Ehrlichiosis & Anaplasmosis Sa Med 1

Front 1

What is the agent that causes both Ehrlichiosis and Anaplasmosis?

Back 1

Obligate intracellular, tick-transmitted rickettsia parasites of leukocytes in several species of animals and humans.

Front 2

What is the classic disease caused by Ehrlichia canis?

Back 2

Canine monocytotropic ehrlichiosis

Front 3

What is the classic disease caused by Ehrlichia chaffeensis?

Back 3

Human monocytotropic ehrlichiosis

Front 4

What is the classic disease caused by Ehrlichia ewingii?

Back 4

Canine granulocytotropic ehrlichiosis

Front 5

What is the classic disease caused by Anaplasma platys?

Back 5

Infectious canine cyclic thrombocytopenia

Front 6

What is the classic disease caused by Anaplasma phagocytophilum?

Back 6

Tick-borne fever, granulocytic anaplasmosis (human & equine)

Front 7

**What transmits ehrlichia and anaplasma?

Back 7

**Ticks, need the animal to complete the cycle bc strictly transtadial transmission by tick

Front 8

True or false. Ticks are a reservoir for ehrlichia and anaplasma.

Back 8

FALSE, not reservoirs (no transovarial spread-doesn't spread from one tick to the next)

Front 9

Are animals needed to maintain ehrlichia and anaplasma in the environment?

Back 9

YES**

Front 10

How are animals infected with ehrlichia and anaplasma?

Back 10

3 host cycle: goes from one host to the second host and now can infect the 3rd host, larvae to nymph jump and find different dog

Front 11

Can dogs get ehrlichia or anasplasma from ticks inside the house?

Back 11

Yes, have adapted because of air conditioning allowed the cooler temps

Front 12

What agent causes canine monocytotropic ehrlichiosis?

Back 12

E. canis- most important cause of ehrlichiosis in dogs

Front 13

What is the distribution of E. canis?

Back 13

Worldwide, but more common near the equator

Front 14

When is the acute phase of canine monocytotropic ehrlichiosis? How long does it last?

Back 14

8-20 days post-infection
Lasts 2-4 weeks

Front 15

What are the clinical signs of the acute phase of canine monocytotropic ehrlichiosis?

Back 15

Non-specific signs such as fever, anorexia, lymphadenopathy

Front 16

What are the lab abnormalities seen in the acute phase of canine monocytotropic ehrlichiosis?

Back 16

Thrombocytopenia (mostly immune-mediated), mild anemia, leukopenia

Front 17

When does the sub-clinical phase of canine monocytotropic ehrlichiosis occur?

Back 17

From 40 days to many years

Front 18

What is the immune response during the sub-clinical phase of canine monocytotropic ehrlichiosis?

Back 18

Immunocompetent dogs can eliminate the infection, dogs that do not eliminate the organism may progress into the chronic phase
-dogs appear normal

Front 19

What are the clinical signs of the chronic phase of canine monocytotropic ehrlichiosis?

Back 19

Vague illness w/ severe hematological changes= pancytopenia due to lack of bone marrow production

Front 20

What is the hallmark of canine monocytotropic ehrlichiosis?

Back 20

Thrombocytopenia***** but some may not have it

Front 21

What are the multisystemic signs of canine monocytotropic ehrlichiosis?

Back 21

Lethargy, depression, weight loss
Superficial bleeding
Lymphadenomegaly, splenomegaly

Front 22

What are the ocular signs of canine monocytotropic ehrlichiosis?

Back 22

Anterior uveitis & chorioretinitis

Front 23

What are the neuromuscular signs of canine monocytotropic ehrlichiosis?

Back 23

Meningitis, intracranial signs
Polymyositis and polyarthritis
-Any kind of CNS disease

Front 24

What do the clinical signs of canine monocytotropic ehrlichiosis depend on?

Back 24

Just depends on where the organism is and where the infection results

Front 25

What is the most common lab abnormality seen with the initial phase of canine monocytotropic ehrlichiosis?

