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Volume 334:209-215 January 25, 1996 Number 4 Next

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ABSTRACT

Background human granulocytic ehrlichiosis is a potentially fatal tick-borne infection that has recently been described. This acute febrile illness is characterized by myalgias, headache, thrombocytopenia, and elevated serum aminotransferase levels. The disease is difficult to diagnose because the symptoms are nonspecific, intraleukocytic inclusions (morulae) may not be seen, and the serologic results are often initially negative. Little is known about the causative agent because it has never been cultivated.

Methods We studied three patients with symptoms and laboratory findings suggestive of human granulocytic ehrlichiosis, including unexplained fever after probable exposure to ticks, granulocytopenia, and thrombocytopenia. Peripheral blood was examined for ehrlichia microscopically and with use of the polymerase chain reaction (PCR). Blood was inoculated into cultures of HL60 cells (a line of human promyelocytic leukemia cells), and the cultures were monitored for infection by giemsa staining and PCR.

Results Blood from the three patients, only one of whom had inclusions suggestive of ehrlichia in neutrophils, was positive for human granulocytic ehrlichiosis on PCR. Blood from all three patients was inoculated into HL60 cell cultures and caused infection, with intracellular organisms visualized as early as 5 days after inoculation and cell lysis occurring within 12 to 14 days. The identity of the cultured organisms was confirmed by immunofluorescence microscopy, PCR analysis, and DNA sequencing. DNA from the infected cells was sequenced in regions of the 16S ribosomal gene reported to differ between the agent of human granulocytic ehrlichiosis and closely related species, including Ehrlichia equi and E. phagocytophila, which cause infection in animals. The sequences from all three human isolates were identical and differed from the strain of E. equi studied in having guanine rather than adenine at nucleotide 84.

Conclusions We describe the cultivation of the agent of human granulocytic ehrlichiosis in cell culture. The ability to isolate this organism should lead to a better understanding of the biology, treatment, and epidemiology of this emerging infection.

Source Information

From the Division of Infectious Diseases, Department of Medicine, University of Minnesota School of Medicine, Minneapolis (J.L.G., C.N.); the Grantsburg Clinic, Grantsburg, Wis. (B.V.); the Departments of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis (J.E.M.); the Department of Pathology, University of Maryland School of Medicine, Baltimore (J.S.D.); and the Department of Entomology, College of Agriculture, University of Minnesota, St. Paul (T.J.K., U.G.M.).

Address reprint requests to Dr. Goodman at Box 250 UMHC, 420 Delaware St. SE, Minneapolis, MN 55455.

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