenne (42.7%), A. bovis (39.9%), Theileria sp. (sable) (32.7%), T. parva (12.9%) and T. taurotragi (8.5%), with minor occurrences of eight other haemoparasites. The unexpectedly low prevalence of the pathogenic species Ehrlichia ruminantium was confirmed by a species-specific PCR targeting the pCS20 gene region. Coinfection analyses of the seven most prevalent haemoparasites indicated that they were present as coinfections in over 90% of the cases. The analyses revealed significant associations between several of the Theileria parasites, in particular T. velifera with Theileria sp. sable and T. mutans, and T. parva with T. taurotragi. There was very little coinfection of the two most common Anaplasma species, although they were commonly detected as coinfections with the Theileria parasites. The comparison of reverse line blot and serological results for four haemoparasites (T. parva, T. mutans, A. marginale and B. bigemina) indicated that, except for the mostly benign T. mutans, indigenous cattle seem capable of clearing infections of the three other, pathogenic parasites to below detectable levels. Although the study site was located across four agroecological zones, there was little restriction of the parasites to particular zones.

Intraoperative bleeding in dogs from Grenada seroreactive to Anaplasma platys and Ehrlichia canis

BACKGROUND

Frequent exposure of Grenadian dogs to Rhipicephalus sanguineus results in Anaplasma platys, and Ehrlichia canis seroreactivity. During elective surgeries, substantial intraoperative hemorrhage occurs in some seroreactive dogs.

OBJECTIVES

To assess hemostatic parameters and bleeding tendencies as well as prevalence of PCR positivity in apparently healthy A. platys and E. canis seroreactive and seronegative free-roaming dogs from Grenada.

ANIMALS

Forty-seven elective surgery dogs allocated to 4 groups: Seronegative control (n = 12), A. platys (n = 10), E. canis (n = 14) and A. platys, and E. canis (n = 11) seroreactive.

METHODS

Preoperatively, hemostasis was assessed by platelet count, prothrombin time, activated partial thromboplastin time, and buccal mucosal bleeding time. Intra- and postoperative bleeding scores were subjectively assigned. Blood, spleen, bone marrow, and lymph node aspirates were tested by PCR.

RESULTS

Bleeding scores in dogs coseroreactive for A. platys and E. canis were higher (P = .015) than those of seronegative dogs. A. platys DNA was amplified from 7/21 (33%) A. platys seroreactive dogs and from 1 E. canis seroreactive dog; E. canis DNA was amplified from 21/25 (84%) E. canis seroreactive dogs. E. canis DNA was amplified most often from blood, whereas A. platys DNA was amplified most often from bone marrow.

CONCLUSIONS AND CLINICAL IMPORTANCE

Apparently healthy, free-roaming dogs coseropositive for A. platys and E. canis may have increased intraoperative bleeding tendencies despite normal hemostatic parameters. Future investigations should explore the potential for vascular injury as a cause for bleeding in these dogs. Improved tick control is needed for dogs in Grenada.

Acute respiratory distress syndrome in human granulocytic ehrlichiosis

The ehrlichioses are emerging zoonotic infections. They have a very nonspecific clinical presentation. The diseases generally present as undifferentiated fever, but thrombocytopenia, leucopenia, and transaminitis are important laboratory features. Ehrlichiosis as a cause of acute respiratory distress syndrome (ARDS) has been infrequently described in the literature. Physicians should be aware of this life-threatening but treatable entity. We present a patient who developed ARDS shortly after being diagnosed with and initiating treatment for human granulocytic ehrlichiosis (HGE). A 54-year-old woman presented with fever, hypotension, and pancytopenia, with peripheral smear diagnostic of ehrlichiosis. She was started on doxycycline therapy following which she developed ARDS which resolved with methylprednisone. The fatality for HGE has been estimated as 7-10%. ARDS secondary to Ehrlichia has been shown to respond dramatically to steroids.

[Serological verification of tick-borne encephalitis cases in the Altai Republic]

Serologic testing of Lyme disease, human granulocytic anaplasmosis and human monocytotopic ehrlichiosis, showed the prevalence of these infections and the risk of mixed infection. The patients with tick-borne encephalitis were found to have its monoinfection and mixed infection in 66.1% and 33.9% of cases, respectively.

Ehrlichiosis presenting with toxic shock-like syndrome and secondary hemophagocytic lymphohistiocytosis

Human monocytotropic ehrlichios is a tick borne illness caused by Ehrlichia chaffeensis. Ehrlichiosis presenting with septic shock and severe azotemia is rare, and may be seen in immunocompromised individuals. We present a case of ehrlichia induced toxic shock like syndrome in a patient with rheumatoid arthritis on disease modifying agents. He also had oliguric renal failure requiring dialysis on presentation and later found to have Hemophagocytic Lymphohistiocytosis secondary to severe ehrlichia sepsis.

[The application of polymerase chain reaction in real-time operation mode to detect DNA of agents of human granulocytic anaplasmosis and monocytic erlychiosis]

The analysis was applied to detect DNA of agents of human granulocytic anaplasmosis and monocytic erlychiosis. The sampling included 109 ticks of Ixodes species from Novosibirsk oblast and Khabarovsk kray and blood samples of 111 mouse-like rodents from Omsk oblast. The used techniques included polymerase chain reaction in real-time operation mode with set of reagents "RealBest DNA Anaplasma phagocytophilum/Ehrlichia muris, ehrlichia chaffeensis" ("Vector-Best" Novosibirsk) and double round polymerase chain reaction. The DNA of A. phagocytophilum, agent of granulocytic anaplasmosis and/or DNA of E. muris, agent of monocytic erlychiosis was detected in 21 ticks and in blood samples of 52 voles. Both techniques were applied. The DNA of A. phagocytophilum was detected in samples of 2 voles and in 1 tick only after polymerase chain reaction in real-time operation mode was applied. It demonstrated that the set of reagents "RealBest DNA Anaplasma phagocytophilum/Ehrlichia muris, ehrlichia chaffeensis" permits to detect the DNA of isolates of A. phagocytophilum subsumed to different genetic groups. The set can be used for fast and effective detection of the DNA of agents of agents of human granulocytic anaplasmosis and monocytic erlychiosis in suspensions of analyzed ticks and blood samples.

