Ehrlichiosis

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Ehrlichiosis
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Ehrlichiosis is a tickborne [1] bacterial infection, [2] caused by bacteria of the family Anaplasmataceae, genera Ehrlichia and Anaplasma . These obligate intracellular bacteria infect and kill white blood cells.

Tick-borne diseases, which afflict humans and other animals, are caused by infectious agents transmitted by tick bites. Tick-borne illnesses are caused by infection with a variety of pathogens, including rickettsia and other types of bacteria, viruses, and protozoa. Because individual ticks can harbor more than one disease-causing agent, patients can be infected with more than one pathogen at the same time, compounding the difficulty in diagnosis and treatment. As of 2016, 16 tick-borne diseases of humans are known.

Anaplasmataceae is a Proteobacteria family that includes genera Anaplasma, Ehrlichia, Neorickettsia and Wolbachia.

Ehrlichia is a genus of rickettsiales bacteria that is transmitted to vertebrates by ticks. These bacteria cause the Ehrlichiosis infection, which is considered zoonotic, because the main reservoirs for the disease are animals.

Contents

The average reported annual incidence is on the order of 2.3 cases per million people. [3]

Species

Five (see note below) species have been shown to cause human infection: [4]

<i>Anaplasma phagocytophilum</i> species of bacterium

Anaplasma phagocytophilum is a Gram-negative bacterium that is unusual in its tropism to neutrophils. It causes anaplasmosis in sheep and cattle, also known as tick-borne fever and pasture fever, and also causes the zoonotic disease human granulocytic anaplasmosis.

Human granulocytic anaplasmosis human disease

Human granulocytic anaplasmosis (HGA) is a tick-borne, infectious disease caused by Anaplasma phagocytophilum, an obligate intracellular bacterium that is typically transmitted to humans by ticks of the Ixodes ricinus species complex, including Ixodes scapularis and Ixodes pacificus in North America. These ticks also transmit Lyme disease and other tick-borne diseases.

Ehrlichia ewingii is a species of rickettsiales bacteria. It has recently been associated with human infection, and can be detected via PCR serological testing. The name Ehrlichia ewingii was proposed in 1992.

The latter two infections are not well studied. In 2006, human infection by Boone County, Missouri. Symptoms: high fever,severe joint and muscle aches, vomiting. Onset of symptoms began exactly 14 days after bite occurred. Symptoms affected patient on a 12-hour cycle; beginning early evening, ending early morning. No symptoms occurred for next 12 hours. CBC presented low WBC. Note: In 2008, human infection by Panola Mountain (Georgia, USA) Ehrlichia species was reported. [5] On August 3, 2011, infection by a yet-unnamed bacterium in the genus Ehrlichia carried by deer ticks that has caused flu-like symptoms in at least 25 people in Minnesota and Wisconsin was reported; human ehrlichiosis was thought to be very rare or absent in Minnesota and Wisconsin. [6] The new species, which is very similar genetically to an Ehrlichia species found in Eastern Europe and Japan called E. muris, was identified at Mayo Clinic Health System's Eau Claire hospital. [6]

Complete blood count medical laboratory test

A complete blood count (CBC) is a blood panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood, such as the cell count for each blood cell type and the concentrations of hemoglobin. A scientist or lab technician performs the requested testing and provides the requesting medical professional with the results of the CBC.

Panola Mountain mountain in United States of America

Panola Mountain is a 100-acre (40 ha) granite monadnock near Stockbridge on the boundary between Henry County and Rockdale County, Georgia. The peak is 946 feet (288 m) above sea level, rising 260 feet (79 m) above the South River. The South River marks the boundary between Henry/Rockdale counties and DeKalb County, Georgia. Due to its delicate ecological features, Panola Mountain was designated a National Natural Landmark in 1980.

<i>Ixodes scapularis</i> parasit ixodes scapularis

Ixodes scapularis is commonly known as the deer tick or black-legged tick, and in some parts of the US as the bear tick. It is a hard-bodied tick of the eastern and northern Midwestern United States and southeastern Canada. It is a vector for several diseases of animals, including humans and is known as the deer tick owing to its habit of parasitizing the white-tailed deer. It is also known to parasitize mice, lizards, migratory birds, etc. especially while the tick is in the larval or nymphal stage.

