Chapter 65 : , , and Related Intracellular Bacteria

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Members of the genera and are now recognized to be important human pathogens. and species infect bone marrow-derived cells, such as granulocytes, monocytes, erythrocytes, and platelets, of humans and other mammals. and spp. are Gram-negative obligate intracellular bacteria that reside and propagate within membrane-lined vacuoles in the cytoplasm of the bone marrow-derived cells. They are zoonotic agents transmitted to animals and humans by ticks. Recognized natural reservoirs for include deer, domestic dogs, and perhaps other animals that host ticks. The causative agent of human monocytic ehrlichiosis (HME) is , a monocytotropic ehrlichia first identified as a human pathogen in a patient with a severe febrile illness after tick bites in 1986. The causative agent of human granulocytic anaplasmosis (HGA) is . Other human ehrlichioses include Venezuelan human ehrlichiosis, ehrlichiosis, -like agent ehrlichiosis, “ Neoehrlichia mikurensis” ehrlichiosis, and neorickettsiosis. Currently, there are 3 methods for diagnosis of acute HME or HGA: (i) PCR amplification of nucleic acids from or species in blood, (ii) detection of morulae in the cytoplasm of infected leukocytes by Romanowsky stains (e.g., Giemsa or Wright) or by specific immunostains using or antibodies, and (iii) culture of or from blood or cerebrospinal fluid. Although disease can be severe or fatal, in retrospective studies and routine clinical practice, patients with either HME or HGA defervesce within 48 h of therapy with doxycycline, the drug of choice.

Citation: Reller M, Dumler J. 2015. , , and Related Intracellular Bacteria, p 1135-1149. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch65
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Image of FIGURE 1

Neighbor-joining phylogenetic tree inferred from (16S ribosomal RNA gene) sequences of selected , “ Neoehrlichia,” , , and spp. and are used as outgroups. The bar represents the estimated number of substitutions per site. Modified from Juan P. Olano and Maria E. Aguero-Rosenfeld in chapter 67 of the 9th edition of this (156). doi:10.1128/9781555817381.ch65.f1

Citation: Reller M, Dumler J. 2015. , , and Related Intracellular Bacteria, p 1135-1149. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch65
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Image of FIGURE 2

(A and C) Wright stains (original magnification, ×1,000) of (A) and (C) in peripheral blood leukocytes. Note that an morula (arrowhead) is present in a monocyte (A) and that an morula (arrow) is present in a neutrophil (C). (B) Romanowsky (Leukostat) stain (original magnification, ×1,000) of 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. (D) Wright stain (original magnification, × 1,000) of from the blood of an infected patient cultured in the human promyelocytic cell line HL-60. Note the presence of multiple basophilic, stippled, intracytoplasmic inclusions (arrowheads) in an HL-60 cell. doi:10.1128/9781555817381.ch65.f2

Citation: Reller M, Dumler J. 2015. , , and Related Intracellular Bacteria, p 1135-1149. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch65
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Selected features of , , , “ Neoehrlichia mikurensis,” and species of human and veterinary interest

Citation: Reller M, Dumler J. 2015. , , and Related Intracellular Bacteria, p 1135-1149. In Jorgensen J, Pfaller M, Carroll K, Funke G, Landry M, Richter S, Warnock D (ed), Manual of Clinical Microbiology, Eleventh Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817381.ch65

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