Isolation and establishment of the raccoon Ehrlichia-like agent in tick cell culture

Feral animals are reservoirs of emerging human pathogens, as well as carriers of closely related wildlife diseases. The latter may interfere with epidemiologic studies by inducing cross-reactive antibodies, or by providing false positive signals in PCR based tests. We cultured a novel intracellular bacterium from the blood of two raccoons (Procyon lotor): RAC413 and RAC414. RAC413 had been experimentally inoculated with blood from a wild-caught raccoon, and provided the material for a blood passage into RAC414. The microbes grew in Ixodes scapularis (black-legged tick) cells, line ISE6, inoculated either with the leukocyte or erythrocyte fraction of anticoagulated blood. Giemsa-stained cells sampled two and three months after initial inoculation of the cultures revealed inclusions similar to those of Ehrlichia sp., except that individual bacteria commonly were elongated and clustered within endosomes. Electronmicroscopy confirmed the presence of irregularly shaped bacteria with evenly granular bacterioplasm bounded by a unit membrane. 16S rDNA sequencing identified the microbes as the raccoon Ehrlichia-like agent previously detected in feral raccoons from Georgia, United States. In conclusion, the availability of a culture isolate of this agent will facilitate future studies to determine its biology, epidemiologic significance, vector association, and host range. The Ehrlichia-like agent infecting raccoons joins a growing list of tick-borne agents cultivable in tick cells.

Detection of Ehrlichia canis by PCR in different tissues obtained during necropsy from dogs surveyed for naturally occurring canine monocytic ehrlichiosis

A molecular study for the detection of Ehrlichia canis was carried out on tissues obtained at necropsy from randomly selected dogs with the intention of investigating naturally-occurring canine ehrlichiosis. The tissues evaluated for the presence of E. canis included lymph nodes, spleen, liver, bone marrow, and blood. Eight of the 18 dogs included were found to be positive for E. canis by polymerase chain reaction (PCR) and sequencing of the 16S rRNA gene. Two dogs were positive for Anaplasma platys of which one dog was co-infected with E. canis and A. platys. Blood (5/8) and lymph nodes (5/8) were the tissues found to yield the highest number of positive E. canis PCR results with 7/8 dogs positive in the blood or lymph node. E. canis and A. platys DNA could be amplified by PCR when tissue samples were obtained 72h after the time of death.

Chronic canine ehrlichiosis (Ehrlichia canis): a retrospective study of 19 natural cases

Nineteen dogs from Greece with chronic ehrlichiosis were studied. The dogs exhibited bicytopenia or pancytopenia, bone marrow hypoplasia, seroreactivity to Ehrlichia canis (E. canis) antigens, and had no history of drug or radiation exposure. Anorexia, depression, severe bleeding tendencies, hypoalbuminemia, and increased serum alanine aminotransferase activity were also hallmarks of the disease. All these animals eventually died, irrespective of the treatment applied. Some dogs were also serologically positive for Rickettsia conorii, Leishmania infantum (L. infantum), and Bartonella vinsonii subspp. berkhoffii. Polymerase chain reaction testing of bone marrow samples revealed E. canis, Anaplasma phagocytophilia, Anaplasma platys, and L. infantum in some dogs. Concurrent infections did not appear to substantially influence the clinical course and final outcome of the chronic canine ehrlichiosis.

Serological survey of Ehrlichia and Anaplasma infection of feral raccoons (Procyon lotor) in Kanagawa Prefecture, Japan

Numbers of feral raccoon; the possible reservoir animal of Ehrlichia and Anaplasma, are increasing in Japan. Thus serological methods were utilized to examine Ehrlichia and Anaplasma infection in raccoons from Kanagawa Prefecture, Japan. By using an indirect immunofluorescence assay, among 187 feral raccoons examined, 1 (0.5%) serologically reacted with Ehrlichia canis, 3 (1.6%) with Ehrlichia chaffeensis and 1 (0.5%) with Anaplasma phagocytophilum with the titers of 1:40 or more. Although screening PCR for Ehrlichia and Anaplasma species failed to detect the presence of ehrlichial DNA in serum samples, results of the serological tests suggested that the feral raccoons might be infected with some species of Ehrlichia and Anaplasma.

Platelet Aggregation and Haemostatic Response in Dogs Naturally Co-infected by Leishmania infantum and Ehrlichia canis

Haemostatic alterations in dogs naturally infected by ehrlichiosis and/or leishmaniasis were studied. Platelet count, ADP and collagen-induced platelet aggregation, prothrombin time, activated partial thromboplastin time (APTT) and plasma fibrinogen concentration were measured. An evident reduction of platelet aggregation response was shown for Leishmania-Ehrlichia co-infected dogs where platelet aggregation was lower in comparison with control and leishmaniotic dogs (ADP and collagen, P < or = 0.01) and ehrlichiotic dogs (ADP 10 and 7.5 microm, P < or = 0.05). Moreover, a significant increase in APTT as well as a reduction of the albumin/globulin rate (A/G) for leishmaniotic and co-infected dogs versus control and ehrlichiotic dogs was detected. The hypothesis of a synergism between leishmaniosis and ehrlichiosis in altering platelet function by different pathways is discussed.

