Tissue diagnosis of Ehrlichia chaffeensis in patients with fatal ehrlichiosis by use of immunohistochemistry, in situ hybridization, and polymerase chain reaction.

Dawson, Jacqueline E.; Paddock, Christopher D.; Warner, Cynthia K.; Greer, Patricia W.; Bartlett, Jeanine; Ewing, S. A.; Munderloh, Ulrike G.; Zaki, Sherif R.

doi:10.4269/ajtmh.2001.65.603

Cited by 41 publications

(36 citation statements)

References 27 publications

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“…The greatest distribution of bacteria occurs in tissues containing abundant mononuclear phagocytic cells, including splenic cords and periarteriolar sheaths, lymph nodes, and bone marrow (23,79,180,208). Morulae are less frequently observed in macrophages in the pulmonary microvasculature and in the liver within Kupffer cells (79,89,208) (Fig.…”

Section: Pathologymentioning

confidence: 99%

“…Pathologic findings in other tissues have been described most frequently in patients with fatal disease (79,89,91,180,208,209). Because persons who die of HME often represent specialized patient cohorts (e.g., immunocompromised patients), quantitative and qualitative features of the histopathologic findings in these patients may not be directly comparable to features of disease in the general patient population.…”

Section: Pathologymentioning

confidence: 99%

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Ehrlichia chaffeensis: a Prototypical Emerging Pathogen

2003

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Ehrlichia chaffeensis is an obligately intracellular, tick-transmitted bacterium that is maintained in nature in a cycle involving at least one and perhaps several vertebrate reservoir hosts. The moderate to severe disease caused by E. chaffeensis in humans, first identified in 1986 and reported for more than 1,000 patients through 2000, represents a prototypical “emerging infection.” Knowledge of the biology and natural history of E. chaffeensis, and of the epidemiology, clinical features, and laboratory diagnosis of the zoonotic disease it causes (commonly referred to as human monocytic ehrlichiosis [HME]) has expanded considerably in the period since its discovery. In this review, we summarize briefly the current understanding of the microbiology, pathogenesis, and clinical manifestations associated with this pathogen but focus primarily on discussing various ecological factors responsible for the recent recognition of this important and potentially life-threatening tick-borne disease. Perhaps the most pivotal element in the emergence of HME has been the staggering increases in white-tailed deer populations in the eastern United States during the 20th century. This animal serves as a keystone host for all life stages of the principal tick vector (Amblyomma americanum) and is perhaps the most important vertebrate reservoir host for E. chaffeensis. The contributions of other components, including expansion of susceptible human populations, growth and broadening geographical distributions of other potential reservoir species and A. americanum, and improvements in confirmatory diagnostic methods, are also explored

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Section: Pathologymentioning

confidence: 99%

Section: Pathologymentioning

confidence: 99%

Ehrlichia chaffeensis: a Prototypical Emerging Pathogen

2003

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“…chaffeensis invasion of myeloid cells in human bone marrow and other organs has been previously described (3,4,15), and A. phagocytophilum in association with bone marrow infection has also been previously described (16). Prior to this case report, E. ewingii infection of human marrow cells had yet to be documented.…”

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confidence: 94%

First Reported Case of Ehrlichia ewingii Involving Human Bone Marrow

et al. 2014

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A 65-year-old female with a history of multiple tick bites presented with fever and pancytopenia. Intracytoplasmic rickettsial morulae were detected on peripheral smear and bone marrow biopsy specimens, and PCR amplified Ehrlichia ewingii DNA from both specimens. To our knowledge, this is the first report of E. ewingii infection of human bone marrow. CASE REPORTA 65-year-old female from rural north-central Arkansas presented in July to an emergency department with weakness and fatigue. She had a 5-day history of subjective fever, productive cough, generalized myalgia, and progressive fatigue. She denied nausea, diarrhea, bleeding, and rash but stated that she had had a urinary tract infection (UTI) 1 month prior that had been treated with sulfamethoxazole-trimethoprim without resolution. She reported multiple recent tick bites while working in her yard and was in close contact with several pet dogs.Past medical history was significant for type 2 diabetes mellitus, hypertension, hypothyroidism, and laryngeal squamous carcinoma that had been in remission since treatment with chemotherapy and radiation 2 years prior to presentation. The physical examination was significant for fever of 101.3°F and bilateral upper extremity petechiae and bruising.Initial laboratory studies revealed a white blood count (WBC) of 2,000/l (reference range, 3,000 to 12,000/l), a hemoglobin level of 8.9 g/dl (reference range, 11.5 to 16 g/dl), and a platelet count of 32,000/l (reference range, 150,000 to 500,000/l). Each of these values had been within normal limits during an evaluation for her UTI that had been performed 3 weeks earlier. The total bilirubin level was 1.3 mg/dl (reference range, 0.2 to 1.2 mg/dl), and the lactate dehydrogenase level was 314 IU/liter (reference range, 100 to 248 IU/liter). Iron studies showed a decreased total iron binding capacity of 234 g/dl (reference range, 250 to 425 g/dl) and an increased peripheral blood ferritin level of 732 g/dl (reference range, 11 to 306 g/dl) with normal iron and folate levels. The antinuclear antibody (ANA) titer was increased at 1:160. Random-inpatient blood glucose levels ranged from 102 to 111 mg/dl, and her diabetes was adequately controlled with metformin and glipizide by her treatment as an outpatient. HIV serology results were negative.The patient was admitted to the hospital and was started on vancomycin and cefepime because of fever and neutropenia and was started on doxycycline to address the potential for tick-borne illness. Since recurrent malignancy, myelodysplastic syndrome following chemotherapy, and other marrow processes were in the differential diagnosis for her pancytopenia, peripheral smear and bone marrow aspirate and core biopsy procedures were performed. Review of the peripheral blood smear revealed leukopenia with neutrophilic bands containing intracytoplasmic morulae (Fig. 1), pancytopenia with leftshifted granulopoiesis, reactive lymphocytes, a relative monocytosis, thrombocytopenia, and mild erythrocyte anisopoikilocytosis. The marrow aspirate showed...

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“…In cases of ehrlichiosis or anaplasmosis in which bone marrow biopsies are performed as part of the investigation of cytopenias, immunostaining of bone marrow biopsy specimens can reveal the diagnosis (156,160). Immunostaining can be particularly useful for diagnosing fatal tickborne rickettsial diseases in tissue specimens from patients who had not developed diagnostic levels of antibodies before death (16,141,293,300). Immunostaining methods are most likely to reveal organisms in patients before or within the first 48 hours after initiating appropriate antibacterial therapy.…”

Section: Immunostaining Of Biopsy or Autopsy Tissuementioning

confidence: 99%