Ehrlichia are transported between cells through the host cell filopodia during initial stages of infection, whereas, in the final stages of infection the pathogen ruptures the host cell membrane. [7]

Filopodia

Filopodia are slender cytoplasmic projections that extend beyond the leading edge of lamellipodia in migrating cells. They contain actin filaments cross-linked into bundles by actin-binding proteins, e.g. fascin and fimbrin. Filopodia form focal adhesions with the substratum, linking it to the cell surface. Many types of migrating cells display filopodia, which are thought to be involved in both sensation of chemotropic cues, and resulting changes in directed locomotion.

Signs and symptoms

The most common symptoms include headache, muscle aches, and fatigue. A rash may occur, but is uncommon. Ehrlichiosis can also blunt the immune system by suppressing production of TNF-alpha, which may lead to opportunistic infections such as candidiasis.[ citation needed ]

Most of the signs and symptoms of ehrlichiosis can likely be ascribed to the immune dysregulation that it causes.[ citation needed ] A "toxic shock-like" syndrome is seen in some severe cases of ehrlichiosis. Some cases can present with purpura and in one such case the organisms were present in such overwhelming numbers that in 1991 Dr. Aileen Marty of the AFIP was able to demonstrate the bacteria in human tissues using standard stains, and later proved that the organisms were indeed Ehrlichia using immunoperoxidase stains. [8]

Experiments in mouse models further supports this hypothesis, as mice lacking TNF-alpha I/II receptors are resistant to liver injury caused by ehrlichia infection. [9]

3% of human monocytic ehrlichiosis cases result in death; however, these deaths occur "most commonly in immunosuppressed individuals who develop respiratory distress syndrome, hepatitis, or opportunistic nosocomial infections." [10]

Diagnosis

Prevention

No human vaccine is available for ehrlichiosis. Tick control is the main preventive measure against the disease. However, in late 2012 a breakthrough in the prevention of CME (canine monocytic ehrlichiosis) was announced when a vaccine was accidentally discovered by Prof. Shimon Harrus, Dean of the Hebrew University of Jerusalem's Koret School of Veterinary Medicine. [11]

Treatment

Doxycycline and minocycline are the medications of choice. For people allergic to antibiotics of the tetracycline class, rifampin is an alternative. [3] Early clinical experience suggested that chloramphenicol may also be effective, however, in vitro susceptibility testing revealed resistance.[ citation needed ]

Epidemiology

Ehrlichiosis is a nationally notifiable disease in the United States. There have been cases reported in every month of the year, but most cases are reported during April–September. [12] [13] [14] These months are also the peak months for tick activity in the United States.

From 2008-2012, the average yearly incidence of ehrlichiosis was 3.2 cases per million persons. This is more than twice the estimated incidence for the years 2000-2007. [14] The incidence rate increases with age, with the ages of 60–69 years being the highest age-specific years. Children of less than 10 years and adults aged 70 years and older, have the highest case-fatality rates. [14] There is a documented higher risk of death among persons who are immunosuppressed. [12]

See also

Related Research Articles

Ehrlichiosis (; also known as canine rickettsiosis, canine hemorrhagic fever, canine typhus, tracker dog disease, and tropical canine pancytopenia is a tick-borne disease of dogs usually caused by the organism Ehrlichia canis. Ehrlichia canis is the pathogen of animals. Humans can become infected by E. canis and other species after tick exposure. German Shepherd Dogs are thought to be susceptible to a particularly severe form of the disease, other breeds generally have milder clinical signs. Cats can also be infected.

Babesiosis malaria-like parasitic disease caused by infection with Babesia, a genus of Apicomplexa

Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a type of Apicomplexa. Human babesiosis transmission via tick bite is most common in the Northeastern and Midwestern United States and parts of Europe, and sporadic throughout the rest of the world. It occurs in warm weather. People can get infected with Babesia parasites by the bite of an infected tick, by getting a blood transfusion from an infected donor of blood products, or by congenital transmission. Ticks transmit the human strain of babesiosis, so it often presents with other tick-borne illnesses such as Lyme disease. After trypanosomes, Babesia is thought to be the second-most common blood parasite of mammals, and they can have a major impact on health of domestic animals in areas without severe winters. In cattle the disease is known as Texas cattle fever, redwater, or piroplasmosis.

