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3 février 2013 7 03 /02 /février /2013 17:39
Emergence of a New Pathogenic Ehrlichia Species, Wisconsin and Minnesota, 2009
Bobbi S. Pritt, M.D., Lynne M. Sloan, B.S., Diep K. Hoang Johnson, B.S., Ulrike G. Munderloh, Ph.D., Susan M. Paskewitz, Ph.D., Kristina M. McElroy, D.V.M., Jevon D. McFadden, M.D., Matthew J. Binnicker, Ph.D., David F. Neitzel, M.S., Gongping Liu, Ph.D., William L. Nicholson, Ph.D., Curtis M. Nelson, B.S., Joni J. Franson, B.S., Scott A. Martin, M.D., Scott A. Cunningham, B.S., Christopher R. Steward, B.S., Kay Bogumill, R.N., Mary E. Bjorgaard, R.N., Jeffrey P. Davis, M.D., Jennifer H. McQuiston, D.V.M., David M. Warshauer, Ph.D., Mark P. Wilhelm, M.D., Robin Patel, M.D., Ph.D., Vipul A. Trivedi, M.D., and Marina E. Eremeeva, M.D., Ph.D., Sc.D.
N Engl J Med 2011; 365:422-429August 4, 2011
BACKGROUND
Ehrlichiosis is a clinically important, emerging zoonosis. OnlyEhrlichia chaffeensis and E. ewingii have been thought to cause ehrlichiosis in humans in the United States. Patients with suspected ehrlichiosis routinely undergo testing to ensure proper diagnosis and to ascertain the cause.
METHODS
We used molecular methods, culturing, and serologic testing to diagnose and ascertain the cause of cases of ehrlichiosis.
RESULTS
On testing, four cases of ehrlichiosis in Minnesota or Wisconsin were found not to be from E. chaffeensis or E. ewingii and instead to be caused by a newly discovered ehrlichia species. All patients had fever, malaise, headache, and lymphopenia; three had thrombocytopenia; and two had elevated liver-enzyme levels. All recovered after receiving doxycycline treatment. At least 17 of 697Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerase-chain-reaction testing. Genetic analyses revealed that this new ehrlichia species is closely related to E. muris.
CONCLUSIONS
We report a new ehrlichia species in Minnesota and Wisconsin and provide supportive clinical, epidemiologic, culture, DNA-sequence, and vector data. Physicians need to be aware of this newly discovered close relative of E. muris to ensure appropriate testing, treatment, and regional surveillance. (Funded by the National Institutes of Health and the Centers for Disease Control and Prevention.)
Presented in part at the annual meeting of the American Society of Tropical Medicine and Hygiene, Washington, DC, November 18–22, 2009; the annual conference of the Epidemic Intelligence Service, Atlanta, April 19–23, 2010; the International Conference on Emerging Infectious Diseases, Atlanta, July 11–14, 2010; the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, September 12–15, 2010; the annual meeting of the American Society of Tropical Medicine and Hygiene, Atlanta, November 3–7, 2010; and the 6th International Meeting on Rickettsiae and Rickettsial Diseases, Heraklion, Greece, June 5–7, 2011. The findings reported here were also described in a Health Alert Network public health announcement by the Minnesota Department of Health and the Wisconsin Division of Public Health.

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