Canine Granulocytic Ehrlichiosis Research Articles

Isolation and Short-Term Persistence of Ehrlichia ewingii in Cell Culture.

Ehrlichia ewingii is the causative agent of human and canine granulocytic ehrlichiosis. Since its discovery in 1970, little work has been done to characterize the pathogen or study the transmission dynamics due to the inability to grow the agent in vitro. The aim of this study was to assess the suitability of multiple cell lines and media formulations for propagation of E. ewingii in cell culture. In this study, we present an overview of attempts to isolate E. ewingii from the buffy coat of goats naturally infected by Amblyomma americanum ticks, as well as a methodology for maintaining the pathogen for up to 16 weeks in culture. The most promising results were seen with HL-60 cells differentiated by the addition of 1.5% DMSO to the media and supplemented with 8 mM l-glutamine. Cultures were passaged multiple times, and fluorescence and morulae were observed by indirect fluorescent antibody test and Diff-Quik staining. It is our hope that this information will provide a foundation for future attempts to propagate and maintain E. ewingii in cell culture.

Detection of Vector-Borne Agents in Lone Star Ticks, <I>Amblyomma americanum</I> (Acari: Ixodidae), From Mississippi

In this study, we evaluated Amblyomma americanum (lone star tick) in Mississippi for the presence of Ehrlichia chaffeensis, causative agent of human monocytic ehrlichiosis; Ehrlichia ewingii, causative agent of human and canine granulocytic ehrlichiosis; Borrelia lonestari, putative agent of southern tick-associated rash illness; Francisella tularensis, the agent of tularemia; and Rickettsia spp., particularly R. amblyommii, a suspected pathogen. We collected adult A. americanum from four regions of Mississippi: Northeast, Northwest, Southeast, and East. Of the ticks collected, 192 were dissected and DNA was extracted for nested polymerase chain reaction (PCR) assays to detect the above bacteria. In all, 3% of tick extracts had evidence of Borrelia sp., 4% for E. chaffeensis, 6% for E. ewingii, and 44% for a Rickettsia species. As determined by sequencing, most Rickettsia spp. were R. amblyommii. In addition, extracts from 42 pools (total of 950) of larval A. americanum collected in Southwest Mississippi were tested for the presence of E. chaffeensis and Rickettsia species. Of these extracts from pools, nine of 37 (24%) were PCR positive for a Rickettsia sp., most often, R. amblyommii; none had evidence of E. chaffeensis, supporting the ability of lone star ticks to transovarially transmit R. amblyommii, but not E. chaffeensis. This study demonstrates E. chaffeensis, E. ewingii, "B. lonestari", and R. amblyommii in A. americanum by PCR for the first time in Mississippi. Understanding the prevalence and epidemiology of these agents in Mississippi should increase awareness of tick-borne disease in the medical community.

Clinical, serological, and molecular evidence of ehrlichiosis and anaplasmosis in dogs in Tunisia

A seroepidemiological survey was conducted in five bioclimatic areas of Tunisia to determine the prevalence of antibodies to Ehrlichia canis and Anaplasma phagocytophilum antigens, surrogate markers of the agents of canine monocytic ehrlichiosis (CME) and canine granulocytic ehrlichiosis, respectively. Among 286 collected sera, 54.2% and 25.2% were seropositive for E. canis and A. phagocytophilum, respectively, by the indirect immunofluorescence antibody (IFA) test. Clinical and hematological tests were done only for 58 sick dogs from Tunis area. A reverse line blot (RLB) hybridization was then used to identify isolated Ehrlichia and Anaplasma species infecting dogs (n = 228). Among them, only two dogs were infected by A. phagocytophilum; ten sample dogs were demonstrated infected by E. canis and ten infected by Ehrlichia sp., from which one dog showed a mixed infection with A. phagocytophilum and E. canis and one with A. phagocytophilum and Ehrlichia sp. RLB findings were confirmed by sequencing; BLAST search against GenBank revealed high similarity of the sequence of Ehrlichia sp. PCR/RLB amplicons with Anaplasma platys 16S rRNA partial sequence.