Back 25

Severe lymphocytosis
**Not many differentials for young dog with severe lymphocytosis

Front 26

What are 2 differentials for granular lymphocytes?

Back 26

Leukemia
Ehrlichiosis

Front 27

What are the protein levels in an animal with ehrlichiosis?

Back 27

Hyperproteinemia, hyperglobulinemia, hypoalbuminemia
-because of inflammation

Front 28

What do will you find when electrophoresis is performed on an animal with canine monocytotropic ehrlichiosis?

Back 28

Monoclonal or polyclonal gammopathy
-Can be either one, but vast majority is polyclonal

Front 29

What are 2 differentials for monoclonal gammopathy?

Back 29

Multiple myeloma
Ehrlichiosis

Front 30

Compare the hematological changes in the subclinical phase of ehrlichiosis to that of the chronic phase.

Back 30

During the subclinical phase only thrombocytopenia, during chronic phase bone marrow isn't working= pancytopenia

Front 31

Does ehrlichiosis affect the liver or kidneys at all?

Back 31

Yes, can have increased ALT and ALP and proteinuria

Front 32

What does a positive serology test for E. canis mean?

Back 32

Just means that animal has been exposed (documents exposure), does not mean that clinical signs are due to ehrlichiosis

Front 33

How do you diagnose E. canis?

Back 33

Serology & clinical signs

Front 34

What are 2 reasons that false positives can occur when using serology to diagnose E. canis?

Back 34

1) Cross reactivity
2) Previous exposure: antibodies may persist for over a year

Front 35

What does E. canis cross-react with on serology?

Back 35

-Mostly w/ E. chaffeensis and E. ewingii
-Some w/ N. risticii
-Minimal w/ A. phagocytophilum
-works if just want to diagnose ehrlichiosis

Front 36

Why can false negative serology tests result when testing for E. canis?

Back 36

- too soon: may take up to 28 days to seroconvert
-other ehrlichia or anaplasma

Front 37

What test should you use if you want to confirm what specie of ehrlichia an animal has?

Back 37

PCR- can tell genus or species

Front 38

What can cause a false negative ehrlichiosis PCR?

Back 38

If give doxycycline to the animal before testing him

Front 39

How can you find the ehrlichia organism?

Back 39

-Look for morulae in the cells and in this case in the monocytes
-High specificity, low sensitivity

Front 40

What is the most common treatment for ehrlichiosis?

Back 40

Doxycycline for 21 days, most dogs get better

Front 41

What is so difficult about ehrlichiosis treatment with imidocarb? (3)

Back 41

-It's an injection that has to be repeated in 2-3 weeks so compliance is an issue
-When there's co-infection with B. canis, E. canis cannot be eliminated from the bloodstream
-Not effective against B. gibsoni or Rickettsia ricketsii

Front 42

True or false. Enrofloxacin is somewhat effective against canine monocytotropic ehrlichiosis.

Back 42

False, NOT effective

Front 43

How long does it take clinical signs and platelet count to improve after receiving therapy?

Back 43

48 hours

Front 44

How can you prevent canine monocytotropic ehrlichiosis?

Back 44

-Strict tick control
-Low dose tetracycline daily if traveling to highly endemic areas

Front 45

Is E. canis a zoonotic concern?

Back 45

Confirmed infections of people with E. canis is not thought to be a substantial zoonotic risk

Front 46

What type of ehrlichia is of human concern?

Back 46

E. Chaffeensis= human monocytotropic ehrlichiosis
-can affect dogs

Front 47

What are the symptoms of human monocytotropic ehrlichiosis?

Back 47

Very vague signs: joint pain, chills, weakness, nausea, leukopenia, fever, headaches, thrombocytopenia, elevated liver enzymes

Front 48

What animal is the reservoir for E. chaffeensis?

