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Stromdahl EY, Feldman KA, Nadolny RM, Kennedy AC, Bement ZJ, Buoni M, Rutz H, Broyhill JC, Bernick J, Brinkerhoff RJ, Ayuk-Takor L, Crum D, da Silva AJ, Dotseth E, Flammia L, Girone K, Gaines D, Phan A, Pritt BS, Wee SB, Gaff HD, Hynes WL. Emerging babesiosis in the mid-Atlantic: autochthonous human babesiosis cases and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) and Ixodes keiransi (Acari: Ixodidae) ticks from Delaware, Maryland, Virginia, West Virginia, and the District of Columbia, 2009 to 2024. JOURNAL OF MEDICAL ENTOMOLOGY 2025:tjaf054. [PMID: 40261095 DOI: 10.1093/jme/tjaf054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 02/17/2025] [Accepted: 03/26/2025] [Indexed: 04/24/2025]
Abstract
The range of Babesia microti (Franca, 1910)-infected ticks is expanding, resulting in locally acquired human babesiosis cases occurring in new areas: Maryland (2009), the District of Columbia (2013), Virginia (2016), and West Virginia (2017). We collected host-seeking ticks from old fields, ecotones, forested habitats and animal hosts in Delaware, Maryland, and Virginia, 2010 to 2024. Ixodes scapularis Say, the tick vector of babesiosis, was captured in all 3 states. PCR revealed B. microti in 2.7% (36/1310) of I. scapularis, with site prevalence ranging from <1% to 12.5% infected. The first B. microti-positive I. scapularis was collected in Northampton County, Virginia, 2012. Of the B. microti-infected ticks, 50% (18/36) were coinfected with Borrelia burgdorferi and one was triple-infected with B. microti, B. burgdorferi, and Anaplasma phagocytophilum. We collected Ixodes keiransi Beati, Nava, Venzal, and Guglielmone ticks from Delaware and Virginia. We found B. microti and B. burgdorferi in those from Virginia, and B. burgdorferi in ticks from a shrew in Delaware. To our knowledge, this is the first report of B. microti and B. burgdorferi-positive I. keiransi from Virginia, and the first report of B. burgdorferi-positive I. keiransi from Delaware. Ixodes keiransi ticks rarely bite humans but are involved in the maintenance and spread of pathogens when sympatric with I. scapularis. We tested a subset of both tick species for Babesia duncani; none were positive. Jurisdictions in the southern mid-Atlantic region should expect babesiosis cases, and Lyme disease and anaplasmosis coinfections, and healthcare providers should consider these tick-borne infections as part of the differential diagnosis.
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Affiliation(s)
- Ellen Y Stromdahl
- Defense Centers for Public Health-Aberdeen, DHA Public Health, Edgewood, MD, USA
| | | | - Robyn M Nadolny
- Defense Centers for Public Health-Aberdeen, DHA Public Health, Edgewood, MD, USA
| | - Ashley C Kennedy
- Delaware Department of Natural Resources and Environmental Control, Mosquito Control Section, Newark, DE, USA
| | - Zachary J Bement
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
| | - Michael Buoni
- Delaware Technical Community College, Georgetown, DE, USA
| | - Heather Rutz
- Maryland Department of Health, Baltimore, MD, USA
| | | | | | - R Jory Brinkerhoff
- University of Richmond, Richmond, VA, USA
- University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - David Crum
- Maryland Department of Health, Baltimore, MD, USA
| | - Alexandre J da Silva
- Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Food & Drug Administration, Laurel, MD, USA
| | - Eric Dotseth
- West Virginia Department of Health, Charleston, WV, USA
| | - Lori Flammia
- Virginia Department of Health, Richmond, VA, USA
| | - Kyle Girone
- Virginia Department of Health, Richmond, VA, USA
| | - David Gaines
- Virginia Department of Health, Richmond, VA, USA
| | - Anna Phan
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
| | | | - Siok-Bi Wee
- Maryland Department of Health, Baltimore, MD, USA
| | - Holly D Gaff
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
- University of KwaZulu-Natal, University Rd., Durban, South Africa
| | - Wayne L Hynes
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA
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2
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Abdoli A, Olfatifar M, Zaki L, Nikkhahi F, Fardsanei F, Sobhani S, Sadeghi H, Eslahi AV, Badri M. Global Prevalence of Anaplasma phagocytophilum in Cattle: A One Health Perspective, Meta-Analysis and Future Predictions (up to 2035). Vet Med Sci 2025; 11:e70251. [PMID: 39969156 PMCID: PMC11837283 DOI: 10.1002/vms3.70251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 01/30/2025] [Accepted: 02/04/2025] [Indexed: 02/20/2025] Open
Abstract
Anaplasma phagocytophilum is an emerging tick-borne zoonotic bacterium, which is considered a significant risk to the health and industry of cattle in tropical and sub-tropical regions worldwide. This research focuses on examining the worldwide occurrence of A. phagocytophilum in cattle. Several databases, including Scopus, PubMed, ProQuest, Web of Science, ScienceDirect, and Google Scholar, were searched for publications spanning October 2004 to November 2024. The pooled prevalence was calculated with a 95% confidence interval (CI) using a random-effects model based on the Freeman-Tukey double arcsine transformation. A total of 72 studies satisfied the inclusion criteria, revealing a global prevalence of A. phagocytophilum in cattle estimated at 8.5% (5.9%-11.5%). Mongolia (51.9%, 45.9%-56.2%) and Guatemala (51%, 41.2%-60.7%) were countries that accounted for the highest prevalence. Moreover, the infection was most prevalent in African region with prevalence of 11.3% (3.9%-21.5%). The highest prevalence rate was observed in hot-summer Mediterranean climate (13.7%, 4.7%-26.2%). The analysis indicated that immunological techniques were associated with the highest prevalence rate (14.2%, 6.5%-24.3%). The findings of the present research highlighted important geographical and environmental factors that affect the prevalence of disease. In the fields of veterinary medicine and public health, these findings enhance disease management plans and preventative initiatives.
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Affiliation(s)
- Amir Abdoli
- Zoonoses Research CenterJahrom University of Medical SciencesJahromIran
- Department of Parasitology and MycologyJahrom University of Medical SciencesJahromIran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research CenterQom University of Medical SciencesQomIran
| | - Leila Zaki
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
| | - Farhad Nikkhahi
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
| | - Fatemeh Fardsanei
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
| | - Sona Sobhani
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
| | - Hamid Sadeghi
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
| | - Aida Vafae Eslahi
- Zoonoses Research CenterJahrom University of Medical SciencesJahromIran
| | - Milad Badri
- Medical Microbiology Research CenterQazvin University of Medical SciencesQazvinIran
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3
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Gygax L, Schudel S, Kositz C, Kuenzli E, Neumayr A. Human monocytotropic ehrlichiosis-A systematic review and analysis of the literature. PLoS Negl Trop Dis 2024; 18:e0012377. [PMID: 39093857 PMCID: PMC11324158 DOI: 10.1371/journal.pntd.0012377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/14/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024] Open
Abstract
Human monocytotropic ehrlichiosis (HME) is a tick-borne bacterial infection caused by Ehrlichia chaffeensis. Most available data come from case reports, case series and retrospective studies, while prospective studies and clinical trials are largely lacking. To obtain a clearer picture of the currently known epidemiologic distribution, clinical and paraclinical presentation, diagnostic aspects, complications, therapeutic aspects, and outcomes of HME, we systematically reviewed the literature and analyzed and summarized the data. Cases of HME are almost exclusively reported from North America. Human infections due to other (non-chaffeensis) Ehrlichia spp. are rare. HME primarily presents as an unspecific febrile illness (95% of the cases), often accompanied by thrombocytopenia (79.1% of the cases), leukopenia (57.8% of the cases), and abnormal liver function tests (68.1% of the cases). Immunocompromized patients are overrepresented among reviewed HME cases (26.7%), which indicates the role of HME as an opportunistic infection. The incidence of complications is higher in immunocompromized compared to immunocompetent cases, with ARDS (34% vs 19.8%), acute renal failure (34% vs 15.8%), multi organ failure (26% vs 14.9%), and secondary hemophagocytic lymphohistiocytosis (26% vs 14.9%) being the most frequent reported. The overall case fatality is 11.6%, with a significant difference between immunocompetent (9.9%) and immunocompromized (16.3%) cases, and sequelae are rare (4.2% in immunocompetent cases, 2.5% in immunocompromised cases).
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Affiliation(s)
- Larissa Gygax
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sophie Schudel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Kositz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Esther Kuenzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
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Oundo JW, Kalayou S, Bosch QT, Villinger J, Koenraadt CJM, Masiga D. Ticks (Acari: Ixodidae) infesting cattle in coastal Kenya harbor a diverse array of tick-borne pathogens. Ticks Tick Borne Dis 2024; 15:102266. [PMID: 37813003 DOI: 10.1016/j.ttbdis.2023.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/27/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
Ticks and the microbes they transmit have emerged in sub-Saharan Africa as a major threat to veterinary and public health. Although progress has been made in detecting and identifying tick-borne pathogens (TBPs) across vast agroecologies of Kenya, comprehensive information on tick species infesting cattle and their associated pathogens in coastal Kenya needs to be updated and expanded. Ticks infesting extensively grazed zebu cattle in 14 villages were sampled and identified based on morphology and molecular methods and tested for the presence of bacterial and protozoan TBPs using PCR with high-resolution melting analysis and gene sequencing. In total, 3,213 adult ticks were collected and identified as Rhipicephalus appendiculatus (15.8%), R. evertsi (12.8%), R. microplus (11.3%), R. pulchellus (0.1%), Amblyomma gemma (24.1%), A. variegatum (35.1%), Hyalomma rufipes (0.6%), and H. albiparmatum (0.2%). Ticks were infected with Rickettsia africae, Ehrlichia ruminantium, E. minasensis, Theileria velifera and T. parva. Coxiella sp. endosymbionts were detected in the Rhipicephalus and Amblyomma ticks. Co-infections with two and three different pathogens were identified in 6.9% (n = 95/1382) and 0.1% (n = 2/1382) of single tick samples, respectively, with the most common co-infection being R. africae and E. ruminantium (7.2%, CI: 4.6 - 10.6). All samples were negative for Coxiella burnetii, Anaplasma spp. and Babesia spp. Our study provides an overview of tick and tick-borne microbial diversities in coastal Kenya.