Molecular Diagnosis of Granulocytic Anaplasmosis and Infectious Cyclic Thrombocytopenia by PCR‐RFLP

Anaplasma phagocytophilum (A. phagocytophilum, formerly Ehrlichia phagocytophila) is a tick-borne pathogen responsible for tick-borne fever in ruminants, equine granulocytic ehrlichiosis (EGE) in horses, canine granulocytic ehrlichiosis (CGE) in dogs, and for human granulocytic ehrlichiosis (HGE). Human cases have been registered in many countries with a broad range of symptoms and pathogenicity. This article focused on Sardinia as the prevalence in humans was almost seven times higher than in the rest of Italy. To evaluate the risk, blood samples were collected from dogs and horses on the island. Genomic DNA was extracted from the buffy coat and amplified by heminested polymerase chain reaction (PCR) using the groEL gene primers. The first PCR reaction amplified a 624-bp fragment for both A. phagocytophilum and A. platys while the second PCR reaction amplified 573-bp and 515-bp fragments for the above two pathogens, respectively. Six A. phagocytophilum samples were PCR positive (3 dogs and 3 horses) while another dog was A. platys PCR positive. A phylogenetic analysis was conducted with A. phagocytophilum sequences in GenBank from the United States, Slovenia, Switzerland, Germany, UK, Austria, and Czech Republic. Surprisingly, the related phylogenetic tree showed that the Sardinian isolates were closer to the American isolates, which were showing highest mortality rates than from the other two European lineages.

Immune‐mediated haemolytic anaemia and thrombocytopenia associated with Anaplasma phagocytophilum in a dog

A 10-year-old, crossbreed dog was presented with a history of severe lethargy, pyrexia and inappetence of several days' duration. Clinical examination revealed pallor of the mucous membranes, petechiae, generalised lymphadenopathy and effusions in multiple joints. Laboratory evaluation showed severe anaemia and thrombocytopenia, with positive in-saline agglutination and the presence of antiplatelet antibodies. The DNA of Anaplasma phagocytophilum, an endemic granulocytic rickettsial parasite, was detected by PCR. A poor response to doxycycline and immunosuppressive therapy with corticosteroids was seen. Euthanasia was performed after the development of disseminated intravascular coagulation. Postmortem examination demonstrated changes consistent with the development of disseminated intravascular coagulation and infection with granulocytic ehrlichiosis. This case documents the presence of canine granulocytic ehrlichiosis caused by A phagocytophilum in the U.K., and highlights the range of clinical signs and clinicopathological abnormalities that may be observed in infected dogs.

Canine granulocytic ehrlichiosis (CGE) in Italy.

Medical records of thirty-five consecutive cases of canine granulocytic ehrlichiosis (CGE) diagnosed cytologically in Central Italy in 1995-2000 were analysed retrospectively. Tick exposure was reported in 16 dogs (45.7%) and concurrent babesiosis in 19 dogs (54.3%). Ehrlichia-like inclusion bodies were found in neutrophils in a percentage varying from 0.5% to 11%. Frequently recorded clinical signs included anorexia (71.4%), lethargy (45.7%), conjunctivitis (31.4%), fever (25.7%), lameness (20%) and ataxia (20%). Among the 16 representative dogs in which protein, electrophoresis was performed, 10 (62.5%) showed high globulin levels and 6 (37.5%) had concurrent high total protein levels. During treatment with doxycycline, all associated symptoms, including those unusually described, such as pyoderma intertrigo, erythema, apparent blindness and oral papillomatosis, progressively disappeared in 31 (89%) out of 35 dogs. The efficacy of treatment was marked in dogs simultaneously treated twice with imidocarb dipropionate: among the 14 dogs in which a fast recovery was noted, 11 (80%) were concurrently affected by babesiosis and consequently treated with the specific medicament leading to excellent outcomes. The main conclusion is that CGE is present among dogs from Central Italy and should be included in the differential diagnosis of possible zoonotic agents affecting the canine population.