Molecular Survey of Ehrlichia canis and Anaplasma phagocytophilum from Blood of Dogs in Italy

We investigated the prevalence of Ehrlichia canis (E. canis) (n = 601) and Anaplasma phagocytophilum (A. phagocytophilum) (n = 460) infection by means of real-time PCR from blood of Italian dogs. The prevalence of E. canis in northern, central, and southern Italy was 2.9%, 8%, and 9.7%, respectively. The prevalence of A. phagocytophilum was 0%.

Human Infection with Ehrlichia Canis Accompanied by Clinical Signs in Venezuela

A total of 20 human patients with clinical signs compatible with human monocytic ehrlichiosis (HME), who were admitted to the emergency clinic in Lara State, Venezuela, were studied. Thirty percent (6/20) patients were positive for Ehrlichia canis 16S rRNA on gene-specific polymerase chain reaction (PCR). Compared with the U.S. strains, 16S rRNA gene sequences from all six patients had the same base mutation as the sequence of the E. canis Venezuelan human Ehrlichia (VHE) strain previously isolated from an asymptomatic human. This study is the first report of E. canis infection of human patients with clinical signs of HME.

Cytokine Gene Expression by Peripheral Blood Leukocytes in Dogs Experimentally Infected with a New Virulent Strain of Ehrlichia canis

Ehrlichia canis (E. canis) is a lipopolysaccharide (LPS)-deficient obligatory intracellular bacterium that causes canine monocytic ehrlichiosis, a chronic febrile disease accompanied with hematological abnormality. This study analyzed temporal expression levels of IL-1beta, IL-2, IL-6, IL-8, IFN-gamma, and TNF-alpha mRNA by peripheral blood leukocytes from dogs experimentally infected with a new virulent strain of E. canis by using real-time RT-PCR. Relative levels of IL-1beta and IL-8 transcripts normalized by the beta-actin transcript levels, were significantly upregulated, whereas those of TNF-alpha and IFN-gamma transcripts were only weakly upregulated in all three infected dogs, starting from 2 days up to 52 days post inoculation. The expressions of IL-2 and IL-6 genes were extremely low compared with the positive control (ConA-stimulated canine peripheral blood leukocytes). This study showed that E. canis can induce chronic expression of a subset of proinflammatory cytokine genes: balance, timing, and duration of these cytokine generations may contribute to the progression of canine ehrlichiosis.

Clinical Diagnosis and Treatment of Human Granulocytotropic Anaplasmosis

Tick-borne rickettsiae in the genera Ehrlichia and Anaplasma are intracellular bacteria that infect wild and domestic mammals and, more recently, man. The increased desire of humans for recreational activities outdoors has increased the exposure to potential human pathogens that previously cycled almost exclusively within natural, nonhuman enzootic hosts. Anaplasma phagocytophilum causes an acute, nonspecific febrile illness of humans previously known as human granulocytotropic ehrlichiosis (HGE) and now called human granulocytotropic anaplasmosis (HGA). The first patient to have recognized HGA was hospitalized at St Mary's Hospital in Duluth, Minnesota, USA in 1990. However, the clinical and laboratory presentation of this infection remained undefined until 1994, when Bakken and collaborators published their experience with 12 patients who had HGA. By the end of December 2004, at least 2,871 cases of HGA had been reported from 13 U.S. states to the Centers for Disease Control and Prevention (CDC). A limited number of laboratory-confirmed cases have been reported from countries in Europe, including Austria, Italy, Latvia, the Netherlands, Norway, Poland, Slovenia, Spain, and Sweden. Ixodes persulcatus-complex ticks are the arthropod hosts for Borrelia burgdorferi, the agent of Lyme borreliosis, and are also the arthropod hosts for A. phagocytophilum. Most cases of HGA have been contracted in geographic regions that are endemic for Lyme borreliosis. Male patients outnumber female patients by a factor of 3 to 1 and as many as 75% of patients with HGA have had a tick bite prior to their illness. Seroepidemiologic studies have demonstrated that HGA for the most part is a mild or even asymptomatic illness. However, older individuals and patients who are immunocompromised by natural disease processes or medications may develop an acute, influenza-like illness characterized by high fever, rigors, generalized myalgias, and severe headache. Local skin reactions at the site of the tick bite have not been described, and nonspecific skin rashes have been reported only occasionally. Anaplasmosis is associated with variable but suggestive changes in routine laboratory test parameters. Most patients develop transient reductions in total leukocyte and platelet concentrations. Relative granulocytosis accompanied by a left shift and lymphopenia during the first week of illness has been reported frequently. Serum hepatic transaminase concentrations usually increase two- to fourfold, and inflammatory markers, such as C-reactive protein and the erythrocyte sedimentation rate, rise during the acute phase. Abnormal laboratory findings may return toward normal range for patients who have been ill for more than 7 days, which may obfuscate the clinical decision making. Characteristic clusters of bacteria (morulae) are observed in the cytoplasm of peripheral blood granulocytes in 20% to 80% of infected patients during the acute phase of illness. The clinical diagnosis may be confirmed retrospectively by specific laboratory tests, which include positive polymerase chain reaction (PCR), identification of A. phagocytophilum in culture of acute-phase blood, or the detection of specific antibodies to A. phagocytophilum in convalescent serum. Virtually all patients have developed serum antibodies to A. phagocytophilum after completion of antibiotic therapy, and demonstration of seroconversion by indirect immunofluorescent antibody testing of acute-phase and convalescent-phase serum samples is currently the most sensitive and specific tool for laboratory confirmation of HGA. Treatment with doxycycline usually results in rapid improvement and cure. Most patients with HGA have made an uneventful recovery even without specific antibiotic therapy. However, delayed diagnosis in older and immunocompromised patients may place those individuals at risk for an adverse outcome, including death. Thus, prompt institution of antibiotic therapy is advocated for any patient who is suspected to have HGA and for all patients who have confirmed HGA.