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Affiliation(s)
- Joseph Wang'ang'a Oundo
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya; Quantitative Veterinary Epidemiology, Wageningen University & Research, P.O. Box 338 6700AH Wageningen, the Netherlands.
| | - Shewit Kalayou
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | - Quirine Ten Bosch
- Quantitative Veterinary Epidemiology, Wageningen University & Research, P.O. Box 338 6700AH Wageningen, the Netherlands
| | - Jandouwe Villinger
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
| | | | - Daniel Masiga
- International Centre of Insect Physiology and Ecology (icipe), P.O. Box 30772-00100, Nairobi, Kenya
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5
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Mohseni N, Chang M, Garcia K, Weakley M, Do T, Mir S. Development of a Syndromic Molecular Diagnostic Assay for Tick-Borne Pathogens Using Barcoded Magnetic Bead Technology. Microbiol Spectr 2023; 11:e0439522. [PMID: 37166314 PMCID: PMC10269837 DOI: 10.1128/spectrum.04395-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/22/2023] [Indexed: 05/12/2023] Open
Abstract
Infectious disease diagnostics often depend on costly serological testing with poor sensitivity, low specificity, and long turnaround time. Here, we demonstrate proof of the principle for simultaneous detection of two tick-borne pathogens from a single test sample using barcoded magnetic bead technology on the BioCode 2500 system. Specific primer sets complementary to the conserved genes of Anaplasma phagocytophilum and Borrelia burgdorferi were used in PCR amplification of the target, followed by the hybridization of the resulting biotinylated PCR products with specific probes tethered to the barcoded magnetic beads for simultaneous detection, using a fluorophore with high quantum yield. The assay has an extremely high signal to background ratio, with a limit of detection (LOD) of 2.81 50% tissue culture infection dose (TCID50)/mL and 1 CFU/mL for A. phagocytophilum and B. burgdorferi, respectively. The observed LOD for gene blocks was 1.8 copies/reaction for both the pathogens. The assay demonstrated 100% positive and negative agreement on performance evaluation using patient specimens and blood samples spiked with 1 × LOD of pathogen stock. No cross-reactivity was observed with other related tick-borne pathogens and genomic DNA of human, cattle, and canine origin. The assay can be upgraded to a sensitive and cost-effective multiplex diagnostic approach that can simultaneously detect multiple clinically important tick-borne pathogens in a single sample with a short turnaround time. IMPORTANCE The low pathogen load in the tick-borne disease test samples and the lack of highly sensitive multiplex diagnostic approaches have impacted diagnosis during clinical testing and limited surveillance studies to gauge prior insight about the prevalence of tick-borne infections in a geographical area. This article demonstrates proof of the principle for simultaneous detection of two important tick-borne pathogens from a single test sample using digital barcoded magnetic bead technology. Using a fluorophore of high quantum yield, the diagnostic approach showed high sensitivity and specificity. The LOD was 1.8 genome copies per reaction for both A. phagocytophilum and B. burgdorferi. The assay can be upgraded for the detection of all clinically important tick-borne pathogens from a single patient sample with high sensitivity and specificity. The assay can provide a diagnostic answer to the clinician in a short turnaround time to facilitate speedy therapeutic intervention to infected patients and implement public health measures to prevent community spread.
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Affiliation(s)
- Nazleeen Mohseni
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Mariann Chang
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Kathryn Garcia
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Mina Weakley
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Tram Do
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
| | - Sheema Mir
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California, USA
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6
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Pathogens in ticks collected in Israel: II. Bacteria and protozoa found in Rhipicephalus sanguineus sensu lato and Rhipicephalus turanicus. Ticks Tick Borne Dis 2022; 13:101986. [DOI: 10.1016/j.ttbdis.2022.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 05/21/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
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7
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Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients. Case Rep Transplant 2021; 2021:8285326. [PMID: 34840851 PMCID: PMC8612778 DOI: 10.1155/2021/8285326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.
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Mumcuoglu KY, Arslan-Akveran G, Aydogdu S, Karasartova D, Kosar N, Gureser AS, Shacham B, Taylan-Ozkan A. Pathogens in ticks collected in Israel: I. Bacteria and protozoa in Hyalomma aegyptium and Hyalomma dromedarii collected from tortoises and camels. Ticks Tick Borne Dis 2021; 13:101866. [PMID: 34798529 DOI: 10.1016/j.ttbdis.2021.101866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Abstract
Ticks were collected from 30 Greek tortoise (Testudo graeca), and 10 Arabian camels (dromedary) (Camelus dromedarius) in Israel. All those collected from Greek tortoises belonged to Hyalomma aegyptium, while all specimens collected from the camels belonged to Hyalomma dromedarii. Out of 84 specimens of H. aegyptium, 31 pools were examined by PCR, while from 75 H. dromedarii specimens nine pools were studied. Out of 31 pools of H. aegyptium 26 were positive for pathogens or endosymbiont; 14 for one, 11 for two and one for three pathogens. Out of nine pools prepared from H. dromedarii, seven were positive for pathogens (two for C. burnetii and five for Leishmania infantum). In H. aegyptium, Rickettsia africae, Rickettsia aeschlimannii, Rickettsia endosymbiont, Coxiella burnetii, Hemolivia mauritanica, Babesia microti, Theileria sp., and Leishmania infantum was detected, while in H. dromedarii C. burnetii and L. infantum were found. None of the ticks were positive for Anaplasma/Ehrlichia, Listeria monocytogenes, Bartonella spp., Hepatozoon spp. and Toxoplasma gondii. H Rickettsia endosymbionts, C. burnetii, B. microti, Theileria sp. and L. infantum are reported for the first time in H. aegyptium, and C. burnetii and L. infantum for the first time in H. dromedarii.
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Affiliation(s)
- Kosta Y Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Gonul Arslan-Akveran
- Department of Food Processing, Alaca Avni Celik Vocational School, Hitit University, Corum, Turkey
| | - Sabiha Aydogdu
- Department of Nutrition and Dietetics, Faculty of Health Science, Hitit University, Corum, Turkey
| | | | - Nezahat Kosar
- Department of Medical Microbiology, Hitit University, Corum, Turkey
| | | | - Boaz Shacham
- National Natural History Collections, the Hebrew University of Jerusalem, Safra Campus, Jerusalem, Israel
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, Hitit University, Corum, Turkey; Department of Medical Microbiology, Faculty of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
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Saha A, Browning C, Dandamudi R, Barton K, Graepel K, Cullity M, Abusalah W, Christine D, Rossi C, Drexler N, Basavaraju S, Annambhotia P, Guillamet RV, Eid AJ, Maliakkal J, Miller A, Hugge C, Dharnidharka VR, Kandula P, Moritz MJ. Donor-derived ehrlichiosis: two clusters following solid organ transplantation. Clin Infect Dis 2021; 74:918-923. [PMID: 34329411 DOI: 10.1093/cid/ciab667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor derived clusters of ehrlichiosis are described here. During the summer of 2020, two cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis (HLH). Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All three were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization (OPO) and the OPTN for further investigation by public health authorities.
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Affiliation(s)
- Aditi Saha
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Charles Browning
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Raja Dandamudi
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Kevin Barton
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Kevin Graepel
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Madeline Cullity
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wala Abusalah
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Du Christine
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Carla Rossi
- Department of Infectious Disease, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Naomi Drexler
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pallavi Annambhotia
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Albert J Eid
- Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Maliakkal
- Division of Pediatric Nephrology, Saint Louis University, Missouri, USA
| | - Aaron Miller
- Division of Pediatric Infectious Disease, Saint Louis University, Missouri, USA
| | - Christopher Hugge
- Division of Pediatric Hematology Oncology, Saint Louis University, Missouri, USA
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Praveen Kandula
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Michael J Moritz
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Tokarz R, Lipkin WI. Discovery and Surveillance of Tick-Borne Pathogens. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:1525-1535. [PMID: 33313662 PMCID: PMC8285023 DOI: 10.1093/jme/tjaa269] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 05/06/2023]
Abstract
Within the past 30 yr molecular assays have largely supplanted classical methods for detection of tick-borne agents. Enhancements provided by molecular assays, including speed, throughput, sensitivity, and specificity, have resulted in a rapid increase in the number of newly characterized tick-borne agents. The use of unbiased high throughput sequencing has enabled the prompt identification of new pathogens and the examination of tick microbiomes. These efforts have led to the identification of hundreds of new tick-borne agents in the last decade alone. However, little is currently known about the majority of these agents beyond their phylogenetic classification. Our article outlines the primary methods involved in tick-borne agent discovery and the current status of our understanding of tick-borne agent diversity.
