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Chapter 13 : Human Granulocytic Anaplasmosis (Ehrlichiosis)

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Abstract:

Human granulocytic anaplasmosis (HGA) is a recently recognized acute febrile illness caused by . Like Lyme disease, its causative agent is transmitted by ixodid ticks, and small mammals likely serve as reservoir hosts. The pathogen is noteworthy in its preferential targeting and intracellular infection of neutrophils. Its range is still being defined, but it has been documented in geographic areas in North America and Europe similar to those of Lyme disease, and coinfections with can occur. The illness is characterized by high fever, myalgias, arthralgias, and headache, often with accompanying thrombocytopenia and leukopenia. Intracellular colonies of bacteria (morulae) may be seen in peripheral blood neutrophils but are often absent early in the course of infection. If the disease is suspected and appropriate therapy (usually doxycycline) is promptly initiated, the outcome is excellent. However, delayed diagnosis and treatment may result in organ failure and even death. This chapter describes the etiologic agent, biology, life cycle, transmission, and zoonotic hosts of . It also presents epidemiology, clinical manifestations, laboratory and pathologic findings, differential diagnosis, diagnostic testing, treatment, and prevention of infection.

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13

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Figure 1

Life cycle of in infected human (HL60) cells. (A) Binding to the cell surface; (B) internalization; (C) replication within the endosome with failure of fusion with lysosomal granules; (D) cell filled with multiple infected endosomes, near lysis ( ).

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
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Image of Figure 2
Figure 2

Distribution of cases of HGA reported to the CDC in 2001 ( ).

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
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Image of Figure 3
Figure 3

PCR amplification of 16S rRNA sequence from the blood of the first patients from whom the organism was isolated ( ). The pretreatment detection of pathogen DNA is seen, as well as the reduction in signal soon after treatment. WB, sample of whole blood; HL60, same sample(s) following cultivation in HL60 cells. The 16S amplicon was a positive control standard with the described numbers of DNA copies used in the PCR. Tick cell line IDE infected with an equine isolate (likely conspecific with ) is another positive control. The assay is sensitive to ~10 organisms or fewer. (Reprinted with permission from the .)

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
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Tables

Generic image for table
Table 1

History, signs, and symptoms of HGA infection

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
Generic image for table
Table 2

Reported complications of HGA

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
Generic image for table
Table 3

Laboratory findings in HGA

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
Generic image for table
Table 4

Currently available HGA-specific diagnostic laboratory tests

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13
Generic image for table
Table 5

Treatment of infection

Citation: Goodman J. 2005. Human Granulocytic Anaplasmosis (Ehrlichiosis), p 218-238. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch13

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