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Glomerulotubular pathology in dogs with subclinical ehrlichiosis. PLoS One 2021; 16:e0260702. [PMID: 34879085 PMCID: PMC8654155 DOI: 10.1371/journal.pone.0260702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
Subclinical stage of ehrlichiosis is characterized by absence of clinical or laboratory alterations; however, it could lead to silent glomerular/tubular changes and contribute significantly to renal failure in humans and animals. The aim of this study was to evaluate glomerular and tubular alterations in dogs with subclinical ehrlichiosis. We evaluated renal biopsies of 14 bitches with subclinical ehrlichiosis and 11 control dogs. Samples were obtained from the left kidney, and the tissue obtained was divided for light microscopy, immunofluorescence, and transmission electron microscopy. Abnormalities were identified by light microscopy in 92.9% of dogs with ehrlichiosis, but not in any of the dogs of the control group. Mesangial cell proliferation and synechiae (46.1%) were the most common findings, but focal segmental glomerulosclerosis and ischemic glomeruli (38.4%), focal glomerular mesangial matrix expansion (30.7%), mild to moderate interstitial fibrosis and tubular atrophy (23%), and glomerular basement membrane spikes (23%) were also frequent in dogs with ehrlichiosis. All animals with ehrlichiosis exhibited positive immunofluorescence staining for immunoglobulins. Transmission electron microscopy from dogs with ehrlichiosis revealed slight changes such as sparse surface projections and basement membrane double contour. The subclinical phase of ehrlichiosis poses a higher risk of development of kidney damage due to the deposition of immune complexes.
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Caster DJ, Summersgill JT, Paueksakon P, Massung RF, Shieh WJ, McLeish KR. Mixed cryoglobulinemia and secondary membranoproliferative glomerulonephritis associated with ehrlichiosis. CEN Case Rep 2014; 3:178-182. [PMID: 28509195 DOI: 10.1007/s13730-014-0113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 02/17/2014] [Indexed: 12/31/2022] Open
Abstract
Ehrlichiosis is a tick-borne disease with diverse clinical presentations, ranging in severity from a flu-like illness with fever and myalgias to a serious systemic disease with multisystem organ failure. Nephrotic syndrome has been reported previously in two cases of human ehrlichiosis. A kidney biopsy revealed minimal change disease in one of those patients. Herein, we present the case of a 40-year-old man with ehrlichiosis who developed nephrotic syndrome, cryoglobulinemia, and secondary membranoproliferative glomerulonephritis (MPGN). The patient originally presented with shortness of breath, diffuse myalgias, headache, and lower extremity edema. He subsequently developed acute kidney injury and underwent kidney biopsy which showed MPGN and acute tubular injury. A tick-borne disease panel was positive for IgM and IgG to Ehrlichia chaffeensis. Serum testing revealed type 3 mixed cryoglobulinemia with no evidence of hepatitis C infection. The cryoprecipitate contained IgM and IgG antibodies to E. chaffeensis. Cryoglobulinemia is frequently associated with infections, particularly hepatitis C; however, our case is the first to describe ehrlichiosis associated with cryoglobulinemia and secondary MPGN.
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Affiliation(s)
- Dawn J Caster
- Department of Medicine, University of Louisville School of Medicine, 570 South Preston Street - 102 South, Donald Baxter Research Bldg, Louisville, KY, 40202, USA.
| | - James T Summersgill
- Department of Medicine, University of Louisville School of Medicine, 570 South Preston Street - 102 South, Donald Baxter Research Bldg, Louisville, KY, 40202, USA
| | - Paisit Paueksakon
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert F Massung
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kenneth R McLeish
- Department of Medicine, University of Louisville School of Medicine, 570 South Preston Street - 102 South, Donald Baxter Research Bldg, Louisville, KY, 40202, USA.,Robley Rex VAMC, Louisville, KY, USA
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Brady RC, Bissler JJ. Renal, hepatic, and marrow dysfunction in a patient with chronic renal insufficiency. Pediatr Nephrol 2003; 18:293-6. [PMID: 12644928 DOI: 10.1007/s00467-002-1055-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2002] [Revised: 10/24/2002] [Accepted: 10/24/2002] [Indexed: 10/25/2022]
Abstract
Severe illness with acute renal failure, leukopenia, thrombocytopenia, and coagulopathy frequently occurs with hemolytic uremic syndrome/thrombotic thrombocytopenic purpura, hematological malignancies, sepsis, and collagen-vascular diseases. We present a 16-year-old male fast-food worker with underlying chronic renal insufficiency who manifested these abnormalities as a result of Ehrlichia chaffeensis sepsis. Doxycycline therapy and aggressive supportive care led to complete recovery.
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Affiliation(s)
- Rebecca C Brady
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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