Human disease in Europe caused by a granulocytic Ehrlichia species

Petrovec, Miroslav; Furlan, Stanka Lotrič; Avšič-Županc, Tatjana; Strle, Franc; Brouqui, Philippe; Roux, V; Dumler, J. Stephen

doi:10.1128/jcm.35.6.1556-1559.1997

Cited by 264 publications

(102 citation statements)

References 20 publications

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“…Serologic evidence of human infection was first reported from Switzerland and the UK in 1995 20,45 and this was soon followed by similar reports from other parts of Europe. [46][47][48][49] Over the last few years several cases of HGA (previously known as human granulocytic ehrlichiosis [HGE]) have been described in different parts of Europe, 19,[50][51][52][53][54][55][56][57][58] but it remains to be established whether or not TBF variants may be responsible for some or all of these European cases of HGA.…”

Section: Host Range and Reservoirs Of Infectionmentioning

confidence: 99%

Anaplasma phagocytophilum in Ruminants in Europe

Woldehiwet

2006

Annals of the New York Academy of Sciences

112

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The agent that causes tick-borne fever (TBF) in sheep was first described in 1940, 8 years after the disease was first recognized in Scotland. The same agent was soon shown to cause TBF in sheep and pasture fever in cattle in other parts of the UK, Scandinavia, and other parts of Europe. After the initial use of the name Rickettsia phagocytophila, the organism was given the name Cytoecetes phagocytophila to reflect its association with granulocytes and its morphological similarity with Cytoecetes microti. This name continued to be used by workers in the UK until the recent reclassification of the granulocytic ehrlichiae affecting ruminants, horses, and humans as variants of the same species, Anaplasma phagocytophilum. TBF and pasture fever are characterized by high fever, recurrent bacteremia, neutropenia, lymphocytopenia, thrombocytopenia, and general immunosuppression, resulting in more severe secondary infections such as tick pyemia, pneumonic pasteurellosis, listeriosis, and enterotoxemia. During the peak period of bacteremia as many as 90% of granulocytes may be infected. The agent is transmitted transtadially by the hard tick Ixodes ricinus, and possibly other ticks. After patent bacteremia, sheep, goats, and cattle become persistently infected "carriers," perhaps playing an important role in the maintenance of infection, in the flock/herd. Little is known about how efficiently ticks acquire and maintain infection in ruminant populations or whether "carrier" domestic ruminants play an important role as reservoirs of infection, but deer, other free-living ruminants, and wild rodents are also potential sources of infection. During the late 1990s serological evidence of infection of humans was demonstrated in several European countries, creating a renewed interest and increased awareness of the zoonotic potential of TBF variants. More recently, a few cases of human granulocytic anaplasmosis (HGA) have been reported in some European countries, but it remains to be established whether the variants causing HGA in Europe are genetically and biologically different from those causing TBF in ruminants. TBF is readily diagnosed by demonstrating intracytoplasmic inclusions in peripheral blood granulocytes or monocytes of febrile animals or by detecting specific DNA by polymerase chain reaction (PCR), and TBF variants of A. phagocytophilum can be cultivated in tick cell lines, but the differentiation of TBF variants from HGA variants awaits further investigations.

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Section: Host Range and Reservoirs Of Infectionmentioning

confidence: 99%

Anaplasma phagocytophilum in Ruminants in Europe

Woldehiwet

2006

Annals of the New York Academy of Sciences

112

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“…1 The first case of human disease caused by a granulocytropic ehrlichia species was described in the 1994 in the United States and later in Europe (Slovenia). 2,3 Two cases of HGE were confirmed in the Friuli Venezia Giulia, an Italian region close to Slovenia. 4 In Sardinia, no human confirmed case of HGE has been reported, except the four cases of clinical and serological diagnosis of Ehrlichia chaffensis (E. chaffensis) infection; the patients were U.S. citizens temporarily living on the U.S. Navy base of La Maddalena.…”