Meningoencephalitis central nervous system disease that involves encephalitis which occurs along with meningitis

Meningoencephalitis, also known as herpes meningoencephalitis, is a medical condition that simultaneously resembles both meningitis, which is an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain.

<i>Dermacentor variabilis</i> species of arachnid

Dermacentor variabilis, also known as the American dog tick or wood tick, is a species of tick that is known to carry bacteria responsible for several diseases in humans, including Rocky Mountain spotted fever and tularemia. It is one of the most well-known hard ticks. Diseases are spread when it sucks blood from the host, which could take several days for the host to experience some symptoms.

A canine vector-borne disease (CVBD) is one of "a group of globally distributed and rapidly spreading illnesses that are caused by a range of pathogens transmitted by arthropods including ticks, fleas, mosquitoes and phlebotomine sandflies." CVBDs are important in the fields of veterinary medicine, animal welfare, and public health. Some CVBDs are of zoonotic concern.

Powassan virus is a flavivirus transmitted by ticks, found in North America and in the Russian Far East. It is named after the town of Powassan, Ontario, where it was identified in a young boy who eventually died from it. It can cause encephalitis, an infection of the brain. No vaccine or antiviral drug exists. Prevention of tick bites is the best precaution.

Anaplasmosis disease, mostly animal, caused by bacteria of the genus Anaplasma

Anaplasmosis is a disease caused by a rickettsial parasite of ruminants, Anaplasma spp. The microorganisms are Gram-negative, and infect red blood cells. They are transmitted by natural means through a number of haematophagous species of ticks. The Ixodes tick that commonly transmits Lyme disease also spreads anaplasmosis. Anaplasmosis can also be transmitted by the use of surgical, dehorning, castration, and tattoo instruments and hypodermic needles that are not disinfected between uses.

<i>Amblyomma americanum</i> species of arachnid

Amblyomma americanum, also known as the lone star tick, the northeastern water tick, or the turkey tick, is a type of tick indigenous to much of the eastern United States and Mexico, that bites painlessly and commonly goes unnoticed, remaining attached to its host for as long as seven days until it is fully engorged with blood. It is a member of the phylum Arthropoda, class Arachnida. The adult lone star tick is sexually dimorphic, named for a silvery-white, star-shaped spot or "lone star" present near the center of the posterior portion of the adult female shield (scutum); adult males conversely have varied white streaks or spots around the margins of their shields.

Heartwater is a tick-borne rickettsial disease of domestic and wild ruminants. It is caused by Ehrlichia ruminantium - an intracellular gram-negative coccal bacterium. The disease is spread by bont ticks, which are members of the genus Amblyomma. Affected mammals include cattle, sheep, goats, antelope, and buffalo, but the disease has the biggest economic impact on cattle production in affected areas. The disease's name is derived from the fact that fluid can collect around the heart or in the lungs of infected animals.

Ehrlichia chaffeensis is an obligate intracellular gram-negative species of rickettsiales bacteria. It is a zoonotic pathogen transmitted to humans by the lone star tick. It is the causative agent of human monocytic ehrlichiosis.

Human monocytotropic ehrlichiosis human disease

Human monocytotropic ehrlichiosis (HME) is a form of ehrlichiosis associated with Ehrlichia chaffeensis. This bacterium is an obligate intracellular pathogen affecting monocytes and macrophages.

Ehrlichiosis ewingii infection is an infectious disease caused by an intracellular bacteria, Ehrlichia ewingii. The infection is transmitted to humans by the tick, Amblyomma americanum. This tick can also transmit Ehrlichia chaffeensis, the bacteria that causes human monocytic ehrlichiosis (HME).

Ehrlichia canis is an obligate, intracellular bacterium that acts as the causative agent of Ehrlichiosis, a disease most commonly affecting canine species. This pathogen is present throughout the United States, South America, Asia, and Africa. First defined in 1935, E. canis emerged in the United States in 1963 and its presence has since been found in all 48 contiguous United States. Reported primarily in dogs, E. canis has also been documented in felines and humans where it is transferred most commonly via Rhipicephalus sanguineus, the brown dog tick.