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Affiliation(s)
- Rafal Tokarz
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Corresponding author, e-mail:
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, NY
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Milholland MT, Eisen L, Nadolny RM, Hojgaard A, Machtinger ET, Mullinax JM, Li AY. Surveillance of Ticks and Tick-Borne Pathogens in Suburban Natural Habitats of Central Maryland. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:1352-1362. [PMID: 33511396 PMCID: PMC10947375 DOI: 10.1093/jme/tjaa291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Indexed: 06/12/2023]
Abstract
Lyme and other tick-borne diseases are increasing in the eastern United States and there is a lack of research on integrated strategies to control tick vectors. Here we present results of a study on tick-borne pathogens detected from tick vectors and rodent reservoirs from an ongoing 5-yr tick suppression study in the Lyme disease-endemic state of Maryland, where human-biting tick species, including Ixodes scapularis Say (Acari: Ixodidae) (the primary vector of Lyme disease spirochetes), are abundant. During the 2017 tick season, we collected 207 questing ticks and 602 ticks recovered from 327 mice (Peromyscus spp. (Rodentia: Cricetidae)), together with blood and ear tissue from the mice, at seven suburban parks in Howard County. Ticks were selectively tested for the presence of the causative agents of Lyme disease (Borrelia burgdorferi sensu lato [s.l.]), anaplasmosis (Anaplasma phagocytophilum), babesiosis (Babesia microti), ehrlichiosis (Ehrlichia ewingii, Ehrlichia chaffeensis, and 'Panola Mountain' Ehrlichia) and spotted fever group rickettsiosis (Rickettsia spp.). Peromyscus ear tissue and blood samples were tested for Bo. burgdorferi sensu stricto (s.s), A. phagocytophilum, Ba. microti, and Borrelia miyamotoi. We found 13.6% (15/110) of questing I. scapularis nymphs to be Bo. burgdorferi s.l. positive and 1.8% (2/110) were A. phagocytophilum positive among all sites. Borrelia burgdorferi s.s. was found in 71.1% (54/76) of I. scapularis nymphs removed from mice and 58.8% (194/330) of captured mice. Results from study on tick abundance and pathogen infection status in questing ticks, rodent reservoirs, and ticks feeding on Peromyscus spp. will aid efficacy evaluation of the integrated tick management measures being implemented.
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Affiliation(s)
- Matthew T. Milholland
- Invasive Insect Biocontrol and Behavior Laboratory, USDA, ARS, Bldg. 007, Rm. 301, BARC-West, 10300 Baltimore Avenue, Beltsville, MD 20705
- AGNR-Environmental Science and Technology, University of Maryland, College Park, MD
| | - Lars Eisen
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| | - Robyn M. Nadolny
- Tick-Borne Disease Laboratory, Army Public Health Center, Aberdeen Proving Ground, MD
| | - Andrias Hojgaard
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| | - Erika T. Machtinger
- Department of Entomology, Pennsylvania State University, University Park, PA
| | - Jennifer M. Mullinax
- AGNR-Environmental Science and Technology, University of Maryland, College Park, MD
| | - Andrew Y. Li
- Invasive Insect Biocontrol and Behavior Laboratory, USDA, ARS, Bldg. 007, Rm. 301, BARC-West, 10300 Baltimore Avenue, Beltsville, MD 20705
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12
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Chung IH, Austin AL, Kato CY. Development and validation of real-time PCR assays for the detection of Ehrlichia species and E. chaffeensis in clinical specimens. J Microbiol Methods 2021; 186:106225. [PMID: 33872636 DOI: 10.1016/j.mimet.2021.106225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
Ehrlichiosis, caused by Gram-negative bacteria of the genus Ehrlichia, is considered an emerging infectious disease due to the increasing number of reported cases. Symptoms are non-specific and occur within 1 to 2 weeks following the bite of an infected tick. Confirmatory laboratory diagnostic methods vary in sensitivity and specimen requirements, which can lead to delayed diagnosis. PCR testing serves as an efficient approach to Ehrlichia confirmation in the acute stage of illness. Published assays have been effectively used to detect human ehrlichiosis at limit of detections ranging from 10 to 50 genomic copies (GC) of Ehrlichia DNA. With the discovery of new species capable of human infection, we wanted to develop assays that are sensitive and encompass a wide range of Ehrlichia. Here we developed and validated two sensitive and specific real-time PCR assays (PanE1 and PanE2) for the detection of Ehrlichia species, as well as two real-time PCR assays (ECh2 and ECh4) for the detection of Ehrlichia chaffeensis, specifically. The limit of detection was determined to be 10 GC per reaction with 100% confidence, and as little as 1 GC with lower efficiencies. Accuracy was assessed at 100% correlation. Specificity from exclusivity testing demonstrated that neither the Ehrlichia species assays (n = 60), nor the E. chaffeensis specific assays (n = 64) had cross reactivity with near neighbors or environmental bacteria. A positive predictive value of 100% and a negative predictive value of ≥93% was determined by evaluating banked clinical specimens from 62 patients with the assays. These real-time PCR assays are effective tools to detect human Ehrlichia species during the acute stage of illness. Early detection of Ehrlichia infection by these real-time PCR assays can facilitate diagnosis and treatment.
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Affiliation(s)
- Ida H Chung
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Amy L Austin
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Cecilia Y Kato
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
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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: 12] [Impact Index Per Article: 2.4] [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.
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Akveran GA, Karasartova D, Keskin A, Comba A, Celebi B, Mumcuoglu KY, Taylan-Ozkan A. Bacterial and protozoan agents found in Hyalomma aegyptium (L., 1758) (Ixodida: Ixodidae) collected from Testudo graeca L., 1758 (Reptilia: Testudines) in Corum Province of Turkey. Ticks Tick Borne Dis 2020; 11:101458. [PMID: 32389537 DOI: 10.1016/j.ttbdis.2020.101458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 01/12/2023]
Abstract
Hyalomma aegyptium (L., 1758) (Ixodida: Ixodidae) is a hard tick and the main host for adults are Palearctic tortoises of the genus Testudo, while larvae and nymphs are less host-specific and nymphs also attach to humans. In the present study, a total of 261 H. aegyptium ticks were removed from 26 Testudo graeca L., 1758 in Corum Province of Turkey. The most prevalent pathogens identified molecularly in the ticks were Hemolivia mauritanica (51.9 %), followed by Rickettsia aeschlimannii (32.6 %), Ehrlichia spp. (30.2 %), and Bartonella bovis (0.8 %). All samples were negative for Coxiella burnetii, Francisella tularensis, Anaplasma phagocytophilum, Babesia spp., Hepatozoon spp. and Theileria spp. Overall, 97.4 % of the examined adult ticks and 26.3 % of nymphs were infected with at least one pathogen, while 40.9 % of all ticks were infected with only one pathogen, 27.4 % with two pathogens, and 9.9 % with three pathogens, concomitantly. Overall, 80.8 % of the examined blood smears of tortoises were H. mauritanica-positive, and the mean intensity of parasitemia was 4.8 % (1-21). As a conclusion, since the examined tortoises were sampled in gardens and vineyards close to human habitation, and as a relatively large percentage of them were infested with ticks carrying pathogenic agents affecting also humans, the importance of tortoises, their ticks and pathogens in terms of the public health should be farther examined.
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Affiliation(s)
- Gonul Arslan Akveran
- Department of Food Processing, Alaca Avni Celik Vocational School, Hitit University, Corum, Turkey.
| | | | - Adem Keskin
- Department of Biology, Faculty of Science and Art, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Arzu Comba
- Department of Veterinary Medicine, Alaca Avni Celik Vocational School, Hitit University, Corum, Turkey
| | - Bekir Celebi
- National High Risk Pathogens Reference Laboratory, Public Health Institution of Turkey, Ankara, Turkey
| | - Kosta Y Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, Hitit University, Corum, Turkey; Department of Medical and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Cyprus
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Morshed MG, Hojgaard A, Lee MK, Osikowicz LM, Eisen L. Detection of 'Candidatus Ehrlichia khabarensis' in rodents and ticks removed from rodents in British Columbia, Canada. Ticks Tick Borne Dis 2019; 11:101277. [PMID: 31501035 DOI: 10.1016/j.ttbdis.2019.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 08/23/2019] [Indexed: 11/25/2022]
Abstract
'Candidatus Ehrlichia khabarensis' was first described from rodents and insectivores in the Far East territory of Khabarovsk on the Russian Pacific Coast. Here we report the detection of DNA from this microorganism in rodents and fed ticks collected from rodents in British Columbia, Canada in 2013-2014. 'Candidatus Ehrlichia khabarensis' was detected in (i) a female Ixodes angustus tick collected from a Peromyscus maniculatus; (ii) a female Dermacentor andersoni tick collected from a Perognathus parvus; (iii) a pool of 2 larval Ixodes pacificus ticks collected from a single P. maniculatus; and (iv) a pool of 3 nymphal I. pacificus ticks collected from a single P. maniculatus. Three of these four rodents (2 P. maniculatus and 1 P. parvus) with infected ticks also had evidence of 'Candidatus Ehrlichia khabarensis' in at least one tissue type. The infected P. maniculatus and Ixodes ticks came from the Vancouver area in western British Columbia and the P. parvus and Dermacentor tick from an inland site in central British Columbia. Although it remains to be determined whether 'Candidatus Ehrlichia khabarensis' has any negative impacts on wildlife, domestic animals or humans, we note that all three tick species found to contain the DNA of this microorganism are known to bite humans. Future detection of this microorganism either in ticks collected from rodents and allowed to molt to the next life stage prior to being tested, or from host-seeking ticks, is required to determine if it can survive the tick's molt after being ingested via an infectious blood meal.
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Affiliation(s)
- Muhammad G Morshed
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, B.C., V5Z 4R4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, B.C., V6T 2B5, Canada
| | - Andrias Hojgaard
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO, 80521, United States
| | - Min-Kuang Lee
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, B.C., V5Z 4R4, Canada
| | - Lynn M Osikowicz
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO, 80521, United States
| | - Lars Eisen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO, 80521, United States.
