title: Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis.
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.
authors.affiliation: Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. rjthomas@vcu.edu
authors.forename: Rachael J
authors.initials: RJ
authors.lastname: Thomas
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Dumler
authors.forename: Jason A
authors.initials: JA
authors.lastname: Carlyon
mesh_terms: D041081:Anaplasma phagocytophilum / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001096:Arachnid Vectors / Q000382:microbiology; D004318:Doxycycline / Q000627:therapeutic use; D004536:Ehrlichia / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D018469:Ehrlichia chaffeensis / Q000254:growth & development / Q000302:isolation & purification / Q000472:pathogenicity; D016873:Ehrlichiosis / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D026863:Ixodidae / Q000382:microbiology; D009000:Monocytes / Q000382:microbiology; D009504:Neutrophils / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
references.citation: Ann N Y Acad Sci. 2003 Jun;990:80-9
references.pmid: 12860604
references.citation: J Clin Microbiol. 1999 May;37(5):1332-4
references.pmid: 10203481
references.citation: J Clin Microbiol. 1999 Sep;37(9):2968-73
references.pmid: 10449483
references.citation: Vet Rec. 1950 Aug 12;62(32):465-70
references.pmid: 15431506
references.citation: Eur J Clin Microbiol Infect Dis. 2001 Mar;20(3):196-8
references.pmid: 11347671
references.citation: N Engl J Med. 1998 Dec 24;339(26):1941-2; author reply 1942-3
references.pmid: 9874610
references.citation: N Engl J Med. 1996 Jan 25;334(4):209-15
references.pmid: 8531996
references.citation: Appl Environ Microbiol. 2008 Dec;74(23):7118-25
references.pmid: 18820068
references.citation: Clin Microbiol Infect. 2002 Dec;8(12):763-72
references.pmid: 12519349
references.citation: Infect Dis Clin North Am. 2008 Sep;22(3):433-48, viii
references.pmid: 18755383
references.citation: J Clin Microbiol. 1997 Jun;35(6):1465-8
references.pmid: 9163463
references.citation: N Engl J Med. 1999 Apr 15;340(15):1214-6
references.pmid: 10206853
references.citation: Am J Trop Med Hyg. 1999 Jan;60(1):58-61
references.pmid: 9988323
references.citation: Lakartidningen. 1999 Sep 29;96(39):4200-4
references.pmid: 10544585
references.citation: Clin Infect Dis. 1998 Dec;27(6):1491-6
references.pmid: 9868666
references.citation: Appl Environ Microbiol. 2006 Feb;72(2):1102-9
references.pmid: 16461655
references.citation: Pediatrics. 1971 Mar;47(3):567-70
references.pmid: 4993997
references.citation: Adv Med Sci. 2006;51:283-6
references.pmid: 17357327
references.citation: Clin Infect Dis. 2000 Aug;31(2):554-60
references.pmid: 10987720
references.citation: Clin Microbiol Rev. 2003 Jan;16(1):37-64
references.pmid: 12525424
references.citation: Med Vet Entomol. 2005 Mar;19(1):101-6
references.pmid: 15752184
references.citation: J Clin Microbiol. 1995 Oct;33(10):2710-4
references.pmid: 8567911
references.citation: Vector Borne Zoonotic Dis. 2006 Winter;6(4):404-10
references.pmid: 17187576
references.citation: Pediatr Infect Dis J. 1998 May;17(5):429-31
references.pmid: 9613662
references.citation: Scand J Infect Dis. 2001;33(1):73-4
references.pmid: 11234985
references.citation: J Clin Microbiol. 1998 Apr;36(4):1090-5
references.pmid: 9542943
references.citation: Ann N Y Acad Sci. 2003 Jun;990:75-9
references.pmid: 12860603
references.citation: Ann Agric Environ Med. 2007;14(2):281-5
references.pmid: 18247465
references.citation: Vet Parasitol. 1998 Aug 14;78(3):203-13
references.pmid: 9760062
references.citation: Exp Appl Acarol. 1989 May;6(4):343-52
references.pmid: 2743839
references.citation: Antimicrob Agents Chemother. 2003 Jan;47(1):413-5
references.pmid: 12499227
references.citation: Clin Infect Dis. 2002 Jan 1;34(1):22-7
references.pmid: 11731941
references.citation: J Med Entomol. 2004 Nov;41(6):1064-7
references.pmid: 15605645
references.citation: JAMA. 2008 Nov 19;300(19):2308-9
references.pmid: 19017920
references.citation: Int J Syst Bacteriol. 1992 Apr;42(2):299-302
references.pmid: 1581189
