title: Neoehrlichiosis: an emerging tick-borne zoonosis caused by Candidatus Neoehrlichia mikurensis.
abstract: Candidatus Neoehrlichia mikurensis is an emerging tick-borne pathogen causing a systemic inflammatory syndrome mostly in persons with underlying hematologic or autoimmune diseases. As it is neither well-known nor well-recognized, it might be misdiagnosed as recurrence of the underlying disease or as an unrelated arteriosclerotic vascular event. The pathogen is transmitted by hard ticks of the genus Ixodes and is closely associated with rodents in which transplacental transmission occurs. Transovarial transmission in ticks has not yet been shown. Infection rates vary greatly in ticks and rodents, but the causes for its spatiotemporal variations are largely unknown. This review summarizes the current state of knowledge on the geographical distribution and clinical importance of Ca. N. mikurensis. By elucidating the life history traits of this pathogen and determining more accurately its incidence in the human population, a better assessment of its public health relevance can be made. Most urgent research needs are the in vitro-cultivation of the pathogen, the development of specific serological tests, the determination of the full genomic sequence, the routine implementation of molecular diagnosis in diseased patients with a particular panel of underlying diseases, and promoting the knowledge about neoehrlichiosis among general practitioners, hospital physicians and the risk groups such as forest workers or immune-compromised people to raise awareness about this disease that can easily be treated when correctly diagnosed.
authors.affiliation: National Center for Vector Entomology, Institute of Parasitology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 266a, 8057, Zurich, Switzerland. cornelia.silaghi@uzh.ch.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Silaghi
authors.affiliation: Department for Bacteriology and Parasitology, Croatian Veterinary Institute, Zagreb, Croatia.
authors.forename: Relja
authors.initials: R
authors.lastname: Beck
authors.affiliation: Center of Rickettsiosis and Arthropod-borne Diseases, Hospital San Pedro-Center of Biomedical Research of La Rioja, Logroño, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Oteo
authors.affiliation: Institute for Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Pfeffer
authors.affiliation: Laboratory for Zoonoses and Environmental Microbiology, National Institute of Public Health and Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Sprong
mesh_terms: D000710:Anaplasmataceae; D000711:Anaplasmataceae Infections / Q000382:microbiology*; D000818:Animals; D021821:Communicable Diseases, Emerging / Q000382:microbiology*; D006801:Humans; D018884:Ixodes; D017282:Tick-Borne Diseases / Q000382:microbiology*; D015047:Zoonoses / Q000382:microbiology*
keywords: Anaplasmataceae; Apodemus spp.; Candidatus Neoehrlichia mikurenis; Diagnostics; Haematological disorders; Immunodeficiency; Ixodes persulcatus; Ixodes ricinus; Myodes spp.; Rodents; Thrombosis; Treatment