Chapter 62 : , and Related Intracellular Bacteria

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Members of the genus and are now recognized to be important human pathogens. They are obligate intracellular bacteria currently placed in the phylum (), order , and family . , within the genus , now includes , , and the human granulocytic ehrlichiosis (HGE) agent. and spp. are gram-negative obligate intracellular bacteria that reside and propagate within membrane-lined vacuoles found in the cytoplasm of bone marrow-derived cells, such as granulocytes, monocytes, erythrocytes, and platelets. The causative agent of human monocytic ehrlichiosis (HME) is , a monocytotropic ehrlichia that was first identified as a human pathogen in a patient with a severe febrile illness after tick bites in 1986. The culture conditions for and species are still being optimized. The most widely used method is polymerase chain reaction (PCR) amplification of DNA from in clinical samples using the HE1/HE3 primer set. In a prospective study, the overall sensitivity and specificity of PCR were 56% and 100%, respectively, using the 16S rRNA subunit, nadA, and 120-kDa protein genes. In this study several samples had high titers of antiehrlichial antibodies by immunofluorescence assay (IFA), suggesting that the pathogen may have already been cleared. Routine antimicrobial susceptibility testing of or species isolates is unnecessary. The typical morphology of an or spp. morula is observed, an assessment as to the hematopoietic lineage and the percentage of cells that contain morulae should be made and reported.

Citation: Reller M, Dumler J. 2011. , and Related Intracellular Bacteria , p 1013-1026. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch62

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Real-Time Reverse Transcriptase PCR Assay
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Image of FIGURE 1

Neighbor-joining phylogenetic tree inferred from 16S rRNA gene sequences of selected , Neoehrlichia,” , , and spp. and are used as outgroups. The bar represents the estimated number of substitutions per site.

Citation: Reller M, Dumler J. 2011. , and Related Intracellular Bacteria , p 1013-1026. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch62
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Image of FIGURE 2

(A) cultured in the canine histiocyte cell line DH82. Note the presence of basophilic, stippled, intracytoplasmic inclusions approximately 2 to 3 µm in diameter (arrows). The smaller intracytoplasmic granules may also be ehrlichial morulae. Romanowsky (Leukostat) stain; original magnification, ×1,000. (B) cultured in the human promyelocytic cell line HL-60 from the blood of an infected patient. Note the presence of multiple basophilic, stippled, intracytoplasmic inclusions (arrowheads) in an HL-60 cell. Wright stain; original magnification, ×1,000. (C and D) (C) and (D) in peripheral blood leukocytes. Note that an morula (arrowhead) is present in a monocyte (C) and that an morula (arrow) is present in a neutrophil (D). Wright stain; original magnification, ×1,000.

Citation: Reller M, Dumler J. 2011. , and Related Intracellular Bacteria , p 1013-1026. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch62
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Generic image for table

Selected features of ,, , and species of human and veterinary interest

EGE, equine granulocytic ehrlichiosis; CGE, canine granulocytic ehrlichiosis; CME, canine monocytic ehrlichiosis.

Citation: Reller M, Dumler J. 2011. , and Related Intracellular Bacteria , p 1013-1026. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch62

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