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16
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Development of a tick-borne pathogen QPCR panel for detection of Anaplasma, Ehrlichia, Rickettsia, and Lyme disease Borrelia in animals. J Microbiol Methods 2018; 151:83-89. [PMID: 29802869 DOI: 10.1016/j.mimet.2018.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
Abstract
Anaplasma spp., Ehrlichia spp., Rickettsia spp., and Lyme disease associated Borrelia spp. are the most common tick-borne pathogens reported to infect human beings worldwide and other animals, such as dogs and horses. In the present study, we developed a broad-coverage SYBR Green QPCR panel consisting of four individual assays for the detection and partial differentiation of the aforementioned pathogens. All assays were optimized to the same thermocycling condition and had a detection limit of 10 copies per reaction. The assays remained sensitive when used to test canine and equine blood DNA samples spiked with known amounts of synthetic DNA (gBlock) control template. The assays were specific, as evidenced by lack of cross reaction to non-target gBlock or other pathogens commonly tested in veterinary diagnostic labs. With appropriate Ct cutoff values for positive samples and negative controls and the melting temperature (TM) ranges established in the present study, the QPCR panel is suitable for accurate, convenient and rapid screening and confirmation of tick-borne pathogens in animals.
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17
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Karasartova D, Gureser AS, Gokce T, Celebi B, Yapar D, Keskin A, Celik S, Ece Y, Erenler AK, Usluca S, Mumcuoglu KY, Taylan-Ozkan A. Bacterial and protozoal pathogens found in ticks collected from humans in Corum province of Turkey. PLoS Negl Trop Dis 2018; 12:e0006395. [PMID: 29649265 PMCID: PMC5916866 DOI: 10.1371/journal.pntd.0006395] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/24/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background Tick-borne diseases are increasing all over the word, including Turkey. The aim of this study was to determine the bacterial and protozoan vector-borne pathogens in ticks infesting humans in the Corum province of Turkey. Methodology/Principal findings From March to November 2014 a total of 322 ticks were collected from patients who attended the local hospitals with tick bites. Ticks were screened by real time-PCR and PCR, and obtained amplicons were sequenced. The dedected tick was belonging to the genus Hyalomma, Haemaphysalis, Rhipicephalus, Dermacentor and Ixodes. A total of 17 microorganism species were identified in ticks. The most prevalent Rickettsia spp. were: R. aeschlimannii (19.5%), R. slovaca (4.5%), R. raoultii (2.2%), R. hoogstraalii (1.9%), R. sibirica subsp. mongolitimonae (1.2%), R. monacensis (0.31%), and Rickettsia spp. (1.2%). In addition, the following pathogens were identified: Borrelia afzelii (0.31%), Anaplasma spp. (0.31%), Ehrlichia spp. (0.93%), Babesia microti (0.93%), Babesia ovis (0.31%), Babesia occultans (3.4%), Theileria spp. (1.6%), Hepatozoon felis (0.31%), Hepatozoon canis (0.31%), and Hemolivia mauritanica (2.1%). All samples were negative for Francisella tularensis, Coxiella burnetii, Bartonella spp., Toxoplasma gondii and Leishmania spp. Conclusions/Significance Ticks in Corum carry a large variety of human and zoonotic pathogens that were detected not only in known vectors, but showed a wider vector diversity. There is an increase in the prevalence of ticks infected with the spotted fever group and lymphangitis-associated rickettsiosis, while Ehrlichia spp. and Anaplasma spp. were reported for the first time from this region. B. microti was detected for the first time in Hyalomma marginatum infesting humans. The detection of B. occultans, B. ovis, Hepatozoon spp., Theileria spp. and Hemolivia mauritanica indicate the importance of these ticks as vectors of pathogens of veterinary importance, therefore patients with a tick infestation should be followed for a variety of pathogens with medical importance. Ticks are important vectors for different kind of pathogens, both of medical and veterinary importance, while tick-borne diseases (TBDs) are increasing all over the world. In Turkey, many important human and zoonotic TBDs such as, Lyme borreliosis, rickettsiosis, anaplasmosis, ehrlichiosis, tularemia, bartonellosis, babesiosis, theileriosis, and hepatozoonosis have been reported. Nonetheless, there is lack of research-based information concerning the epidemiology, ecology, and vector diversity of these tick-borne pathogens. In this study, we aimed to investigate broad-range bacterial and protozoan vector-borne pathogens by PCR/RT-PCR and sequencing, those ticks infesting humans in the Corum province. Spotted fever group rickettsiae and lymphangitis-associated rickettsiae, Borrelia afzelii, Anaplasma spp., Ehrlichia spp. were detected. Babesia microti was detected in Hyalomma marginatum infesting humans. Interestingly zoonotic pathogens like Babesia ovis, Babesia occultans, Theileria spp, Hepatozoon felis, Hepatozoon canis, and Hemolivia mauritanica were also detected, showing the role of ticks for diseases also of veterinary importance. This study provides important data for understanding the epidemiology of tick-borne pathogens and it is hoped that these results will challenge clinicians and veterinarians to unify their efforts in the management of TBDs.
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Affiliation(s)
| | | | - Tuncay Gokce
- Department of Biology, Faculty of Arts and Science, Hitit University, Corum, Turkey
| | - Bekir Celebi
- National High Risk Pathogens Reference Laboratory, Public Health Institution of Turkey, Ankara, Turkey
| | - Derya Yapar
- Department of Infectious Diseases and Clinical Microbiology, Hitit University, Corum, Turkey
| | - Adem Keskin
- Department of Biology, Faculty of Science and Arts, Gaziosmanpasa University, Tokat, Turkey
| | - Selim Celik
- Emergency Medicine, Hitit University Corum Training and Research Hospital, Corum, Turkey
| | - Yasemin Ece
- Emergency Medicine, Hitit University Corum Training and Research Hospital, Corum, Turkey
| | - Ali Kemal Erenler
- Department of Emergency Medicine, Faculty of Medicine; Hitit University, Corum, Turkey
| | - Selma Usluca
- National Parasitology Reference Laboratory, Public Health Institution of Turkey, Ankara, Turkey
| | - Kosta Y. Mumcuoglu
- Parasitology Unit, Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, Hitit University, Corum, Turkey
- Department of Medical and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
- * E-mail:
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Reller ME, Dumler JS. Development and Clinical Validation of a Multiplex Real-Time Quantitative PCR Assay for Human Infection by Anaplasma phagocytophilum and Ehrlichia chaffeensis. Trop Med Infect Dis 2018; 3:tropicalmed3010014. [PMID: 30274412 PMCID: PMC6136628 DOI: 10.3390/tropicalmed3010014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/19/2018] [Accepted: 01/21/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Human granulocytic anaplasmosis (HGA), caused by Anaplasma phagocytophilum, and human monocytic ehrlichiosis (HME), caused by Ehrlichia chaffeensis, often present as undifferentiated fever but are not treated by typical empiric regimens for acute febrile illness. Their role as agents of vector-borne febrile disease in tropical regions is more poorly studied than for other rickettsial infections. Limitations in diagnosis have impaired epidemiologic and clinical research and needless morbidity and mortality occur due to untreated illness. Methods: We designed and clinically validated a multiplex real-time quantitative PCR assay for Anaplasma phagocytophilum and Ehrlichia chaffeensis using samples confirmed by multiple gold-standard methods. Results: Clinical sensitivity and specificity for A. phagocytophilum were 100% (39/39) and 100% (143/143), respectively, and for E. chaffeensis 95% (20/21) and 99% (159/161), respectively. Conclusions: These assays could support early diagnosis and treatment as well as the high-throughput testing required for large epidemiologic studies.
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Affiliation(s)
- Megan E Reller
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
- Duke Hubert-Yeargan Center for Global Health, Durham, NC 27708, USA.
- Duke Global Health Institute, Durham, NC 27710, USA.
| | - J Stephen Dumler
- Joint Departments of Pathology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Joint Pathology Center, Bethesda, MD 20814, USA.
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Schotthoefer AM, Schrodi SJ, Meece JK, Fritsche TR, Shukla SK. Pro-inflammatory immune responses are associated with clinical signs and symptoms of human anaplasmosis. PLoS One 2017. [PMID: 28628633 PMCID: PMC5476275 DOI: 10.1371/journal.pone.0179655] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Human anaplasmosis (HA) is an emerging tick-borne disease that may present as a mild flu-like illness or a life threatening, sepsis-like condition. Although disease severity is hypothesized to relate to immunopathology and immune dysfunction in humans, studies to directly measure immune responses in infected humans have been very limited. We quantified cytokines in 80 confirmed HA patients using a multiplex chemiluminescence immunoassay system and compared similarly measured responses in 1000 control subjects. Pro-inflammatory cytokines were significantly elevated in HA patients (all seven p<0.0001). Interferon gamma (IFN-γ) concentrations were particularly high, with average concentrations 7.8 times higher in the HA patients than the controls. A subset of cytokines consisting of IL-1β, IL-8, IL-6, TNF-α, and IL-10 was also coordinately high and significantly associated with severity of thrombocytopenia in HA patients. Patients with infections in the very acute stage (≤ 4 days ill) tended to have the highest IFN-γ, IL-12p70, and IL-2 levels. Higher concentrations of IL-13 and IL-5 were associated with diarrhea and vomiting. Our findings support a pathophysiological role for a pro-inflammatory response in HA, especially with regard to the modulation of hematopoiesis and subsequent hematopoietic complications.