Back 48

White-tailed deer, importance of dogs as reservoir is unknown

Front 49

What agent causes canine granulocytotropic ehrlichiosis?

Back 49

Ehrlichia ewingii

Front 50

What is the distribution of Ehrlichia ewingii?

Back 50

Only in the US, almost exclusively in S central & SE states

Front 51

What is the seasonality of canine granulocytotropic ehrlichiosis?

Back 51

Spring to late autumn

Front 52

Canine granuocytotropic ehrlichiosis is similar to E. canis infections, but what's different?

Back 52

E. ewingii infections are milder with no deaths ever attributed to E. ewingii in dogs or humans

Front 53

*What is the classic presentation of canine granulocytotropic ehrlichiosis?

Back 53

**Lameness & joint swelling
-also fever, depression, lethargy, neurologic signs, thrombocytopenia

Front 54

How do you diagnose canine granulocytotropic ehrlichiosis?

Back 54

Morula on granulocytes OR PCR (Best)
-no specific serology

Front 55

What samples do you use to look for morula on granulocytes when you suspect canine granulocytotropic ehrlichiosis?

Back 55

Blood or joint fluids

Front 56

What is the disadvantage to diagnosing canine granulocytotropic ehrlichiosis by looking for morula in granulocytes?

Back 56

Cannot differentiate E. ewingii from A. phagocytopilum based on morphology

Front 57

What is the vector of E. ewingii?

Back 57

Amblyomma americanum

Front 58

What is the therapy for canine granulocytotropic ehrlichiosis?

Back 58

Same as E. canis (doxycylcine)

Front 59

How do you prevent canine granulocytotropic ehrlichiosis?

Back 59

Same as E. canis:
-strict tick-control
-low dose daily tetracycline if dogs traveling to highly endemic areas

Front 60

Is E. ewingii a public health concern?

Back 60

It's similar (but a milder disease) to the human granulocytic anaplasmosis caused by A. phagocytophilum

Front 61

What agent causes canine granulocytotropic anaplasmosis?

Back 61

Anaplasma phagocytophilum

Front 62

What is the distribution of canine granulocytotropic anaplasmosis?

Back 62

Worldwide, probably more common than E. canis in some parts of the north

Front 63

What animals are susceptible to A. phagocytophilum?

Back 63

A wide variety of mammals -equal opportunity agent

Front 64

True or false. Dogs are important in the transmission of anaplasma phagocytophilum.

Back 64

False, dogs and humans are accidental hosts & dogs are not a risk factor for human exposure

Front 65

How long are animals infected with anaplasma phagocytophilum bacteremic?

Back 65

< 28 days

Front 66

How is A. phagocytophilum transmitted?

Back 66

Via ixodes ticks-tick must be attached 24-36 hours to transmit the organism!!!

Front 67

Why can canine granulocytotropic anaplasmosis cause secondary infections?

Back 67

Delays normal neutrophil apoptosis ---> immunosuppression

Front 68

What dogs are most commonly affected by A. phagocytophilum? Humans?

Back 68

Dogs > 6-8 years
Humans > 50 years

Front 69

What are 3 risk factors associated with A. phagocytophilum infection?

Back 69

1) Seasonality
-peaks when nymph and adult activity peak
2) Age
3) Infection with other tick-borne diseases

Front 70

Can canine granulocytotropic anaplasmosis reactivate?

Back 70

Has been 1 case in a horse and experimentally achieved w/ immunosuppression

Front 71

***What is the one main difference in the clinical signs between anaplasma phagocytophilum compared to ehrlichiosis?

Back 71

**No bleeding associated w/ A. phagocytophilum

Front 72

Are most cases of canine granulocytotropic anaplasmosis clinical or subclinical?

Back 72

-Subclinical- it's a self-limiting disease and most infections are asympomatic
-No fatalities documented in dogs

Front 73

True or false. Thrombocytopenia doesn't occur with canine granulocytotropic anaplasmosis.

