Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009

Bobbi S. Pritt, Lynne M. Sloan, Diep K. Hoang Johnson, Ulrike G. Munderloh, Susan M. Paskewitz, Kristina M. McElroy, Jevon D. McFadden, Matthew J. Binnicker, David F. Neitzel, Gongping Liu, William L. Nicholson, Curtis M. Nelson, Joni J. Franson, Scott A. Martin, Scott A. Cunningham, Christopher R. Steward, Kay Bogumill, Mary E. Bjorgaard, Jeffrey P. Davis, Jennifer H. McQuiston & 5 others David M. Warshauer, Mark P. Wilhelm, Robin Patel, Vipul A. Trivedi, Marina E. Eremeeva

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

BACKGROUND: Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia 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 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerasechain- 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.)

Original languageEnglish (US)
Pages (from-to)422-429
Number of pages8
JournalNew England Journal of Medicine
Volume365
Issue number5
DOIs
StatePublished - Aug 4 2011

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Ehrlichia
Ehrlichiosis
Ehrlichia chaffeensis
Ixodes
Lymphopenia
Doxycycline
National Institutes of Health (U.S.)
Zoonoses
Ticks
Centers for Disease Control and Prevention (U.S.)
Thrombocytopenia
Headache
Fever
Physicians
Liver
Enzymes
Therapeutics

Cite this

Pritt, B. S., Sloan, L. M., Hoang Johnson, D. K., Munderloh, U. G., Paskewitz, S. M., McElroy, K. M., ... Eremeeva, M. E. (2011). Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009. New England Journal of Medicine, 365(5), 422-429. https://doi.org/10.1056/NEJMoa1010493

Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009. / Pritt, Bobbi S.; Sloan, Lynne M.; Hoang Johnson, Diep K.; Munderloh, Ulrike G.; Paskewitz, Susan M.; McElroy, Kristina M.; McFadden, Jevon D.; Binnicker, Matthew J.; Neitzel, David F.; Liu, Gongping; Nicholson, William L.; Nelson, Curtis M.; Franson, Joni J.; Martin, Scott A.; Cunningham, Scott A.; Steward, Christopher R.; Bogumill, Kay; Bjorgaard, Mary E.; Davis, Jeffrey P.; McQuiston, Jennifer H.; Warshauer, David M.; Wilhelm, Mark P.; Patel, Robin; Trivedi, Vipul A.; Eremeeva, Marina E.

In: New England Journal of Medicine, Vol. 365, No. 5, 04.08.2011, p. 422-429.

Research output: Contribution to journalArticle

Pritt, BS, Sloan, LM, Hoang Johnson, DK, Munderloh, UG, Paskewitz, SM, McElroy, KM, McFadden, JD, Binnicker, MJ, Neitzel, DF, Liu, G, Nicholson, WL, Nelson, CM, Franson, JJ, Martin, SA, Cunningham, SA, Steward, CR, Bogumill, K, Bjorgaard, ME, Davis, JP, McQuiston, JH, Warshauer, DM, Wilhelm, MP, Patel, R, Trivedi, VA & Eremeeva, ME 2011, 'Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009', New England Journal of Medicine, vol. 365, no. 5, pp. 422-429. https://doi.org/10.1056/NEJMoa1010493
Pritt, Bobbi S. ; Sloan, Lynne M. ; Hoang Johnson, Diep K. ; Munderloh, Ulrike G. ; Paskewitz, Susan M. ; McElroy, Kristina M. ; McFadden, Jevon D. ; Binnicker, Matthew J. ; Neitzel, David F. ; Liu, Gongping ; Nicholson, William L. ; Nelson, Curtis M. ; Franson, Joni J. ; Martin, Scott A. ; Cunningham, Scott A. ; Steward, Christopher R. ; Bogumill, Kay ; Bjorgaard, Mary E. ; Davis, Jeffrey P. ; McQuiston, Jennifer H. ; Warshauer, David M. ; Wilhelm, Mark P. ; Patel, Robin ; Trivedi, Vipul A. ; Eremeeva, Marina E. / Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009. In: New England Journal of Medicine. 2011 ; Vol. 365, No. 5. pp. 422-429.
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abstract = "BACKGROUND: Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia 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 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerasechain- 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.)",
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T1 - Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009

AU - Pritt, Bobbi S.

AU - Sloan, Lynne M.

AU - Hoang Johnson, Diep K.

AU - Munderloh, Ulrike G.

AU - Paskewitz, Susan M.

AU - McElroy, Kristina M.

AU - McFadden, Jevon D.

AU - Binnicker, Matthew J.

AU - Neitzel, David F.

AU - Liu, Gongping

AU - Nicholson, William L.

AU - Nelson, Curtis M.

AU - Franson, Joni J.

AU - Martin, Scott A.

AU - Cunningham, Scott A.

AU - Steward, Christopher R.

AU - Bogumill, Kay

AU - Bjorgaard, Mary E.

AU - Davis, Jeffrey P.

AU - McQuiston, Jennifer H.

AU - Warshauer, David M.

AU - Wilhelm, Mark P.

AU - Patel, Robin

AU - Trivedi, Vipul A.

AU - Eremeeva, Marina E.

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N2 - BACKGROUND: Ehrlichiosis is a clinically important, emerging zoonosis. Only Ehrlichia 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 697 Ixodes scapularis ticks collected in Minnesota or Wisconsin were positive for the same ehrlichia species on polymerasechain- 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.)

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