references.citation: J Infect Dis. 1989 Nov;160(5):803-9
references.pmid: 2809255
references.citation: N Engl J Med. 1987 Oct 1;317(14):899-900
references.pmid: 3627212
references.citation: Ann N Y Acad Sci. 2006 Oct;1078:110-7
references.pmid: 17114689
references.citation: Acta Med Croatica. 2006 Dec;60(5):411-9
references.pmid: 17217096
references.citation: J Med Entomol. 1998 Mar;35(2):180-3
references.pmid: 9538582
references.citation: Ann N Y Acad Sci. 2006 Oct;1078:316-9
references.pmid: 17114729
references.citation: Ann N Y Acad Sci. 2005 Dec;1063:333-6
references.pmid: 16481536
references.citation: Antimicrob Agents Chemother. 1997 Jan;41(1):76-9
references.pmid: 8980758
references.citation: Emerg Infect Dis. 2002 Jul;8(7):668-71
references.pmid: 12095432
references.citation: J Clin Microbiol. 1997 Dec;35(12):3365-6
references.pmid: 9399564
references.citation: Clin Infect Dis. 2006 Nov 1;43(9):1089-134
references.pmid: 17029130
references.citation: J Infect Dis. 1990 Jul;162(1):91-5
references.pmid: 2192013
references.citation: J Clin Microbiol. 1999 Jan;37(1):209-10
references.pmid: 9854093
references.citation: J Clin Microbiol. 1991 Dec;29(12):2838-42
references.pmid: 1757557
references.citation: N Engl J Med. 1998 Aug 6;339(6):375-8
references.pmid: 9691104
references.citation: Proc Natl Acad Sci U S A. 1996 Jun 11;93(12):6209-14
references.pmid: 8650245
references.citation: N Engl J Med. 1987 Apr 2;316(14):853-6
references.pmid: 3029590
references.citation: Int J Syst Evol Microbiol. 2001 Nov;51(Pt 6):2145-2165
references.pmid: 11760958
references.citation: J Parasitol. 2003 Feb;89(1):194-6
references.pmid: 12659331
references.citation: J Clin Microbiol. 1994 Sep;32(9):2107-12
references.pmid: 7814533
references.citation: J Clin Microbiol. 2002 Aug;40(8):3082-5
references.pmid: 12149387
references.citation: Vet Res. 2005 May-Jun;36(3):469-92
references.pmid: 15845235
references.citation: Eur J Clin Microbiol Infect Dis. 2008 Jun;27(6):473-5
references.pmid: 18293019
references.citation: Emerg Infect Dis. 2005 Mar;11(3):485-8
references.pmid: 15757574
references.citation: J Clin Microbiol. 1999 Jul;37(7):2215-22
references.pmid: 10364588
references.citation: J Med Entomol. 2001 Jul;38(4):471-4
references.pmid: 11476325
references.citation: N Engl J Med. 1995 Aug 17;333(7):420-5
references.pmid: 7616991
references.citation: Am J Trop Med Hyg. 2009 Feb;80(2):242-4
references.pmid: 19190221
references.citation: Lancet. 1995 Sep 16;346(8977):782-3
references.pmid: 7658904
references.citation: Vector Borne Zoonotic Dis. 2002 Fall;2(3):125-36
references.pmid: 12737542
references.citation: Curr Protoc Microbiol. 2005 Jul;Chapter 3:Unit 3A.2
references.pmid: 18770564
references.citation: Am J Vet Res. 1990 Jun;51(6):929-31
references.pmid: 2368951
references.citation: JAMA. 1996 Jan 17;275(3):199-205
references.pmid: 8604172
references.citation: Vector Borne Zoonotic Dis. 2009 Dec;9(6):573-7
references.pmid: 19327022
references.citation: Annu Rev Entomol. 2008;53:323-43
references.pmid: 17877457
references.citation: Clin Infect Dis. 1998 Jul;27(1):213-5
references.pmid: 9675481
references.citation: J Clin Microbiol. 2000 Mar;38(3):1002-7
references.pmid: 10698987
references.citation: Vector Borne Zoonotic Dis. 2006 Spring;6(1):24-31
references.pmid: 16584324
references.citation: J Clin Microbiol. 1997 Jun;35(6):1556-9
references.pmid: 9163481
references.citation: Clin Infect Dis. 2001 Nov 1;33(9):1586-94
references.pmid: 11568857
references.citation: J Med Entomol. 2008 Jul;45(4):763-9
references.pmid: 18714881
references.citation: Eur J Clin Microbiol Infect Dis. 2006 Nov;25(11):737-9
references.pmid: 17033789
references.citation: Vector Borne Zoonotic Dis. 2009 Oct;9(5):565-8
references.pmid: 18973438
references.citation: Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51
references.pmid: 17582569
references.citation: Ann Trop Med Parasitol. 2004 Jun;98(4):401-5
references.pmid: 15228721
references.citation: J Clin Microbiol. 1999 Nov;37(11):3448-51
references.pmid: 10523532
references.citation: Vector Borne Zoonotic Dis. 2009 Feb;9(1):33-40