Back 73

False, thrombocytopenia occurs in 80% of cases, but not bleeding

Front 74

What are the laboratory changes found in cases of canine granulocytotropic anaplasmosis?

Back 74

Thrombocytopenia (80%)
-increased megakaryocytes in the bone marrow
-other cytopenias

Front 75

How do you diagnose canine granulocytotropic anaplasmosis?

Back 75

Clinical signs and laboratory findings PLUS one of the following:
- morula on granulocytes w/ a single titer > 80 (IFA or dot-ELISA )
-A 4-fold increase or decrease in titers (IFA)
-A positive PCR using specific A. phagocytophilum primers
-Isolation of A. phagocytophilum in the blood

Front 76

What sample(s) do you want to examine for morula in granulocytes when you suspect an A. phagocytophilum infection?

Back 76

Blood (7-37% of neutrophils) or joint fluids
-36-100%

Front 77

What is the disadvantage of using visualization of morula as a diagnostic technique for A. phagocytophilum?

Back 77

Doesn't differnetiate A. phagocytophilum from E. ewingii based on morphology

Front 78

When do antibodies to A. phagocytophylum appear? When do they disappear?

Back 78

-Develop 2-5 days after morulae appear in peripheral blood
-last 8-9 months

Front 79

When do you get a positive PCR using A. phagocytophilum primers?

Back 79

-Positive 6-8 days before morulae appear in the peripheral blood
-still + 3 days after appearance of morulae

Front 80

How can false positives resulting from using PCR primers for A. phagocytophilum for a diagnostic test?

Back 80

Cross-reactivity w/ A. platys NOT E. canis

Front 81

How do you prevent A. phagocytophilum infection?

Back 81

Same as E. canis= strict tick control

Front 82

What is the treatment for A. phagocytophilum?

Back 82

Doxycycline for 2 weeks

Front 83

How long does it take the clinical signs of canine granulocytotropic anaplasmosis to improve w/ treatment?

Back 83

24-48 hours
-may require 1 weeks for complete resolution

Front 84

Is A. phagocytophilum a public health concern?

Back 84

YES* it causes the human granulocytic anaplasmosis

Front 85

A. phagocytophilus is transmitted by the same tick that transmits _______.

Back 85

Lyme disease

Front 86

Why should you wear gloves when taking a tick off a dog?

Back 86

Because some agents such as A. phagocytophilum & Rocky mountain spotted fever can be transmitted through direct contact with blood -can be exposed when squeeze the tick

Front 87

When should you treat anaplasmosis diagnosed via a 4 DX SNAP test?

Back 87

When positive test and clinical signs

Front 88

What are the clinical signs of human granulocytotropic anaplasmosis?

Back 88

Vague signs of fever (sometimes fever of unknown origin is only presenting symtpom) headaches, myalgia, and malaise

Front 89

True or false. Human granulocytotropic anaplasmosis has a high fatality rate.

Back 89

False, fatality rates range from 0.7-4.9%

Front 90

What causes thrombocytotropic anaplasmosis? What is the distribution?

Back 90

Anaplasma platys
Occurs worldwide

Front 91

What are the clinical findings of thrombocytotropic anaplasmosi?

Back 91

-Fever, hematochezia, superficial bleeding, epistaxis
-weight loss & anterior uveitis

Front 92

What are the laboratory findings of thrombocytotropic anaplasmosis?

Back 92

**Cyclic thrombocytopenia
-tropism for platelets
-in thrombocytes and then leave the platelets and then new generation comes in and gets worse, then they leave platelets again, so goes through 1-2 week interval where its bad then it gets better

Front 93

What are 3 methods used to diagnose A. platys?

Back 93

1) Organisms in platelets
2) Serology
-IFA
3) PCR

Front 94

Is A. platys a public health concern?

Back 94

**NO not zoonotic that we know of

Front 95

What is the therapy and prevention for A. platys?

Back 95

Same as E. canis
-Doxycycline
-strict tick control