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Affiliation(s)
- Anna M. Schotthoefer
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, Wisconsin, United States of America
- * E-mail:
| | - Steven J. Schrodi
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, Wisconsin, United States of America
| | - Jennifer K. Meece
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, Wisconsin, United States of America
| | - Thomas R. Fritsche
- Marshfield Labs, Marshfield Clinic, Marshfield, Wisconsin, United States of America
- Microbiology Department, University of Wisconsin-La Crosse, La Crosse, Wisconsin, United States of America
| | - Sanjay K. Shukla
- Marshfield Clinic Research Institute, Marshfield Clinic, Marshfield, Wisconsin, United States of America
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Direct detection of Anaplasma phagocytophilum by polymerase chain reaction followed by electrospray ionization mass spectrometry from human blood. Int J Infect Dis 2017; 60:61-63. [PMID: 28526564 DOI: 10.1016/j.ijid.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/05/2017] [Accepted: 05/10/2017] [Indexed: 12/21/2022] Open
Abstract
Bacterial pathogens not detectable via commercial blood culture assays represent an important challenge for infectious disease physicians, in particular if clinical symptoms of the illness are non-specific. In this report, Anaplasma phagocytophilum was detected directly in a peripheral blood sample from a febrile patient reporting a tick bite. This was done using a commercial system based on PCR followed by electrospray ionization mass spectrometry (ESI-MS). The diagnosis of a human granulocytic anaplasmosis infection was established using this diagnostic methodology for the first time. Human granulocytic anaplasmosis is a neglected zoonotic disease in Europe. Its seroprevalence is similar in North America and Europe, but in contrast to the USA, it is rarely diagnosed in the old world. PCR followed by ESI-MS is a novel, complex, but highly promising diagnostic methodology for the rapid assessment of rare or exotic pathogens, including intracellular bacteria.
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Christenson M, Lee X, Larson S, Johnson DH, Jensen J, Meller M, Paskewitz S. Occurrence of Amblyomma americanum (Acari: Ixodidae) and Human Infection With Ehrlichia chaffeensis in Wisconsin, 2008-2015. JOURNAL OF MEDICAL ENTOMOLOGY 2017; 54:752-756. [PMID: 28011735 DOI: 10.1093/jme/tjw218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 06/06/2023]
Abstract
Because of the increasing incidence of human ehrlichiosis in Wisconsin, we assessed reports of human infections by Ehrlichia chaffeensis and the distribution of its vector, the lone star tick (Amblyomma americanum (L.)). From 2008 through 2015, 158 probable and confirmed human cases of E. chaffeensis infections were reported to the Wisconsin Department of Health Services. Five cases without travel history outside of Wisconsin were confirmed as E. chaffeensis by polymerase chain reaction. Surveillance for the vector occurred from 2008 through 2015 and was based on active and passive methods, including examination of white-tailed deer, collections from live-trapped small mammals, submissions of ticks removed from wild and domestic animals through the Wisconsin Surveillance of Animals for Ticks (SWAT) program, digital or physical submissions by the public to the University of Wisconsin Insect Diagnostic or Medical Entomology laboratories, and active tick dragging. More than 50 lone star ticks (46 adults, 6 nymphs, and 1 larva) were identified. Lone star ticks were more commonly found in south central Wisconsin, particularly in Dane County, where discovery of more than one life stage in a single year indicates possible establishment.
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Affiliation(s)
- Megan Christenson
- Division of Public Health, Wisconsin Department of Health Services, 1 West Wilson St., Madison, WI 53703 (; ; ; )
| | - Xia Lee
- Department of Entomology, University of Wisconsin-Madison, 1630 Linden Dr., Madison, WI 53706 (; ; )
| | - Scott Larson
- Department of Entomology, University of Wisconsin-Madison, 1630 Linden Dr., Madison, WI 53706 (; ; )
| | - Diep Hoang Johnson
- Division of Public Health, Wisconsin Department of Health Services, 1 West Wilson St., Madison, WI 53703 (; ; ; )
| | - Julia Jensen
- Division of Public Health, Wisconsin Department of Health Services, 1 West Wilson St., Madison, WI 53703 (; ; ; )
| | - Megan Meller
- Division of Public Health, Wisconsin Department of Health Services, 1 West Wilson St., Madison, WI 53703 (; ; ; )
| | - Susan Paskewitz
- Department of Entomology, University of Wisconsin-Madison, 1630 Linden Dr., Madison, WI 53706 (; ; )
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22
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Regunath H, Rojas-Moreno C, Olano JP, Hammer RD, Salzer W. Early diagnosis of Ehrlichia ewingii infection in a lung transplant recipient by peripheral blood smear. Transpl Infect Dis 2017; 19. [PMID: 28036138 DOI: 10.1111/tid.12652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/11/2016] [Accepted: 09/18/2016] [Indexed: 12/17/2022]
Abstract
Ehrlichiosis in lung transplant (LT) recipients is associated with severe outcomes. Ehrlichia ewingii is a less frequent cause of symptomatic ehrlichiosis, characterized by cytoplasmic inclusions (morulae) within circulating neutrophils. We report a case of E. ewingii infection in an LT recipient diagnosed promptly by blood smear exam and confirmed with molecular studies.
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Affiliation(s)
- Hariharan Regunath
- Division of Pulmonary and Critical Care, Department of Medicine, University of Missouri, Columbia, MO, USA.,Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Christian Rojas-Moreno
- Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, MO, USA
| | - Juan P Olano
- Department of Pathology, Member, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA
| | - Richard D Hammer
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO, USA
| | - William Salzer
- Division of Infectious Diseases, Department of Medicine, University of Missouri, Columbia, MO, USA
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23
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Murphy DS, Lee X, Larson SR, Johnson DKH, Loo T, Paskewitz SM. Prevalence and Distribution of Human and Tick Infections with the Ehrlichia muris-Like Agent and Anaplasma phagocytophilum in Wisconsin, 2009-2015. Vector Borne Zoonotic Dis 2017; 17:229-236. [PMID: 28055326 DOI: 10.1089/vbz.2016.2055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ehrlichiosis and anaplasmosis are important emerging tickborne zoonoses that affect both humans and animals. Knowledge of the geographic distribution and prevalence of Ehrlichia spp. and Anaplasma phagocytophilum in Wisconsin is important information as a baseline for future comparisons. Reported human cases between 2009 and 2015 were identified using the Wisconsin Electronic Disease Surveillance System (WEDSS) and mapped by county of residence. Vector surveillance was established using ticks collected from animals by partners, including veterinary medical clinics, domestic animal shelters, and wildlife rehabilitation centers from 40 Wisconsin counties. A total of 1835 Ixodes scapularis tick specimens (larvae, nymphs, and adults) were collected from 18 different domestic and wildlife species from July 2011 to November 2015. An additional 1136 nymphs were collected by drag sampling at 23 locations in 19 counties in 2015. A real-time PCR assay that detects and distinguishes several Ehrlichia species, including a pathogenic Ehrlichia muris-like agent (EMLA), and A. phagocytophilum was performed on adult and nymphal ticks. A total of 757 I. scapularis ticks (predominately adults) were tested from animal collections, with 67 (8.9%) individuals positive for A. phagocytophilum and 22 (2.9%) positive for EMLA DNA. Of the 1150 questing nymphs, 62 (5.4%) were positive for A. phagocytophilum and 10 (0.9%) were positive for EMLA DNA. Specimens of I. scapularis that were positive for A. phagocytophilum were found in 27 of the 33 counties surveyed. Specimens that were positive for EMLA were less common and were found in nine counties. This study provides the first statewide survey of I. scapularis ticks for these pathogens and indicates that the risk of human exposure is widely distributed.
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Affiliation(s)
- Darby S Murphy
- 1 Department of Entomology, University of Wisconsin-Madison , Madison, Wisconsin
| | - Xia Lee
- 1 Department of Entomology, University of Wisconsin-Madison , Madison, Wisconsin
| | - Scott R Larson
- 1 Department of Entomology, University of Wisconsin-Madison , Madison, Wisconsin
| | - Diep K Hoang Johnson
- 2 Division of Public Health, Wisconsin Department of Health Services , Madison, Wisconsin
| | - Theoren Loo
- 2 Division of Public Health, Wisconsin Department of Health Services , Madison, Wisconsin
| | - Susan M Paskewitz
- 1 Department of Entomology, University of Wisconsin-Madison , Madison, Wisconsin
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24
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Johnson DKH, Schiffman EK, Davis JP, Neitzel DF, Sloan LM, Nicholson WL, Fritsche TR, Steward CR, Ray JA, Miller TK, Feist MA, Uphoff TS, Franson JJ, Livermore AL, Deedon AK, Theel ES, Pritt BS. Human Infection with Ehrlichia muris-like Pathogen, United States, 2007-2013(1). Emerg Infect Dis 2016; 21:1794-9. [PMID: 26402378 PMCID: PMC4593436 DOI: 10.3201/eid2110.150143] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This pathogen has been detected in patients from 5 states, all of whom reported likely tick exposure in Minnesota or Wisconsin. An Ehrlichia muris–like (EML) pathogen was detected among 4 patients in Minnesota and Wisconsin during 2009. We characterized additional cases clinically and epidemiologically. During 2004–2013, blood samples from 75,077 patients from all 50 United States were tested by PCR from the groEL gene for Ehrlichia spp. and Anaplasma phagocytophilum. During 2007–2013, samples from 69 (0.1%) patients were positive for the EML pathogen; patients were from 5 states: Indiana (1), Michigan (1), Minnesota (33), North Dakota (3), and Wisconsin (31). Most (64%) patients were male; median age was 63 (range 15–94) years; and all 69 patients reported likely tick exposure in Minnesota or Wisconsin. Fever, malaise, thrombocytopenia, and lymphopenia were the most common symptoms. Sixteen (23%) patients were hospitalized (median 4 days); all recovered, and 96% received doxycycline. Infection with the EML pathogen should be considered for persons reporting tick exposure in Minnesota or Wisconsin.
