Serologic evidence of human monocytic and granulocytic ehrlichiosis in Israel.

Avi Keysary,Amir Jacob,Jacqueline E Dawson,Trevor Waner,Israel Potasman,Lili Amram,Zev Sthoeger,Gershon Keren,Carmella Strenger

doi:10.3201/eid0506.990605

Abstract

We conducted a retrospective serosurvey of 1,000 persons in Israel who had fever of undetermined cause to look for Ehrlichia chaffeensis antibodies. Four of five cases with antibodies reactive to E. chaffeensis were diagnosed in the summer, when ticks are more active. All patients had influenzalike symptoms with high fever. None of the cases was fatal. Three serum samples were also seroreactive for antibodies to E. canis, and one was also reactive to the human granulocytic ehrlichiosis (HGE) agent. The titer to the HGE agent in this patient was higher than the serum titer to E. chaffeensis, and the Western blot analysis also indicated that the HGE agent was the primary cause of infection. We present the first serologic evidence that the agents of human monocytic ehrlichiosis (HME) and HGE are present in Israel. Therefore, human ehrlichiosis should be included in the differential diagnoses for persons in Israel who have been exposed to ticks and have influenzalike symptoms.

Highlights

Human ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE), two emerging infectious diseases transmitted by ticks, are caused by Ehrlichia chaffeensis and the HGE agent of the E. phagocytophila genogroup, respectively
We describe the first serologic survey in Israel for HME and HGE, which documents the detection of antibodies reactive with HME and HGE agents
Laboratory found that one patient (#3) had an antibody titer of 1:2,048 to HGE. This sample was confirmed positive for HGE by Western blot

Summary

Introduction

Human ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE), two emerging infectious diseases transmitted by ticks, are caused by Ehrlichia chaffeensis and the HGE agent of the E. phagocytophila genogroup, respectively. In the United States, HME and HGE were first described in 1987 and 1994, respectively [1]. The first cases of HME and HGE were reported in Europe in 1991 and 1995, respectively [2,3]. In South America, a case of E. canis infection was reported in Venezuela [5]. One clinical case of HME has been reported in Mali, Africa [6]. A serosurvey for HME of 756 patients from eight African countries suggested that the disease is rare in Africa [7]. We describe the first serologic survey in Israel for HME and HGE, which documents the detection of antibodies reactive with HME and HGE agents

Methods

Results

Conclusion