Human Monocytic Ehrlichiosis and Human Granulocytic Anaplasmosis in the United States, 2001-2002

The epidemiologic features are described of cases of human monocytic ehrlichiosis and human granulocytic anaplasmosis in the United States.

Dog tick-borne diseases in Sicily

In Sicily many tick borne diseases are endemic, in particular way those that see like main carrier ticks that prefer, for their vital cycle, climatic conditions characterized by high temperatures and a warmth-humid atmosphere. The more important pathologies transmitted by ticks causing diseases in dogs are babesiosis and ehrlichiosis. Borrelia burgdorferi, Anaplasma phagocytophilum, Rickettsia conorii, Coxiella burnetii and tick transmitted encephalitis virus assume particular relevance because they are agents of zoonosis. Our centre, C.R.A.Ba.R.T, have conducted many researches and carried out many tests for diagnostic aim in order to estimate the spread of the main tick borne diseases in Sicilians' dogs. A study lead on 342 dogs has evidenced seroprevalence for Babesia canis, Ehrlichia canis and Rickettsia respective of 5.17%, 21.70% and 53.43%. A study on zoonotic agent seroprevalences in dogs gave the following percentages: C. burnetii 31.50%, R. conorii 73.60% and A. phagocytophilum 32.80%. The data carried out from IZS Sicily diagnostic service on 5,634 tests done in 2004-2005, confirm the experimental results on the presence of B. canis, E. canis, R. conorii, A. phagocytophilum, C. burnetii, Rickettsia spp., Anaplasma spp. and Ehrlichia spp. in all the Sicilian areas.

Platelet aggregation studies in acute experimental canine ehrlichiosis

BACKGROUND

Thrombocytopenia is the most common and consistent hematologic finding in patients with canine monocytic ehrlichiosis. Dogs that recover from the severe thrombocytopenia still show bleeding tendencies, which suggest that platelet dysfunction is present.

OBJECTIVES

The purpose of this study was to determine the occurrence and duration of platelet dysfunction in dogs with ehrlichiosis and to assess whether dysfunction is related to thrombocytopenia.

METHODS

Ten adult male and female mongrel dogs were used in the study; 7 were inoculated intravenously with whole blood containing Ehrlichia canis, and 3 were used as controls. Platelet aggregation (with collagen/epinephrine and adenosine diphosphate (ADP)/epinephrine) and platelet counts were evaluated weekly for 112 days.

RESULTS

The infected group showed a decrease in platelet aggregation response to collagen/epinephrine and ADP/epinephrine on days 7, 14, 21, 28, and 35 (P <.05). Thrombocytopenia was observed in all infected animals from day 7 to 35 postinfection (P <.05).

CONCLUSIONS

The tendency of dogs infected with E canis to bleed may be related not only to thrombocytopenia but also to platelet dysfunction associated with the disease.

Comparison of an indirect immunofluorescence assay, western blot analysis, and a commercially available ELISA for detection ofEhrlichia canisantibodies in canine sera

OBJECTIVE

To examine the correlation between results for an indirect immunofluorescence assay (IFA) that uses Ehrlichia canis antigen as a substrate (ie, E canis-IFA), 2 western blot (WB) analyses, and a commercially available ELISA in the detection of E canis antibody in dog sera.

SAMPLE POPULATION

54 canine serum samples that were reactive on E canis-IFA and 16 canine serum samples that were E canis-IFA nonreactive.

PROCEDURE

Serum samples were evaluated by use of 2 WB analyses and a commercially available ELISA. Correlation between results of the 3 testing modalities (ie, IFA, WB analyses, and the ELISA) was examined by use of nonreactive (E canis-IFA reciprocal titer, < 20), low-titer (reciprocal titer, 80 to 160), medium-titer (reciprocal titer, 320 to 2,560), and high-titer (reciprocal titer, 5,120 to > 20,480) serum samples.

RESULTS

For all serum samples in the nonreactive (n = 16), medium-titer (17), and high-titer (18) groups, correlation of results among IFA, WB analyses, and the commercially available ELISA was excellent. A poor correlation was found between IFA results and those of WB analyses and the ELISA for serum samples in the low-titer group (19), with only 4 of the 19 serum samples having positive results on both WB analyses and the commercially available ELISA.

CONCLUSIONS AND CLINICAL RELEVANCE

The discrepancy between E canis-IFA, WB analyses, and the commercially available ELISA results for the low-titer serum samples may be related to a high IFA sensitivity or, more likely, a lack of specificity associated with cross-reactivity among Ehrlichia spp.

Experimental Ehrlichia canis infection in the dog does not cause immunosuppression

A carrier state develops in some Ehrlichia canis-infected dogs due to ineffective host defenses. The subsequent development of immune-mediated diseases or opportunistic infections in chronic ehrlichiosis suggests dysregulation of immunity; however, the immunobiology of this infection has not been well characterized. In this study, eight dogs were infected with E. canis, and changes in seroreactivity, serum immunoglobulin (Ig) concentrations, peripheral blood T cell subsets, lymphocyte blastogenesis (LBT), and lymphokine-activated killer (LAK) activity were evaluated over 4 months. Infection, which was documented by seroconversion, polymerase chain reaction, and blood culture, caused self-limiting fever and thrombocytopenia. Infected dogs developed an anti-E. canis antibody response but were not immune to re-infection. Serum IgM, IgG, and IgA concentrations were unaffected by E. canis. The percentage of circulating CD4(+) T cells was similar in uninfected and infected dogs at all points. Infected dogs developed a CD8(+) lymphocytosis 6 weeks after inoculation that subsequently subsided, despite organism persistence. Functional defects of cell-mediated immunity, measured as suppression of LAK activity or mitogen-driven LBT, were not observed. These results suggest that immune responses are not grossly impaired in young dogs during the first several months following experimental E. canis infection.