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25
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Allerdice MEJ, Pritt BS, Sloan LM, Paddock CD, Karpathy SE. A real-time PCR assay for detection of the Ehrlichia muris-like agent, a newly recognized pathogen of humans in the upper Midwestern United States. Ticks Tick Borne Dis 2015; 7:146-149. [PMID: 26507653 DOI: 10.1016/j.ttbdis.2015.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/07/2015] [Accepted: 10/10/2015] [Indexed: 11/24/2022]
Abstract
The Ehrlichia muris-like agent (EMLA) is an emerging, tick-transmitted human pathogen that occurs in the upper Midwestern United States. Here, we describe the development and validation of a p13-based quantitative real-time PCR TaqMan assay to detect EMLA in blood or tissues of ticks, humans, and rodents. The primer and probe specificities of the assay were ascertained using a large panel of various Ehrlichia species and other members of Rickettsiales. In addition to control DNA, both non-infected and EMLA-infected human blood, Mus musculus blood, and M. musculus tissue extracts were evaluated, as were non-infected and EMLA-infected Ixodes scapularis and uninfected Dermacentor variabilis DNA lysates. The specificity of the probe was determined via real-time PCR. An EMLA p13 control plasmid was constructed, and serial dilutions were used to determine the analytical sensitivity, which was found to be 1 copy per 4μl of template DNA. The sensitivity and specificity of this assay provides a powerful tool for ecological studies involving arthropod vectors and their mammalian hosts.
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Affiliation(s)
- Michelle E J Allerdice
- Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, United States.
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Lynne M Sloan
- Division of Clinical Microbiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, United States
| | - Sandor E Karpathy
- Rickettsial Zoonoses Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30329, United States
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26
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Guillemi EC, Tomassone L, Farber MD. Tick-borne Rickettsiales: Molecular tools for the study of an emergent group of pathogens. J Microbiol Methods 2015; 119:87-97. [PMID: 26471201 DOI: 10.1016/j.mimet.2015.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 10/09/2015] [Accepted: 10/09/2015] [Indexed: 12/16/2022]
Abstract
The use of molecular techniques in recent years has enhanced the sensitivity and specificity of the diagnosis of Rickettsiales, a bacterial order which includes significant emerging and re-emerging pathogens of humans and animals. Molecular detection enables the accurate identification at the species level, providing additional information on the epidemiology and course of the clinical cases. Moreover, PCR and enzyme restriction analysis of the vector blood meal can be employed to study the tick feeding source and possibly identify pathogen's reservoir. Here, we review the molecular tools available for the identification and characterization of tick-borne bacteria from the genera Rickettsia, Ehrlichia and Anaplasma and for the study of ticks feeding behavior. We summarize the significant criteria for taxonomic identification of Rickettsiales species and propose a procedure algorithm for the classification of bacterial isolates as members of this order.
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Affiliation(s)
- Eliana C Guillemi
- Inst. de Biotecnología, INTA Castelar. Los Reseros y N. Repetto, 1686 Hurlingham, Buenos Aires, Argentina.
| | - Laura Tomassone
- Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Largo Braccini 2, 10095 Grugliasco, Torino, Italy
| | - Marisa D Farber
- Inst. de Biotecnología, INTA Castelar. Los Reseros y N. Repetto, 1686 Hurlingham, Buenos Aires, Argentina
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27
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Stromdahl E, Hamer S, Jenkins S, Sloan L, Williamson P, Foster E, Nadolny R, Elkins C, Vince M, Pritt B. Comparison of phenology and pathogen prevalence, including infection with the Ehrlichia muris-like (EML) agent, of Ixodes scapularis removed from soldiers in the midwestern and the northeastern United States over a 15 year period (1997-2012). Parasit Vectors 2014; 7:553. [PMID: 25465046 PMCID: PMC4265324 DOI: 10.1186/s13071-014-0553-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 1997, human-biting ticks submitted to the Department of Defense Human Tick Test Kit Program (HTTKP) of the US Army Public Health Command have been tested for pathogens by PCR. We noted differences in the phenology and infection prevalence among Ixodes scapularis ticks submitted from military installations in different geographic regions. The aim of this study was to characterize these observed differences, comparing the phenology and pathogen infection rates of I. scapularis submitted from soldiers at two sites in the upper Midwest (Camp Ripley, MN, and Ft. McCoy, WI) and one site in the northeastern US (Ft. Indiantown Gap, PA). METHODS From 1997 through 2012, the HTTKP received 1,981 I. scapularis from the three installations and tested them for Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi and the Ehrlichia muris-like (EML) agent using PCR; pathogen presence was confirmed via sequencing or amplification of a second gene target. Pathogen and co-infection prevalence, tick engorgement status, and phenology were compared among installations. RESULTS Greater rates of A. phagocytophilum and Ba. microti infections were detected in ticks submitted from installations in Minnesota than in Wisconsin or Pennsylvania, and the EML agent was only detected in ticks from Minnesota and Wisconsin. Midwestern ticks were also more likely to be co-infected than those from Pennsylvania. Both adult and nymphal ticks showed evidence of feeding on people, although nymphs were more often submitted engorged. Adult I. scapularis were received more frequently in June from Minnesota than from either of the other sites. Minnesota adult and nymphal peaks overlapped in June, and submissions of adults exceeded nymphs in that month. CONCLUSIONS There were clear differences in I. scapularis phenology, pathogen prevalence and rates of co-infection among the three military installations. Seasonal and temperature differences between the three sites and length of time a population had been established in each region may contribute to the observed differences. The synchrony of adults and nymphs observed in the upper Midwest has implications for pathogen infection prevalence. The EML agent was only detected in Minnesota and Wisconsin, supporting the previous assertion that this pathogen is currently limited to the upper Midwest.
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Affiliation(s)
- Ellen Stromdahl
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, USA.
| | - Sarah Hamer
- Texas A&M University, College Station, TX, USA.
| | | | | | - Phillip Williamson
- University of North Texas Health Science Center, Ft. Worth, TX, USA. .,Creative Testing Solutions, Tempe, AZ, USA.
| | - Erik Foster
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, USA. .,Michigan Department of Community Health, Lansing, MI, USA.
| | - Robyn Nadolny
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, USA. .,Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA.
| | - Chad Elkins
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, USA.
| | - Mary Vince
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, USA.
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28
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Castillo CG, Eremeeva ME, Paskewitz SM, Sloan LM, Lee X, Irwin WE, Tonsberg S, Pritt BS. Detection of human pathogenic Ehrlichia muris-like agent in Peromyscus leucopus. Ticks Tick Borne Dis 2014; 6:155-7. [PMID: 25481346 DOI: 10.1016/j.ttbdis.2014.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/11/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
An Ehrlichia muris-like (EML) bacterium was recently detected in humans and Ixodes scapularis ticks in Minnesota and Wisconsin. The reservoir for this agent is unknown. To investigate the occurrence of the EML agent, groEL PCR testing and sequencing was performed on blood from small mammals and white-tailed deer that were collected in areas where human and tick infections were previously demonstrated. DNA of the EML agent was detected in two Peromyscus leucopus of 146 small mammals (1.4%); while 181 O. virginianus tested negative. This report provides the first evidence that DNA from the EML agent is found in P. leucopus, the same animal that is a reservoir for Anaplasma phagocytophilum in this region. The role of white-tailed deer remains inconclusive. Further sampling is warranted to understand the spatial and temporal distribution, transmission and maintenance of this pathogen.
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Affiliation(s)
| | | | | | | | - Xia Lee
- University of Wisconsin, Madison, WI, USA
| | - William E Irwin
- US Army Public Health Command Region-West, Joint Base Lewis-McChord, WA, USA
| | - Stefan Tonsberg
- US Army Public Health Command Region-West, Joint Base Lewis-McChord, WA, USA
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29
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Abstract
A 65-year-old female with a history of multiple tick bites presented with fever and pancytopenia. Intracytoplasmic rickettsial morulae were detected on peripheral smear and bone marrow biopsy specimens, and PCR amplified Ehrlichia ewingii DNA from both specimens. To our knowledge, this is the first report of E. ewingii infection of human bone marrow.
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30
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Han GS, Stromdahl EY, Wong D, Weltman AC. Exposure to Borrelia burgdorferi and other tick-borne pathogens in Gettysburg National Military Park, South-Central Pennsylvania, 2009. Vector Borne Zoonotic Dis 2014; 14:227-33. [PMID: 24689815 DOI: 10.1089/vbz.2013.1363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Since 1998, Lyme disease cases have increased in south-central Pennsylvania, which includes Gettysburg National Military Park (NMP). Limited information is available about tick populations or pathogens in this area, and no data regarding frequency of tick bites or prevention measures among Gettysburg NMP employees are available. To address these gaps, ticks were collected, classified, and replaced (to minimize disruptions to tick populations) at two sites within Gettysburg NMP during April-September, 2009, among eight nonremoval samplings. On two additional occasions during May and June, 2009, ticks were collected and removed from the two original sites plus 10 additional sites and tested for tick-borne pathogens by using PCR. A self-administered anonymous survey of Gettysburg NMP employees was conducted to determine knowledge, attitudes, and practices regarding tick-borne diseases. Peak Ixodes scapularis nymph populations were observed during May-July. Of 115 I. scapularis ticks tested, 21% were infected with Borrelia burgdorferi, including 18% of 74 nymphs and 27% of 41 adults; no other pathogen was identified. The entomologic risk index was calculated at 1.3 infected nymphs/hour. An adult and nymph Amblyomma americanum were also found, representing the first confirmed field collection of this tick in Pennsylvania, but no pathogens were detected. The survey revealed that most park employees believed Lyme disease was a problem at Gettysburg NMP and that they frequently found ticks on their skin and clothing. However, use of personal preventive measures was inconsistent, and 6% of respondents reported contracting Lyme disease while employed at Gettysburg NMP. These findings indicate a need to improve surveillance for tick bites among employees and enhance prevention programs for park staff and visitors.
