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