Cytokine Responses in Dogs Infected with Ehrlichia canis Oklahoma Strain

Ehrlichia canis causes persistent infection of monocytes/macrophages and causes canine monocytic ehrlichiosis. Other than antibody development, very little is known how the dog immune system responds to this pathogen. In the present study, we examined the temporal expression of cytokine mRNA in peripheral blood mononuclear cells (PBMCs) from dogs inoculated with E. canis Oklahoma strain. We also examined production of interferon-gamma (IFN-gamma) by canine PBMCs infected with E. canis in vitro.

Detection of medically important Ehrlichia by quantitative multicolor TaqMan real-time polymerase chain reaction of the dsb gene

Ehrlichia species are the etiological agents of emerging and life-threatening tick-borne human zoonoses, in addition to causing serious and fatal infections in companion animals and livestock. We developed the first tricolor TaqMan real-time polymerase chain reaction assay capable of simultaneously detecting and discriminating medically important ehrlichiae in a single reaction. Analytical sensitivity of 50 copies per reaction was attained with templates from Ehrlichia chaffeensis, Ehrlichia ewingii, and Ehrlichia canis by amplifying the genus-specific disulfide bond formation protein gene (dsb). Ehrlichia genus-specific dsb primers amplified DNA from all known Ehrlichia species but not from other rickettsial organisms including Anaplasma platys, Anaplasma phagocytophilum, Rickettsia conorii, or Rickettsia typhi. High species specificity was attained as each species-specific TaqMan probe (E. chaffeensis, E. ewingii, and E. canis) identified homologous templates but did not cross-hybridize with heterologous Ehrlichia templates at concentrations as high as 10(8) copies. Identification of E. chaffeensis, E. ewingii, and E. canis from natural and experimental infections, previously confirmed by polymerase chain reaction and serological or microscopic evidence, demonstrated the comparable specificity and sensitivity of the dsb real-time assay. This assay provides a powerful tool for prospective medical diagnosis for human and canine ehrlichioses and for ecologic and epidemiological studies involving arthropod and mammalian hosts.

Evaluation of neutrophil oxidative metabolism in canine monocytic ehrlichiosis

BACKGROUND

Canine monocytic ehrlichiosis (CME) is a tick-borne disease caused by Ehrlichia canis, a rickettsia that infects the monocytes of dogs. This infection can result in a chronic and life-threatening disease. Thrombocytopenia, mild anemia, and leukopenia are the most common hematologic findings in CME.

OBJECTIVE

To investigate the role of peripheral blood neutrophils in CME, an evaluation was conducted of their functional state during the acute phase of the disease in dogs experimentally infected by E canis.

METHODS

Seven dogs were inoculated with E canis, and 3 remained as uninfected controls. All dogs had physical exams and hematologic tests (CBC and nitroblue tetrazolium [NBT] reduction) during a 6-week period.

RESULTS

There was no difference (P > .05) in spontaneous NBT reduction results between the 2 groups of dogs throughout the 6-week period of observation. Nevertheless, when stimulated, the neutrophils showed higher activity in the infected group (P = .01) on weeks 4 and 5 after infection.

CONCLUSION

Infection by E canis has no influence on neutrophil oxidative metabolism even though during the remission period of the acute phase of the disease, the neutrophils seem to be more reactive under stimulation.

Anaplasma phagocytophilum infection (granulocytic anaplasmosis) in a dog from Vancouver Island

A 7-year-old Labrador retriever had nonspecific clinical signs that included lethargy, malaise, and difficult ambulation. The dog was native to Vancouver Island, British Columbia, and had never left this area. Morulae were identified in polymorphonuclear cells. Serologic studies and polymerase chain reaction (PCR) testing confirmed canine anaplasmosis caused by Anaplasma phagocytophilum. The dog recovered after treatment with tetracycline.

Transstadial and intrastadial experimental transmission of Ehrlichia canis by male Rhipicephalus sanguineus

The acquisition and transmission of rickettsial pathogens by different tick developmental stages has important epidemiological implications. The purpose of this study was to determine if male Rhipicephalus sanguineus can experimentally acquire and transmit Ehrlichia canis in the absence of female ticks. Two trials were performed where nymphal and male R. sanguineus were simultaneously acquisition fed on the same infected donor hosts, and transstadially or intrastadially exposed male ticks were fed on separate pathogen-free dogs as a test for transmission. A single-step p30-based PCR assay was used to test canine and tick hosts for E. canis infections before and after tick feeding. E. canis was detected after either intrastadial or transstadial passage in male ticks, the organism remained detectable in both tick groups after transmission feeding, and both tick groups transmitted the rickettsia to susceptible dogs. Infection of dogs via tick feeding resulted in milder clinical signs and lower antibody titers than intravenous inoculation of carrier blood, but further investigation is needed to understand the mechanisms responsible for this observation. These results demonstrate that male R. sanguineus can take multiple feedings, and that they can both acquire and transmit E. canis in the absence of female ticks. This tick development stage could be important in transmission of E. canis, and perhaps related pathogens, between vertebrate hosts under natural and experimental conditions.