references.pmid: 18781886
references.citation: J Clin Microbiol. 1996 Sep;34(9):2133-9
references.pmid: 8862572
references.citation: Vector Borne Zoonotic Dis. 2009 Feb;9(1):93-102
references.pmid: 18789001
references.citation: Med Microbiol Immunol. 1999 Dec;188(3):145-9
references.pmid: 10776845
references.citation: J Pathol Bacteriol. 1951 Jan;63(1):1-15
references.pmid: 14832686
references.citation: Ann N Y Acad Sci. 2003 Jun;990:103-6
references.pmid: 12860608
references.citation: MMWR Morb Mortal Wkly Rep. 2008 Oct 24;57(42):1145-8
references.pmid: 18946461
references.citation: Pediatrics. 2003 Sep;112(3 Pt 1):e252-3
references.pmid: 12949322
references.citation: Emerg Infect Dis. 2004 Sep;10(9):1643-8
references.pmid: 15498168
references.citation: J Med Entomol. 2003 Nov;40(6):1000-4
references.pmid: 14765684
references.citation: Clin Microbiol Infect. 2004 Dec;10(12):1108-32
references.pmid: 15606643
references.citation: APMIS. 2007 Mar;115(3):225-30
references.pmid: 17367468
references.citation: Vector Borne Zoonotic Dis. 2008 Spring;8(1):49-55
references.pmid: 18047398
references.citation: Diagn Microbiol Infect Dis. 2005 Dec;53(4):301-6
references.pmid: 16263231
references.citation: J Infect Dis. 2000 Apr;181(4):1388-93
references.pmid: 10751139
references.citation: Emerg Infect Dis. 2000 Jul-Aug;6(4):430-2
references.pmid: 10905986
references.citation: Ann N Y Acad Sci. 2006 Oct;1078:236-47
references.pmid: 17114714
references.citation: J Infect Dis. 1995 May;171(5):1266-73
references.pmid: 7751702
references.citation: J Wildl Dis. 2007 Oct;43(4):684-9
references.pmid: 17984264
references.citation: J Vet Med Sci. 2009 Jan;71(1):101-3
references.pmid: 19194084
references.citation: JAMA. 2008 Nov 19;300(19):2263-70
references.pmid: 19017912
references.citation: J Clin Microbiol. 1994 Mar;32(3):589-95
references.pmid: 8195363
references.citation: J Clin Microbiol. 2000 Nov;38(11):4208-10
references.pmid: 11060091
references.citation: Lancet. 1962 Apr 21;1(7234):827-9
references.pmid: 14004715
references.citation: Clin Infect Dis. 2002 Nov 1;35(9):e99-102
references.pmid: 12384854
references.citation: Vector Borne Zoonotic Dis. 2006 Winter;6(4):388-94
references.pmid: 17187574
references.citation: Ann N Y Acad Sci. 2008 Dec;1149:94-7
references.pmid: 19120182
references.citation: Vet Parasitol. 2006 Jun 30;139(1-3):262-6
references.pmid: 16621285
references.citation: Epidemiol Infect. 2001 Oct;127(2):353-8
references.pmid: 11693514
references.citation: Antimicrob Agents Chemother. 1992 Dec;36(12):2799-803
references.pmid: 1482148
references.citation: Ann N Y Acad Sci. 2006 Oct;1078:309-11
references.pmid: 17114727
references.citation: J Am Vet Med Assoc. 1969 Jul 15;155(2):462-9
references.pmid: 5819585
references.citation: J Infect Dis. 1995 Oct;172(4):1007-12
references.pmid: 7561173
references.citation: MMWR Recomm Rep. 2006 Mar 31;55(RR-4):1-27
references.pmid: 16572105
references.citation: Am J Trop Med Hyg. 1992 Feb;46(2):161-4
references.pmid: 1539750
references.citation: J Med Entomol. 1979 Mar 23;15(3):218-34
references.pmid: 439119
references.citation: Vet Rec. 1986 Nov 22;119(21):531-2
references.pmid: 3811160
references.citation: Curr Top Microbiol Immunol. 2007;315:289-324
references.pmid: 17848069
references.citation: Science. 1982 Jun 18;216(4552):1317-9
references.pmid: 7043737
references.citation: Am J Trop Med Hyg. 2005 Aug;73(2):400-9
references.pmid: 16103612
references.citation: N Engl J Med. 1999 Jul 15;341(3):148-55
references.pmid: 10403852
references.citation: Ann Intern Med. 1994 May 1;120(9):736-43
references.pmid: 8147546
references.citation: J Clin Microbiol. 2000 Jul;38(7):2795
references.pmid: 10979750
references.citation: Emerg Infect Dis. 2005 Dec;11(12):1828-34
references.pmid: 16485466
references.citation: J Mol Diagn. 2005 Oct;7(4):504-10
references.pmid: 16237220
references.citation: Emerg Infect Dis. 2003 Dec;9(12):1579-86
references.pmid: 14720399
references.citation: JAMA. 1994 Jul 20;272(3):212-8
references.pmid: 8022040
references.citation: J Infect Dis. 2000 Mar;181(3):1082-8
references.pmid: 10720534