Cutaneous lesions in dogs with Dirofilaria (Nochtiella) repens infestation and concurrent tick-borne transmitted diseases.

A pruritic dermatitis characterized by the presence of erythema, papules, focal or multifocal alopecia, crusting and nodules was seen in 28 dogs with Dirofilaria repens microfilariae infestation in an endemic area in north-west Italy. Previous unsuccessful nonspecific antipruritic treatments, flea control and restricted diet were recorded in 53.6% of the patients. Both the Knott and the antigen tests were negative for Dirofilaria immitis and Acanthocheilonema reconditum. Concurrent babesiosis and/or canine granulocytic ehrlichiosis was also diagnosed in many affected dogs. Preliminary treatment of the concurrent diseases was followed by specific filaricide treatment. The cutaneous lesions, although slightly improved with the initial treatment, resolved completely with macro- and microfilaricide treatment. Although D. repens may be an opportunistic pathogen, this parasite should not be considered as harmless as previously thought and its potential pathogenic role in causing cutaneous lesions in dogs should be considered. Furthermore, it has a zoonotic importance as human cases have been reported worldwide.

Dermatitis associated with Dirofilaria (Nochtiella) repens microfilariae in dogs from Central Italy

Pruritic dermatitis associated with Dirofilaria (Nochtiella) repens microfilariae in the blood was diagnosed in 22 dogs from Fermo (Central Italy). According to the history, previous unsuccessful treatments with corticosteroids, antibiotics, restricted diet, flea control, levamisole and ivermectin were recorded in 17 dogs (77.3%). The combined filtration tests and antigen tests, performed during the study, were negative for Dirofilaria immitis and Acanthocheilonema reconditum in each case. Dermatological lesions included erythema, papules, single or multifocal alopecia, eczema, lichenification, crusting and nodules. All dogs had pruritus. Concurrent babesiosis was diagnosed in the blood smears of each case (100%), and 60% of the dogs were found to be carriers of canine granulocytic ehrlichiosis (CGE). Three dogs (13.6%) were positive for leishmaniosis. Eradication of the concurrent infections followed by specific macro- and microfilaricide treatment led to complete recovery from the dermatological syndrome. The main conclusion of the study is that D. repens infection can be more pathogenic than is currently considered, and it is apparently an opportunistic disease with serious dermatological consequences.

Seroprevalence of Ehrlichia canis and of canine granulocytic Ehrlichia infection in dogs in Switzerland.

Serum samples from 996 dogs in Switzerland were examined for antibodies to Ehrlichia canis and to the agent causing canine granulocytic ehrlichiosis (CGE). Ehrlichiosis, borreliosis, and systemic illness not associated with ticks were suspected in 75, 122, and 157 of these dogs, respectively. The remainder of the serum samples were obtained from clinically healthy dogs which resided north (n = 235) or south (n = 407) of the Alps. The serum samples were tested by an indirect immunofluorescence technique for antibodies to the two agents incriminated, E. canis and Ehrlichia phagocytophila, a surrogate marker of the agent of CGE. Twenty-two of 996 (2.2%) serum samples had antibodies to E. canis and were distributed as follows: 20 of 75 (26.7%) samples from dogs suspected of having ehrlichiosis, 1 of 122 (0.8%) from dogs suspected of having borreliosis, and 1 of 407 (0.2%) from healthy dogs which resided south of the Alps. Of the 75 (7.5%) serum samples that had antibodies to E. phagocytophila, significantly more samples were from ill dogs than from healthy dogs. Among the sera from healthy dogs, antibodies to E. phagocytophila were significantly more prevalent in the north. Because seropositive dogs had a history of travel outside Switzerland and because Rhipicephalus sanguineus is found exclusively south of the Alps, it was presumed that, in contrast to the agent of CGE, E. canis is not indigenous to Switzerland.

Hematopathology in dogs experimentally infected with a Swedish granulocytic Ehrlichia species.