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Affiliation(s)
- George S Han
- 1 Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, Georgia
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31
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Santos HA, Thomé SMG, Baldani CD, Silva CB, Peixoto MP, Pires MS, Vitari GLV, Costa RL, Santos TM, Angelo IC, Santos LA, Faccini JLH, Massard CL. Molecular epidemiology of the emerging zoonosis agent Anaplasma phagocytophilum (Foggie, 1949) in dogs and ixodid ticks in Brazil. Parasit Vectors 2013; 6:348. [PMID: 24330631 PMCID: PMC3874603 DOI: 10.1186/1756-3305-6-348] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 12/01/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Anaplasma phagocytophilum is an emerging pathogen of humans, dogs and other animals, and it is transmitted by ixodid ticks. The objective of the current study was a) detect A. phagocytophilum in dogs and ixodid ticks using real-time Polymerase Chain Reaction (qPCR); and b) Determine important variables associated to host, environment and potential tick vectors that are related to the presence of A. phagocytophilum in dogs domiciled in Rio de Janeiro, Brazil. METHODS We tested blood samples from 398 dogs and samples from 235 ticks, including 194 Rhipicephalus sanguineus sensu lato, 15 Amblyomma cajennense, 8 Amblyomma ovale and 18 pools of Amblyomma sp. nymphs. A semi-structured questionnaire was applied by interviewing each dog owner. Deoxyribonucleic acid obtained from ticks and dog buffy coat samples were amplified by qPCR (msp2 gene). The sequencing of 16S rRNA and groESL heat shock operon genes and a phylogenetic analysis was performed. The multiple logistic regression model was created as a function of testing positive dogs for A. phagocytophilum. RESULTS Among the 398 blood samples from dogs, 6.03% were positive for A. phagocytophilum. Anaplasma phagocytophilum was detected in one A. cajennense female tick and in five R. sanguineus sensu lato ticks (four males and one female). The partial sequences of the 16S rRNA, and groESL genes obtained were highly similar to strains of A. phagocytophilum isolated from wild birds from Brazil and human pathogenic strains. The tick species collected in positive dogs were R. sanguineus sensu lato and A. cajennense, with A.cajennense being predominant. Tick infestation history (OR = 2.86, CI = 1.98-14.87), dog size (OR = 2.41, IC: 1.51-12.67), the access to forest areas (OR = 3:51, CI: 1.52-16.32), hygiene conditions of the environment in which the dogs lived (OR = 4.35, CI: 1.86-18.63) and Amblyomma sp. infestation (OR = 6.12; CI: 2.11-28.15) were associated with A. phagocytophilum infection in dogs. CONCLUSIONS This is the first report of A. phagocytophilum in ixodid ticks from Brazil. The detection of A. phagocitophylum in A. cajennense, an aggressive feeder on a wide variety of hosts, including humans, is considered a public health concern.
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Affiliation(s)
- Huarrisson A Santos
- Epidemiology and Public Health Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Sandra MG Thomé
- Epidemiology and Public Health Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Cristiane D Baldani
- Medicine and Surgery Veterinary Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Claudia B Silva
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Maristela P Peixoto
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Marcus S Pires
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Gabriela LV Vitari
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Renata L Costa
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Tiago M Santos
- Zootechny Department, ITCA-UFMT, Mato Grosso, Rondonópolis, Brazil
| | - Isabele C Angelo
- Parasitology Department, ICB-UFMG, Minas Gerais, Belo Horizonte, Brazil
| | | | - João LH Faccini
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
| | - Carlos L Massard
- Animal Parasitology Department, IV-UFRRJ, Seropédica, Rio de Janeiro, Brazil
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Comparison of a real-time PCR method with serology and blood smear analysis for diagnosis of human anaplasmosis: importance of infection time course for optimal test utilization. J Clin Microbiol 2013; 51:2147-53. [PMID: 23637292 DOI: 10.1128/jcm.00347-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Anaplasmosis and ehrlichiosis are emerging tick-borne diseases with clinically similar presentations caused by closely related pathogens. Currently, laboratories rely predominantly on blood smear analysis (for the detection of intracellular morulae) and on serologic tests, both of which have recognized limitations, for diagnostic purposes. We compared the performance of a published real-time PCR assay that incorporates melt curve analysis to differentiate Anaplasma and Ehrlichia species with blood smear and serologic methods in an upper Midwest population. Overall, 38.5% of the specimens selected for evaluation had one or more tests that were positive for anaplasmosis. The PCR positivity for all specimens was maximal (21.2%; 29/137) during the early acute phase of illness (0 to 4 days since illness onset) and significantly less frequent (11.5%; 20/174) during later phases (>4 days since illness onset). All positive specimens were Anaplasma phagocytophilum; no Ehrlichia species were identified. The real-time PCR detected 100% of infections that were detected by blood smear analysis (14/14) and broadened the detection window from a maximum of 14 days for smear positivity to 30 days for PCR. Additional infections were detected by real-time PCR in 12.9% (11/85) of smear-negative patients. There was poor agreement between the real-time PCR assay and serologic test results: 19.8% (19/96) and 13.7% (29/212) of seropositive and -negative patients, respectively, were PCR positive. Seropositivity increased with increasing days of illness, demonstrating that serologic detection methods are best utilized during presumed convalescence. Our results indicate that the optimal performance and utilization of laboratory tests for the diagnosis of anaplasmosis require knowledge regarding time of symptom onset or days of illness.
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33
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Allison RW, Little SE. Diagnosis of rickettsial diseases in dogs and cats. Vet Clin Pathol 2013; 42:127-44. [DOI: 10.1111/vcp.12040] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Robin W. Allison
- Department of Veterinary Pathobiology; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater; OK; USA
| | - Susan E. Little
- Department of Veterinary Pathobiology; Center for Veterinary Health Sciences; Oklahoma State University; Stillwater; OK; USA
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34
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Regan J, Matthias J, Green-Murphy A, Stanek D, Bertholf M, Pritt BS, Sloan LM, Kelly AJ, Singleton J, McQuiston JH, Hocevar SN, Whittle JP. A Confirmed Ehrlichia ewingii Infection Likely Acquired Through Platelet Transfusion. Clin Infect Dis 2013; 56:e105-107. [DOI: 10.1093/cid/cit177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Weil AA, Baron EL, Brown CM, Drapkin MS. Clinical findings and diagnosis in human granulocytic anaplasmosis: a case series from Massachusetts. Mayo Clin Proc 2012; 87:233-9. [PMID: 22386178 PMCID: PMC3498394 DOI: 10.1016/j.mayocp.2011.09.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/03/2011] [Accepted: 09/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe clinical findings and the use of a tick-associated pathogen panel in a series of patients with human granulocytic anaplasmosis (HGA) at a suburban Boston hospital. PATIENTS AND METHODS Medical records were reviewed for inpatients and outpatients at Newton-Wellesley Hospital with a positive polymerase chain reaction (PCR) result for Anaplasma phagocytophilum during the study period March 1 through November 30, 2009. A PCR panel was used to test for tick-borne pathogens. Postal ZIP code data from the patients' areas of residence were used to estimate the area of disease transmission. RESULTS Thirty-three cases were confirmed during the 2009 transmission season, and 14 of these patients (42%) required hospitalization. Thrombocytopenia and/or leukopenia were observed at the time of presentation in 25 of 30 patients (86%) in whom both white blood cell and platelet counts were determined, and 28 of 33 patients (85%) reported fever. Rash occurred in only 2 of the 33 patients (6%), and 25 (76%) reported one or more respiratory or gastrointestinal symptom. Cases were geographically distributed diffusely throughout the hospital catchment area, with one possible focus of infection identified in Weston, MA. Due to a lack of clinical data reporting to the Massachusetts Department of Public Health, only 20 of 32 HGA cases (63%) fulfilled the case confirmation criteria. CONCLUSION Diagnosis of HGA requires a high suspicion for infection even in endemic areas. Use of a tick-associated pathogen panel that includes PCR assays for several organisms could improve detection of underrecognized tick-borne diseases in endemic areas. Lack of epidemiological follow-up to confirm corroborating clinical findings prevents accurate case reporting and assessment of the true HGA burden.
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Affiliation(s)
- Ana A Weil
- Department of Medicine, Massachusetts General Hospital, 15 Parkman St., Boston, MA 02114, USA.
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Pritt BS, Sloan LM, Johnson DKH, Munderloh UG, Paskewitz SM, McElroy KM, McFadden JD, Binnicker MJ, Neitzel DF, Liu G, Nicholson WL, Nelson CM, Franson JJ, Martin SA, Cunningham SA, Steward CR, Bogumill K, Bjorgaard ME, Davis JP, McQuiston JH, Warshauer DM, Wilhelm MP, Patel R, Trivedi VA, Eremeeva ME. Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009. N Engl J Med 2011; 365:422-9. [PMID: 21812671 PMCID: PMC3319926 DOI: 10.1056/nejmoa1010493] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia chaffeensis and E. ewingii have been thought to cause ehrlichiosis in humans in the United States. Patients with suspected ehrlichiosis routinely undergo testing to ensure proper diagnosis and to ascertain the cause. METHODS We used molecular methods, culturing, and serologic testing to diagnose and ascertain the cause of cases of ehrlichiosis. RESULTS On testing, four cases of ehrlichiosis in Minnesota or Wisconsin were found not to be from E. chaffeensis or E. ewingii and instead to be caused by a newly discovered ehrlichia species. All patients had fever, malaise, headache, and lymphopenia; three had thrombocytopenia; and two had elevated liver-enzyme levels. All recovered after receiving doxycycline treatment. At least 17 of 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerase-chain-reaction testing. Genetic analyses revealed that this new ehrlichia species is closely related to E. muris. CONCLUSIONS We report a new ehrlichia species in Minnesota and Wisconsin and provide supportive clinical, epidemiologic, culture, DNA-sequence, and vector data. Physicians need to be aware of this newly discovered close relative of E. muris to ensure appropriate testing, treatment, and regional surveillance. (Funded by the National Institutes of Health and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Bobbi S Pritt
- Mayo Clinic, Division of Clinical Microbiology, Hilton 470-B, 200 1st St. SW, Rochester, MN 55905, USA.