Section: Introductionmentioning

confidence: 98%

Two Cases of Human Granulocytic Ehrlichiosis in Sardinia, Italy Confirmed by PCR

Mastrandrea¹,

Mura²,

Tola³

et al. 2006

Annals of the New York Academy of Sciences

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In this work we report the first two cases of human granulocytic ehrlichiosis (HGE) in Sardinia. In early September 2004, a 69-year-old woman (patient 1) was admitted to the Infectious Diseases Institute of Sassari for rickettsiosis like-syndrome: high fever (39.5-40 degrees C), dyspnea, reduced consciousness, vomiting, and cutaneous rash. In late September 2004, a 30-year-old man (patient 2) with high fever was admitted for an evident palmar and oral erythema, edema of the labium, very intense arthralgia, myalgia, and dyspnea. In these two hospitalized patients, the diagnosis was made through indirect IgM and IgG immunofluorescent technique and confirmed by the presence of the specific DNA in the leukocytes. The two patients were A. phagocytophilum-PCR positive.

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“…Granulocytic Ehrlichiae (Rickettsiaceae) are established as tickborne, veterinary pathogens (Woldehiwet & Scott, 1993), but it has recently been recognized that granulocytic Ehrlichiae also cause disease in humans (Human Granulocytic Ehrlichiosis, HGE). HGE, a potentially fatal disease, was first recognized in the U.S.A. (Chen et al, 1994), but also occurs in mainland Europe (Petrovec et al, 1997) and serological evidence indicates that human infections also occur in the U.K.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, there is evidence that rodent reservoirs in the U.S.A. carried infection for at least 12 years before the first clinical case of HGE was reported there (Bunnel et al, 1998). High seroprevalence, combined with clinical evidence, suggests that most HGE infections in mainland Europe are probably either asymptomatic or mild, influenza-like and self-limiting Fingerle et al, 1997;Petrovec et al, 1997). Fatalities due to HGE have been reported in the U.S.A. but these have mostly occurred as a consequence of increased susceptibility to secondary infections (Bakken et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

GranulocyticEhrlichiainfection in Ixodid ticks and mammals in woodlands and uplands of the U.K.

Ogden

Bown

Horrocks

et al. 1998

Medical Vet Entomology

128

100

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The prevalence of infection with Ehrlichiae of the Ehrlichia phagocytophila genogroup (the granulocytic Ehrlichiae), in questing Ixodes ricinus ticks of U.K. upland and woodland habitats, was investigated by PCR. The prevalence of infection in the three feeding stages of I. ricinus indicated that granulocytic Ehrlichiae are transmitted transstadially with no, or inefficient, transovarial transmission. The presence of infected ticks in both habitats indicates that endemic cycles of granulocytic Ehrlichia (GE) infection are maintained by both domesticated sheep and by wild reservoirs, and coexist with endemic cycles of Borrelia burgdorferi infection. Moreover, demonstration, for the first time, of GE infection in engorged Ixodes trianguliceps ticks and blood collected from wild rodents, suggests that European wild rodents are competent reservoirs. GE infection prevalence in nymphal and adult I. ricinus was significantly greater in uplands than woodlands, which is consistent with ticks of all three feeding stages feeding on reservoir-competent sheep in uplands. In one woodland studied, pheasants are important hosts for nymphal I. ricinus but are incompetent or inefficient reservoirs, so reducing GE infection prevalence in I. ricinus ticks in this habitat. 16S rRNA sequences of GE from ticks of these U.K. habitats, showed a high degree of homology with those of granulocytic Ehrlichiae isolated from humans, but also showed some evidence of genetic diversity of granulocytic ehrlichiae in the U.K. The implications of these findings, for the taxonomy of granulocytic ehrlichiae and the potential for human infections to occur in the U.K., is discussed.

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Human disease in Europe caused by a granulocytic Ehrlichia species

Cited by 264 publications

References 20 publications

Anaplasma phagocytophilum in Ruminants in Europe

Anaplasma phagocytophilum in Ruminants in Europe

Two Cases of Human Granulocytic Ehrlichiosis in Sardinia, Italy Confirmed by PCR

GranulocyticEhrlichiainfection in Ixodid ticks and mammals in woodlands and uplands of the U.K.

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