Seven, adult, female beagles were inoculated with a Swedish granulocytic Ehrlichia organism closely related to Ehrlichia equi and E. phagocytophila. Blood and bone marrow changes were evaluated throughout the acute phase of infection. All dogs developed moderate to severe thrombocytopenia during the parasitemic period. The mean platelet volume and platelet distribution width increased, and large platelets were seen on blood smears when platelet numbers were low. In bone marrow, absolute numbers of megakaryocytes and immature megakaryocytes were increased. These results suggested the thrombocytopenia was caused by increased platelet destruction. The dogs also developed mild, normocytic, normochromic anemia, with simultaneous decreases in serum iron concentration and total iron-binding capacity that resembled the anemia of inflammation. In bone marrow, there was a slight increase in immature erythroid cells and no erythroid hypoplasia; iron stores were normal to increased. Myeloid hyperplasia was seen in all infected dogs, despite neutropenia in peripheral blood. Lymphopenia occurred early in the parasitemic period, but lymphocytes responded strongly and numbers increased above baseline levels by the end of parasitemia. Blast-transformed lymphocytes (5% to 20%) were seen in peripheral blood for a few days. Experimentally-induced canine granulocytic ehrlichiosis caused cytopenias of short duration, coincident with the appearance of ehrlichial inclusions in neutrophils.

Granulocytic ehrlichiosis in dogs from North Carolina and Virginia.

Medical records of 3 dogs from North Carolina and 3 dogs from Virginia with ehrlichial morulae in circulating neutrophils were studied retrospectively. Two clinically distinct disease syndromes, including chronic, moderate to severe anemia (n = 3) and polyarthritis (n = 2) were associated with canine granulocytic ehrlichiosis (CGE) in these dogs. One dog was clinically healthy, and abnormalities were not detected during physical examination. Clinical signs were nonspecific and included fever, lethargy, anorexia, vomiting, and diarrhea. The most frequent laboratory abnormalities were normocytic normochromic nonregenerative anemia, moderate thrombocytopenia with large platelets, lymphopenia, and eosinopenia. Considerable variability was found in the serologic responses to Ehrlichia equi, Ehrlichia canis, and Ehrlichia chaffeensis antigens among the 5 dogs for which stored sera were available for indirect fluorescent antibody testing. Polymerase chain reaction amplification and sequencing of portions of the 16S rRNA gene from blood (collected in ethylenediaminetetraacetic acid) of 1 severely anemic dog (dog 3) and 1 polyarthritic dog (dog 4) resulted in DNA sequences nearly identical to the GenBank accessions for Ehrlichia ewingii. The DNA sequence from a 3rd dog (dog 5) was most similar to that of E. canis. Serologic or molecular results support the possibility of E. ewingii, E. equi, and E. canis coinfection or serologic cross-reactivity among canine granulocytic and monocytic Ehrlichia species in dogs from North Carolina and Virginia. Variability in response to tetracycline or doxycycline treatment was noted in these dogs, with more rapid resolution of signs in dogs with polyarthritis. We report the 1st cases of CGE in dogs from North Carolina and Virginia, including recognition of CGE in a healthy dog.

Ehrlichia ewingii sp. nov., the etiologic agent of canine granulocytic ehrlichiosis.

The 16S rRNA gene was amplified, cloned, and sequenced from the blood of two dogs that were experimentally infected with the etiologic agent of canine granulocytic ehrlichiosis. The 16S rRNA sequence was found to be unique when it was compared with the sequences of other members of the genus Ehrlichia. The most closely related species were Ehrlichia canis (98.0% related) and the human ehrlichiosis agent (Ehrlichia chaffeensis) (98.1% related); all other species in the genus were found to be phylogenetically much more distant. Our results, coupled with previous serologic data, provide conclusive evidence that the canine granulocytic ehrlichiosis agent is a new species of the genus Ehrlichia that is related to, but is distinct from, E. canis and all other members of the genus. We propose the name Ehrlichia ewingii sp. nov.; the Stillwater strain is the type strain.