Molecular and serologic evidence of tick-borne Ehrlichiae in three species of lemurs from St. Catherines Island, Georgia, USA

In recent years, several species of ehrlichiae have been recognized as tick-borne disease agents of veterinary and medical importance. Clinically normal free-ranging or previously free-ranging lemurs, including 46 ring-tailed lemurs (Lemur catta), six blue-eyed black lemurs (Eulemur macaco flavifrons), and four black and white ruffed lemurs (Varecia variegata variegata) from St. Catherines Island, Georgia, were tested for evidence of exposure to tick-borne ehrlichiae. All 52 adult lemurs were serologically tested for exposure to Ehrlichia chaffeensis and Anaplasma phagocytophilum. Polymerase chain reaction (PCR) assays for E. chaffeensis, A. phagocytophilum, Ehrlichia ewingii, and Ehrlichia canis were conducted on blood samples from all 56 lemurs. Blood from all lemurs was inoculated into DH82 cell cultures for E. chaffeensis isolation. Of the adult lemurs, 20 (38.5%) and 16 (30.8%) had antibodies reactive (> or =1:128) for E. chaffeensis and A. phagocytophilum, respectively. Two ring-tailed lemurs were PCR and culture positive for E. chaffeensis. Molecular characterization of the two E. chaffeensis isolates showed that both contained 5-repeat variants of the variable-length PCR target (VLPT) antigen gene and 3-repeat variants of the 120-kDa antigen gene. Sequencing of the VLPT genes revealed a novel amino acid repeat unit (type-9). One lemur infected with E. chaffeensis was slightly hypoproteinemic and had moderately elevated serum alanine aminotransferase (ALT) levels. These lemurs from St. Catherines Island have been exposed to or infected with tick-borne ehrlichiae, or both, but showed no clinical disease.

Ehrlichia canis in dogs in Yucatan, Mexico: seroprevalence, prevalence of infection and associated factors

The aim of this study was to determine the prevalence of infection, seroprevalence, and factors associated with antibody response to Ehrlichia canis in dogs of Yucatan, Mexico. The study was carried out in four veterinary clinics located in Merida, the capital city of Yucatan, Mexico. Blood samples were obtained from a total of 120 dogs, and each animal was physically examined to determine age and sex, as well as to record any clinical signs of platelet-related bleeding. Blood samples were analyzed for antibodies to E. canis using an ELISA test, and thrombocyte counts were calculated. Blood smears were prepared to detect typical morulae in leukocytes. The prevalence of infection, seroprevalence and associated factors were calculated. A primary screening was performed using 2 x K contingency tables of exposure variables. All variables with P< or =0.20 were analyzed by a logistic-binomial regression. Fifty-three (44.1%) of the 120 dogs were found to be seropositive to E. canis. In six dogs (5.0%) typical morulae of E. canis were observed in monocytes. These six cases were positive for antibodies and were thrombocytopenic. The following factors associated with seropositive animals were: platelet-related bleeding (Yes: OR=10.26, CI=2.50-42.16, P=0.001), thrombocytopenia (Yes: OR=18.91, CI=4.47-80.03, P=0.000) and age (2-4 years: OR=6.77, CI=1.76-25.97, P=0.005; >4 years: OR=4.24, CI=1.04-17.21, P=0.043).

Primary and Secondary Infection withEhrlichia chaffeensisin White-Tailed Deer (Odocoileus virginianus)

White-tailed deer (Odocoileus virginianus) are the principal reservoir host for Ehrlichia chaffeensis, causative agent of human monocytic ehrlichiosis (HME). Because white-tailed deer maintain a long-term infection with E. chaffeensis and because deer can be naturally exposed to multiple strains of E. chaffeensis, we evaluated the response to secondary infection of E. chaffeensis in deer. For primary infection, six white-tailed deer were injected with 5.4 x 10(6) DH82 cells infected with the Arkansas strain of E. chaffeensis (Ark) and two control deer were injected with noninfected DH82 cells. On post-infection day 54, three E. chaffeensis (Ark) infected deer and one naive deer were injected with 4.2 x 10(6) cells infected with strain WTD-6045B E. chaffeensis, which differs from the Arkansas strain by number of nucleotide repeats in the variable length PCR target (VLPT) gene; three other Arkansas strain infected deer were injected with noninfected DH82 cells. All animals were monitored for 31 additional days. All deer in the primary infection became positive by PCR amplification of the 16S rRNA or VLPT genes and/or cell culture by DPI-8. PCR amplification of the VLPT gene on whole blood, cell culture, and tissues detected primary and/or secondary strains in all deer exposed to both primary and secondary strains; in one deer, the primary strain was cultured from the lymph node. Our culture results demonstrated that both strains were present; however, PCR detection suggests that the secondary strain may have been circulating in blood at higher levels. In conclusion, this study provides evidence that primary infection of deer with E. chaffeensis does not protect against subsequent exposure and confirms that deer can be simultaneously coinfected with at least two different strains of E. chaffeensis.

Acute Clinical, Hematologic, Serologic, and Polymerase Chain Reaction Findings in Horses Experimentally Infected with a European Strain of Anaplasma phagocytophilum

Six horses were experimentally infected by administration of horse blood containing a Swedish strain of Anaplasma phagocytophilum. The polymerase chain reaction (PCR) signal was consistently detected 2-3 days before appearance of clinical signs and persisted 4-9 days beyond abatement of clinical signs, whereas diagnostic inclusion bodies were 1st noted on average 2.6 +/- 1.5 (SD) days after onset of fever. Clinical signs and hematologic changes were largely indistinguishable from those previously reported for diseases caused by A phagocytophilum (formerly Ehrlichia equi--"Californian agent") and the human-derived human granulocytic ehrlichiosis agent. Horses 1st demonstrated antibody response 12-16 days after inoculation, 2 cases of which were still febrile, and serotiters rapidly peaked within 3-7 days of clinical illness. One horse died during the acute stage of disease, but initial clinical signs and hematologic changes were similar to those of other infected horses. This report shows that, despite minor genetic differences, a European equine-derived strain of A. phagocytophilum may be similar in pathogenicity to the Californian agent. The PCR used holds promise to widen the diagnostic window and would also be diagnostic during the initial days of clinical disease when inclusions in neutrophils in blood smears are not yet apparent.