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Santos HA, Pires MS, Vilela JAR, Santos TM, Faccini JLH, Baldani CD, Thomé SMG, Sanavria A, Massard CL. Detection of Anaplasma phagocytophilum in Brazilian dogs by real-time polymerase chain reaction. J Vet Diagn Invest 2011; 23:770-4. [PMID: 21908321 DOI: 10.1177/1040638711406974] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Anaplasma phagocytophilum was detected in dogs from Brazil in the municipalities of Seropédica and Itaguaí, Rio de Janeiro state, by real-time polymerase chain reaction (PCR) using SYBR Green to detect the amplification. Of 253 samples, 18 (7.11%) were positive, with a threshold cycle (Ct) ranging from 31 to 35 cycles. The PCR product from a positive sample was cloned and sequenced. The sequence obtained demonstrated 100% identity with other A. phagocytophilum sequences published in the GenBank database. The analytical sensitivity of RT-PCR using SYBR Green system was able to detect 3 plasmid copies when defined numbers of plasmid copies containing 122 base pairs from the msp2 gene were used. The assay was considered specific when DNA from bacteria (Anaplasma platys, Anaplasma marginale, Ehrlichia canis, Neorickettsia risticii, Rickettsia rickettsii) closely related to A. phagocytophilum was placed in the reaction. These results demonstrate that the canine granulocytic anaplasmosis agent is present in regions in which dogs could be a source of infection for tick vectors. The current study reports the detection of A. phagocytophilum, a zoonotic agent responsible for Human granulocytic anaplasmosis, in Brazilian dogs.
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Affiliation(s)
- Huarrisson A Santos
- Department of Animal Parasitology, Federal Rural University of Rio de Janeiro, Rio de Janeiro, Seropédica 23890-000, Brazil
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Experimental infection and co-infection of dogs with Anaplasma platys and Ehrlichia canis: hematologic, serologic and molecular findings. Parasit Vectors 2010; 3:33. [PMID: 20377870 PMCID: PMC2859368 DOI: 10.1186/1756-3305-3-33] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rhipicephalus sanguineus is a ubiquitous tick responsible for transmitting Ehrlichia canis and most likely Anaplasma platys to dogs, as either single or co-infections. The objective of this study was to assess the effects of either simultaneous or sequential experimental infections with E. canis and A. platys on hematological and serological parameters, duration of infection, and efficacy of doxycycline therapy in dogs infected with one or both organisms. Six dogs per group were either uninfected, A. platys infected, E. canis infected, A. platys and E. canis co-infected, A. platys infected and E. canis challenged or E. canis infected and A. platys challenged at day 112 post-infection (PI). Doxycycline treatment was initiated at 211 days PI, followed by dexamethasone immunosuppression beginning 410 days PI. RESULTS Initially, transient decreases in hematocrit occurred in all groups infected with E. canis, but the mean hematocrit was significantly lower in the A. platys and E. canis co-infected group. All dogs except the controls developed marked thrombocytopenia after initial infection followed by gradually increased platelet counts by 112 days PI in groups with the single infections, while platelet counts remained significantly lower in the A. platys and E. canis co-infected group. Both sequential and simultaneous infections of A. platys and E. canis produced an enhanced humoral immune response to A. platys when compared to infection with A. platys alone. Likewise, co-infection with E. canis and A. platys resulted in a more persistent A. platys infection compared to dogs infected with A. platys only, but nearly all A. platys infected dogs became A. platys PCR negative prior to doxycycline treatment. E. canis infected dogs, whether single or co-infected, remained thrombocytopenic and E. canis PCR positive in blood for 420 days. When treated with doxycycline, all E. canis infected dogs became E. canis PCR negative and the thrombocytopenia resolved. Despite immunosuppression, neither A. platys nor E. canis DNA was PCR amplified from doxycycline-treated dogs. CONCLUSIONS The results of this study demonstrate that simultaneous or sequential infection with A. platys and E. canis can alter various pathophysiological parameters in experimentally infected dogs, and because natural exposure to multiple tick-borne pathogens occurs frequently in dogs, awareness of co-infection is important in clinical practice.
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Oh D, Lee MJ, Park J, Kang SH. Microchip electrophoretic separation for the fast diagnosis of Anaplasma phagocytophilum
infection in cattle. J Sep Sci 2010; 33:1109-14. [DOI: 10.1002/jssc.200900766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Detection and identification of Ehrlichia species in blood by use of PCR and electrospray ionization mass spectrometry. J Clin Microbiol 2009; 48:472-8. [PMID: 19955274 DOI: 10.1128/jcm.01669-09] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid detection and identification of Ehrlichia species improves clinical outcome for patients suspected of ehrlichiosis. We describe an assay that employs multilocus PCR and electrospray ionization mass spectrometry (PCR/ESI-MS) to detect and identify Ehrlichia species directly from blood specimens. The results were compared to those of a colorimetric microtiter PCR enzyme immunoassay (PCR-EIA) used as a diagnostic assay. Among 213 whole-blood samples collected from patients who were clinically suspected of ehrlichiosis from 1 May to 1 August 2008 at Vanderbilt University Hospital, 40 were positive for an Ehrlichia species by PCR/ESI-MS, giving a positive rate of 18.8%. In comparison to the PCR-EIA, PCR/ESI-MS possessed a sensitivity, a specificity, and positive and negative predictive values of 95.0%, 98.8%, 95.0%, and 98.8%, respectively. The 38 specimens that were positive for Ehrlichia by both PCR/ESI-MS and the PCR-EIA were further characterized to the species level, with 100% agreement between the two assays. In addition, Rickettsia rickettsii was detected by PCR/ESI-MS from four specimens that were confirmed retrospectively by serology and PCR-EIA. In three specimens, the PCR/ESI-MS assay identified Pseudomonas aeruginosa, Neisseria meningitidis, and Staphylococcus aureus; these were confirmed by culture and/or clinical diagnosis as being clinically relevant. From specimen processing to result reporting, the PCR/ESI-MS assay can be completed within 6 h, providing another laboratory tool for the diagnosis of ehrlichiosis. Moreover, this system may provide rapid detection and identification of additional pathogens directly from blood specimens.
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Thomas RJ, Stephen Dumler J, Carlyon JA. Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Rev Anti Infect Ther 2009; 7:709-22. [PMID: 19681699 PMCID: PMC2739015 DOI: 10.1586/eri.09.44] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anaplasma phagocytophilum, Ehrlichia chaffeensis and Ehrlichia ewingii are emerging tick-borne pathogens and are the causative agents of human granulocytic anaplasmosis, human monocytic ehrlichiosis and E. ewingii ehrlichiosis, respectively. Collectively, these are referred to as human ehrlichioses. These obligate intracellular bacterial pathogens of the family Anaplasmataceae are transmitted by Ixodes spp. or Amblyomma americanum ticks and infect peripherally circulating leukocytes to cause infections that range in clinical spectra from asymptomatic seroconversion to mild, severe or, in rare instances, fatal disease. This review describes: the ecology of each pathogen; the epidemiology, clinical signs and symptoms of the human diseases that each causes; the choice methods for diagnosing and treating human ehrlichioses; recommendations for patient management; and is concluded with suggestions for potential future research.
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Affiliation(s)
- Rachael J Thomas
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - J Stephen Dumler
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Jason A Carlyon
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Molecular Medicine Research Building, 1220 East Broad Street, Room 4052, PO Box 980678, Richmond, VA 23298-0678, USA Tel.: +1 804 628 3382 Fax: +1 804 828 9946
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Cardozo GP, Oliveira LP, Mansur MAB, Santos EV, Roberto PG, Marins M. Molecular characterisation of two strains of Anaplasma platys in Brazil. Vet Rec 2009; 164:338-40. [PMID: 19287032 DOI: 10.1136/vr.164.11.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G P Cardozo
- Unidade de Biotecnologia, Universidade de Ribeirão Preto, Av. Costabile Romano, 2201, Ribeirão Preto, SP 14091-900, Brazil
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Baneth G, Harrus S, Ohnona FS, Schlesinger Y. Longitudinal quantification of Ehrlichia canis in experimental infection with comparison to natural infection. Vet Microbiol 2009; 136:321-5. [DOI: 10.1016/j.vetmic.2008.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/25/2008] [Accepted: 11/28/2008] [Indexed: 11/25/2022]
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Assi MA, Yao JDC, Walker RC. Lyme disease followed by human granulocytic anaplasmosis in a kidney transplant recipient. Transpl Infect Dis 2007; 9:66-72. [PMID: 17313478 DOI: 10.1111/j.1399-3062.2006.00177.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report the case of a kidney transplant recipient who developed Lyme disease, followed by human granulocytic anaplasmosis (HGA) 3 years later. A review of all previously published cases of Lyme disease (3 cases), HGA (5 cases), and human monocytic ehrlichiosis (HME) (5 cases) in transplant recipients is presented. Manifestations of the cases reviewed were similar to those of non-transplant patients. There appeared to be no obvious correlation between immunosuppression and the occurrence of the illness in the transplant recipients. Serologic testing failed to make a diagnosis in 1 patient with HME in the literature and in our patient with HGA, but molecular tests established the diagnosis in both cases. Tandem infection was observed in 1 patient with two episodes of HME 2 years apart. A high index of suspicion for tick-borne illnesses and appropriate prevention measures are needed for transplant patients with epidemiologic risk factors.
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Affiliation(s)
- M A Assi
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905-0002, USA
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