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Previous Volume 341:148-155 July 15, 1999 Number 3 Next

	Full Text PDF Editorial by Goodman, J. L. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Human ehrlichiosis is a recently recognized tick-borne infection. Four species infect humans: Ehrlichia chaffeensis, E. sennetsu, E. canis, and the agent of human granulocytic ehrlichiosis.

Methods We tested peripheral-blood leukocytes from 413 patients with possible ehrlichiosis by broad-range and species-specific polymerase-chain-reaction (PCR) assays for ehrlichia. The species present were identified by species-specific PCR assays and nucleotide sequencing of the gene encoding ehrlichia 16S ribosomal RNA. Western blot analysis was used to study serologic responses.

Results In four patients, ehrlichia DNA was detected in leukocytes by a broad-range PCR assay, but not by assays specific for E. chaffeensis or the agent of human granulocytic ehrlichiosis. The nucleotide sequences of these PCR products matched that of E. ewingii, an agent previously reported as a cause of granulocytic ehrlichiosis in dogs. These four patients, all from Missouri, presented between May and August 1996, 1997, or 1998 with fever, headache, and thrombocytopenia, with or without leukopenia. All had been exposed to ticks, and three were receiving immunosuppressive therapy. Serum samples obtained from three of these patients during convalescence contained antibodies that reacted with E. chaffeensis and E. canis antigens in a pattern different from that of humans with E. chaffeensis infection but similar to that of a dog experimentally infected with E. ewingii. Morulae were identified in neutrophils from two patients. All four patients were successfully treated with doxycycline.

Conclusions These findings provide evidence of E. ewingii infection in humans. The associated disease may be clinically indistinguishable from infection caused by E. chaffeensis or the agent of human granulocytic ehrlichiosis.

Source Information

From the Edward Mallinckrodt Department of Pediatrics (R.S.B., M.A., S.P.H., M.G.-K., G.A.S.) and the Department of Medicine (A.M.L., N.S.), Washington University School of Medicine, St. Louis; St. Louis Children's Hospital, St. Louis (R.S.B., M.A., S.P.H., M.G.-K., G.A.S.); the Centers for Disease Control and Prevention, Atlanta (C.D.P., J.W.S.); the Department of Veterinary Biosciences, College of Veterinary Medicine, Ohio State University, Columbus (Y.R., A.U.); and St. John's Mercy Medical Center, St. Louis (F.A.M.).

Address reprint requests to Dr. Storch at the Department of Pediatrics, Division of Infectious Diseases, St. Louis Children's Hospital, 1 Children's Pl., St. Louis, MO 63110, or at storch{at}a1.kids. wustl.edu.

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