Histologic, serologic, and molecular analysis of persistent ehrlichiosis in a murine model

Human monocytotropic ehrlichiosis caused by Ehrlichia chaffeensis was reported in 1987. An animal model to study acute fatal ehrlichiosis in mice that has been developed closely resembles the fatal form of human monocytotropic ehrlichiosis. However, animal models for persistent infection in the genus Ehrlichia in immunocompetent mice have not been characterized. We report the histopathological progression of Ehrlichia muris infection in immunocompetent mice (AKR and C57BL/6 strains) correlated with their antibody response determined by indirect immunofluorescence and Western immunoblotting, and the distribution and quantity of the ehrlichial load by immunohistochemistry, polymerase chain reaction (PCR), and real-time PCR in lungs, liver, and spleen. Mild to moderate correlation was observed between histopathological grading in these organs and relative ehrlichial loads. The highest ehrlichial loads were present between days 4 and 14 after infection. E. muris was detected in tissues examined up to 150 days after infection by real-time PCR. Analysis of the serological response revealed several immunodominant antigens, including 200-, 180-, 100-, 73/75-, 45-, and 28-kd proteins. In conclusion, we have provided for the first time a complete histopathological, serological, immunohistochemical, and quantitative analysis of an animal model for the study of persistent ehrlichial infection.

Molecular and serologic evidence of Anaplasma phagocytophilum infection in cats in North America

Anaplasma phagocytophilum DNA was detected in blood of clinically ill cats from Massachusetts (n = 4) and Connecticut (1) by use of polymerase chain reaction assay and DNA sequencing. All 5 cats were allowed outdoors, and Ixodes scapularis were found on 3 cats. Clinical signs of fever, anorexia, and lethargy resolved quickly after treatment with doxycycline or tetracycline. Serum samples from each cat reacted with A. phagocytophilum morulae via an indirect fluorescent antibody assay; positive antibody titers persisted even after 21 to 30 days of treatment with tetracycline. To the authors' knowledge, this is the first report of A. phagocytophilum infection of domestic cats in North America. Results suggest that infection with the organism may be associated with clinical illness in some cats.

Human granulocytic ehrlichiosis in Europe

Human granulocytic ehrlichiosis (HGE) is a tick-borne zoonosis caused by Anaplasma phagocytophilum. A MEDLINE literature search revealed that the European story of HGE began in 1995 with an article on the presence of serum antibodies to A. phagocytophilum. At present, there is seroepidemiological information indicating the presence of infection with HGE agent(s) for several European countries; seroprevalence rates range from zero or very low to up to 28%. The proportion of seropositive persons increases with age and is higher in persons exposed to ticks. Knowledge of the causative agent of HGE and of animal reservoirs in Europe is limited. Ixodes ricinus is a recognized vector of A. phagocytophilum in Europe. Prevalence of the agent in questing I. ricinus is usually higher in adult ticks than in nymphs and ranges from zero or very low to > 30%. Pronounced differences between countries and marked variability by localities were established. Up to March 2003 about 65 human patients (all but one were adults) with confirmed HGE and several patients fulfilling criteria for probable HGE had been reported. The majority of them came from Central Europe (Slovenia) and Scandinavia (Sweden) but there are individual reports from several other European countries. The patients presented with an acute febrile illness that as a rule occurred after a tick bite; the majority had leukopenia and/or thrombocytopenia, elevated concentration of C-reactive protein and mild abnormalities of liver function test results. A small number of patients does not permit reliable conclusions on the clinical features of European HGE; however, there is an impression that at least in central Europe (but maybe not in Scandinavia) the disease is, from the clinical angle, only mild to moderately severe and (most likely) self-limited. The relatively high proportion of the population with HGE serum antibodies and the presence of A. phagocytophilum (like) agent(s) in ticks, small mammals and deer as found in several European countries are discordant with the rather low number of patients with proven HGE. The discordance may indicate inadequate awareness among European physicians, limited recording and reporting of the disease, and/or the presence of and the infection of humans with nonpathogenic A. phagocytophilum (like) strains present in ticks. Additional studies are needed to better define the biological and public health significance of HGE in Europe.

Acute recumbency associated with Anaplasma phagocytophilum infection in a horse

An 11-year-old Hanoverian-cross gelding was evaluated because of acute onset of ataxia, recumbency, and fever. At the stable, this and other horses had recently been infested with ticks. Results of analysis of a sample of CSF were within reference limits, but hematologic abnormalities included lymphopenia, thrombocytopenia, mild anemia, and intracytoplasmic inclusion bodies in neutrophils that were consistent with Anaplasma phagocytophilum (previously Ehrlichia equi). Results of serum biochemical analyses were characteristic of infection and included high, unconjugated bilirubin concentration. Other common causes of recumbency in horses, such as equine protozoal myeloencephalitis, infection with eastern or western equine encephalitis viruses and equine herpesvirus-1, West Nile viral encephalitis, trauma, and metabolic disease, were ruled out. The horse responded quickly to i.v. administration of oxytetracycline and recovered fully within 6 days.