Ehrlichia Wisconsin HM543746 is an unnamed tick bacterium that spread through Minnesota and Wisconsin in 2009 and is similar to Ehrlichia muris.

The Heartland virus (HRTV) is a tick-borne phlebovirus of the Bhanja virus serocomplex discovered in 2009. The Lone Star Tick transmits the virus to people when feeding on blood. As of 2017, only five Midwestern United States have reported 20 human infections, namely Arkansas, Indiana, Missouri, Oklahoma, and Tennessee; symptoms resemble those of two other tick-borne infections ehrlichiosis and anaplasmosis. The reservoir host is unknown, but deer, raccoon, coyotes, and moose in 13 different states have antibody titers against the virus.

References

  1. "Ehrlichiosis". Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention. 15 November 2013.
  2. Dawson, Jacqueline E.; Marty, Aileen M. (1997). "Ehrlichiosis". In Horsburgh, C.R.; Nelson, A.M. Pathology of emerging Infections. 1. American Society for Microbiology Press. ISBN   1555811205.
  3. 1 2 3 Goddard J (September 1, 2008). "What Is New With Ehrlichiosis?". Infections in Medicine.
  4. Dumler JS, Madigan JE, Pusterla N, Bakken JS (July 2007). "Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment". Clin. Infect. Dis. 45 (Suppl 1): S45–51. doi:10.1086/518146. PMID   17582569.
  5. Reeves WK, Loftis AD, Nicholson WL, Czarkowski AG (2008). "The first report of human illness associated with the Panola Mountain Ehrlichia species: a case report". Journal of Medical Case Reports. 2: 139. doi:10.1186/1752-1947-2-139. PMC   2396651 . PMID   18447934.
  6. 1 2 Steenhuysen, J. (3 August 2011). "New tick-borne bacterium found in upper Midwest". Reuters. Archived from the original on 2012-06-09.
  7. Thomas S, Popov VL, Walker DH (2010). Kaushal D, ed. "Exit Mechanisms of the Intracellular Bacterium Ehrlichia". PLoS ONE. 5 (12): e15775. doi:10.1371/journal.pone.0015775. PMC   3004962 . PMID   21187937.
  8. Marty AM, Dumler JS, Imes G, Brusman HP, Smrkovski LL, Frisman DM (August 1995). "Ehrlichiosis mimicking thrombotic thrombocytopenic purpura. Case report and pathological correlation". Hum. Pathol. 26 (8): 920–5. doi:10.1016/0046-8177(95)90017-9. PMID   7635455.
  9. McBride JW, Walker DH (2011). "Molecular and cellular pathobiology of Ehrlichia infection: targets for new therapeutics and immunomodulation strategies". Expert Rev Mol Med. 13: e3. doi:10.1017/S1462399410001730. PMC   3767467 . PMID   21276277.
  10. Thomas, Rachael J; Dumler, J Stephen; Carlyon, Jason A (1 August 2009). "Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and ehrlichiosis". Expert Review of Anti-infective Therapy. 7 (6): 709–722. doi:10.1586/eri.09.44. PMC   2739015 . PMID   19681699.
  11. Rudoler N, Baneth G, Eyal O, van Straten M, Harrus S (December 2012). "Evaluation of an attenuated strain of Ehrlichia canis as a vaccine for canine monocytic ehrlichiosis". Vaccine. 31 (1): 226–33. doi:10.1016/j.vaccine.2012.10.003. PMID   23072894.
  12. 1 2 Dahlgren FS, Heitman KN, Drexler NA, Massung RF, Behravesh CB. Human granulocytic anaplasmosis in the United States from 2008 to 2012: a summary of national surveillance data. Am J Trop Med Hyg 2015;93:66–72.
  13. Drexler NA, Dahlgren FS, Heitman KN, Massung RF, Paddock CD, Behravesh CB. National surveillance of spotted fever group rickettsioses in the United States, 2008–2012. Am J Trop Med Hyg 2016;23–34.
  14. 1 2 3 Nichols KH, Dahlgren FS, Drexler NA, Massung RF, Behravesh CB. Increasing incidence of ehrlichiosis in the United States: a summary of national surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii infections in the United States, 2008–2012. Am J Trop Med Hyg 2016;94:52–60.
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