Canine ehrlichiosis and anaplasmosis are important tick-borne diseases with a worldwide distribution. Information has been continuously collected on these infections in Europe, and publications have increased in recent years. Prevalence rates are high for Ehrlichia and Anaplasma spp. infections in dogs from different European countries. The goal of this article was to provide a practical guideline for veterinary practitioners on the diagnosis, treatment, and prevention of ehrlichiosis and anaplasmosis in dogs from Europe. This guideline is intended to answer the most common questions on these diseases from a practical point of view.

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Guideline for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe

Ticks transmit more pathogens than any other arthropod, and one single species can transmit a large variety of bacteria and parasites. Because co-infection might be much more common than previously thought, we evaluated the prevalence of 38 known or neglected tick-borne pathogens in Ixodes ricinus ticks. Our results demonstrated that coinfection occurred in almost half of the infected ticks, and that ticks could be infected with
up to five pathogens. Moreover, as it is well established that symbionts can affect pathogen transmission in arthropods, we also evaluated the prevalence of four symbiont species and demonstrated that all ticks were infected by at least one microorganism. This work highlights the co-infection phenomenon in ticks, which may have important implications for human and animal health, emphasizing the need for new diagnostic tests better adapted to tick-borne diseases. Finally, the high co-occurrence of symbionts and pathogens in ticks, reveals the necessity to also account for these interactions in the development of new alternative strategies to control ticks and tick-borne disease.

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Co-infection of Ticks: The Rule Rather Than the Exception

This article presents two case reports of Anaplasma platys detection in two women from Venezuela. Both patients were exposed to Rhipicephalus sanguineus, the presumed tick vector, and experienced chronic, nonspecific clinical signs including headaches and muscle pains. Intra-platelet inclusion bodies resembling A. platys were observed in buffy coat smears and A. platys DNA was amplified and sequenced from whole blood; however, treatment with doxycycline did not alleviate their symptoms. These cases provide further support for A. platys as a zoonotic tick-borne pathogen, most likely of low pathogenicity; nonetheless, the cause of illness in humans by A. platys is yet to be confirmed.

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Case report: Molecular evidence of Anaplasma platys infection in two women from Venezuela.

Genetic diversity and molecular epidemiology of Anaplasma

In recent years, an increasing number of Bartonella species have been identified as zoonotic pathogens, transmitted by animal bites, scratches, arthropods and even by needle sticks. Considering the diversity of newly discovered Bartonella species and subspecies and the large number and ecologically diverse animal reservoir hosts and the evolving spectrum of arthropod vectors that can transmit these bacteria among animals and humans, the clinical and diagnostic challenges posed by Bartonella transmission in nature are presumably much more complex than is currently appreciated by diagnosticians, vector biologists, ecologists, physicians, or veterinarians. Historically the term "bartonellosis" was attributed to infections with Bartonella bacilliformis, transmitted by sandflies in the Peruvian Andes. Currently, however, bartonellosis now includes infections caused by any Bartonella sp. anywhere in the world. Potentially, because Bartonella spp. can infect erythrocytes, endothelial cells, pericytes, CD34(+) progenitor cells, and various macrophage-type cells, including microglial cells, dendritic cells, and circulating monocytes in vitro, the clinical and pathological manifestations of bartonellosis appear to be very diverse in both sick animals and human patients. Because 75% of emerging infectious diseases are zoonoses, many of which are vector-transmitted by an arthropod, a One Health approach to bartonellosis and other zoonotic infections is needed to properly address animal health, public health, and environmental factors that influence the distribution and transmission of these bacteria. The One Health concept encourages a spirit of cooperation among animal, environmental, and human health professionals and promotes developing integrated solutions for complex problems that impact the health of animals, humans, and the planet. Importantly, substantial research is needed to define the medical importance of this genus as a cause of animal and human illnesses.

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Bartonellosis: One Health Perspectives for an Emerging Infectious Disease

Background: During a two year period, a 27-year-old female veterinarian experienced migraine headaches, seizures, including status epilepticus, and other neurological and neurocognitive abnormalities. Prior to and during her illness, she had been actively involved in hospital-based work treating domestic animals, primarily cats and dogs, in Grenada and Ireland and anatomical research requiring the dissection of wild animals (including lions, giraffe, rabbits, mongoose, and other animals), mostly in South Africa. The woman reported contact with fleas, ticks, lice, biting flies, mosquitoes, spiders and mites and had also been scratched or bitten by dogs, cats, birds, horses, reptiles, rabbits and rodents. Prior diagnostic testing resulted in findings that were inconclusive or within normal reference ranges and no etiological diagnosis had been obtained to explain the patient’s symptoms. Methods: PCR assays targeting Anaplasma spp. Bartonella spp. and hemotopic Mycoplasma spp. were used to test patient blood samples. PCR positive amplicons were sequenced directly and compared to GenBank sequences. In addition, Bartonella alpha Proteobacteria growth medium (BAPGM) enrichment blood culture was used to facilitate bacterial growth and Bartonella spp. serology was performed by indirect fluorescent antibody testing. Results: Anaplasma platys, Bartonella henselae and Candidatus Mycoplasma haematoparvum DNA was amplified and sequenced from the woman’s blood, serum or blood culture samples. Her serum was variably seroreactive to several Bartonella sp. antigens. Despite symptomatic improvement, six months of doxycycline most likely failed to eliminate the B. henselae infection, whereas A. platys and Candidatus M. haematoparvum DNA was no longer amplified from post-treatment samples. Conclusions: As is typical of many veterinary professionals, this individual had frequent exposure to arthropod vectors and near daily contact with persistently bacteremic reservoir hosts, including cats, the primary reservoir host for B. henselae, and dogs, the presumed primary reservoir host for A. platys and Candidatus Mycoplasma haematoparvum. Physicians caring for veterinarians should be aware of the occupational zoonotic risks associated with the daily activities of these animal health professionals.

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Lauren N Havenga

Papers

Co-infection with Anaplasma platys, Bartonella henselae and Candidatus Mycoplasma haematoparvum in a veterinarian