Characteristic peripheral blood findings in human ehrlichiosis

Human ehrlichiosis is a potentially fatal tick-borne illness if not treated promptly. Ehrlichia infection is difficult to diagnose as the organism does not grow in standard blood culture medium and serological confirmation of infection takes several days to weeks. The most timely way of confirming Ehrlichia infection is identification of characteristic cytoplasmic morulae in peripheral blood leukocytes. A total of 23 patients with clinical and laboratory findings suggesting a rickettsial infection were tested for Ehrlichia using polymerase chain reaction and culture: 16 cases contained Ehrlichia DNA by polymerase chain reaction (15 E. chaffeensis, one E. ewingii), including 14 cases in which the blood culture grew Ehrlichia. The cases that contained Ehrlichia DNA by polymerase chain reaction had lower mean white blood cell and platelet counts and more numerous atypical lymphocytes and pronounced toxic change than cases in which Ehrlichia DNA was not detected. Cytoplasmic morulae were identified on peripheral blood smears in six (five E. chaffeensis, one E. ewingii) of 16 (38%) of the cases that contained Ehrlichia DNA, including 4/4 (100%) immunocompromised and 2/12 (17%) immunocompetent patients. Morulae were present in monocytes in E. chaffeensis-infected cases and granulocytes in the E. ewingii-infected case. In two immunocompromised patients, the number of infected cells was 1-10%, but in four patients it was <0.2%. In conclusion, peripheral blood film examination is diagnostic in a substantial number of Ehrlichia infections, particularly in immunocompromised patients. The number of infected white blood cells may be less than 0.2%, requiring examination of more than 500 white blood cells. Associated changes prompting careful film review include prominent toxic granulation and atypical large granular lymphocytes.

A serosurvey of Hepatozoon canis and Ehrlichia canis antibodies in wild red foxes (Vulpes vulpes) from Israel

A seroepidemiological survey was conducted to investigate the prevalence of antibodies reactive with Ehrlichia canis and Hepatozoon canis antigens in free-ranging red foxes (Vulpes vulpes) in Israel. Of 84 fox sera assayed, 36% were seropositive for E. canis by the indirect fluorescent antibody (IFA) test and 24% were positive for H. canis using an enzyme-linked immunosrbent assay (ELISA). Canine ehrlichiosis and hepatozoonosis appear to be endemic in the wild red fox populations in Israel, and foxes may serve as a reservoir for infection of domestic dogs and other wild canine species.

Successful treatment of human granulocytic ehrlichiosis in children using rifampin

Human granulocytic ehrlichiosis (HGE) is an emerging tick-borne infectious disease caused by Anaplasma phagocytophilum. Clinical features include a flu-like illness that usually resolves within 1 week. More serious infection may occur that requires hospital admission or culminates in death. Doxycycline is the treatment of choice for HGE but may cause permanent staining of teeth in children younger than 8 years of age. We report successful treatment of HGE with rifampin in 2 children, 4 and 6 years old. A course of rifampin for 5 to 7 days should be considered in children younger than 8 years of age who experience non-life-threatening A phagocytophilum infection.

Serological evidence for human granulocytic ehrlichiosis in Western Austria

In order to evaluate the seroprevalence of human granulocytic ehrlichiosis in western Austria, sera from 357 Tyrolean blood donors were tested by an immunofluorescence assay. To assess the concomitant seroreactivity against Borrelia burgdorferi sensu lato, sera were further investigated by enzyme-linked immunoassay and Western blot. Thirty-two sera (9.0%) showed antibodies to Anaplasma phagocytophilum at a titre of 1:128 or higher, and 30 (8.4%) were seroreactive against Borrelia burgdorferi sensu lato. Infection with these two pathogens seems to occur in all Tyrolean districts except Landeck, the most upstream district of the Inn River Valley.

Differences in clinical manifestations and hematological and serological responses after experimental infection with genetic variants of Anaplasma phagocytophilum in sheep

Five-month-old lambs were experimentally infected with two 16S rRNA genetic variants of Anaplasma phagocytophilum, variants 1 (GenBank accession no. M73220) and 2 (GenBank accession no. AF336220). Additional sequencing of the groESL heat shock operon gene indicated that these variants differ in three nucleotides at positions 782, 824, and 890. The variants were obtained by blood sampling of A. phagocytophilum-infected lambs from one sheep flock in Norway and were stored at -70 degrees C with 10% dimethyl sulfoxide as a cryoprotectant before being inoculated intravenously into susceptible lambs. The infectious blood contained, per ml, approximately 0.5 x 10(6) neutrophils infected with either of the variants. Six weeks after the primary inoculation, the lambs were challenged with the same infectious dose of the heterologous variant. The results of the study indicate a marked difference in clinical manifestation, neutropenia, antibody response, and cross-protection after experimental infection with the two variants of A. phagocytophilum.

Purification of ovine neutrophils and eosinophils: Anaplasma phagocytophilum affects neutrophil density

Studies on the functions of ovine granulocytes require pure and functionally active populations of neutrophils and eosinophils. This report describes an improved technique for the separation of neutrophils and eosinophils from the peripheral blood of sheep infected with Anaplasma phagocytophilum and from normal sheep. After centrifugation and discarding the buffy coat layer, which contains the bulk of mononuclear cells, neutrophils with a high degree of purity (94.87 [+/-1.7]%, n=9) and good yield (69 [+/-9]%, n=9) were obtained by density gradient centrifugation on Percoll with a density of 1.09 g/ml (65%). However, this density was not suitable for neutrophils obtained from sheep during the peak period of A. phagocytophilum bacteraemia. Improved purity of infected neutrophils was obtained when the leucocytes were separated on Percoll with a density of 1.08 g/ml (55%). Relatively good purity of eosinophils was obtained when leucocytes from normal sheep were separated on Percoll with a density of 1.10 g/ml (70%). Ovine eosinophils formed a distinct band just below the band of mononuclear cells when a continuous Percoll gradient with a density of 1.10 g/ml was used. The purity of the eosinophils obtained was 87.7 (+/-12.5)% (n=6; range 64.1-97.6%), with a mean recovery rate of 61.9 (+/-20.3)%.