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The “Biological Weapons” of Ehrlichia chaffeensis: Novel Molecules and Mechanisms to Subjugate Host Cells

Emily

Editor, Senior Moderator
https://www.frontiersin.org/articles/10.3389/fcimb.2021.830180/full
Front. Cell. Infect. Microbiol., 14 January 2022 | https://doi.org/10.3389/fcimb.2021.830180

The “Biological Weapons” of Ehrlichia chaffeensis: Novel Molecules and Mechanisms to Subjugate Host Cells
Yasuko Rikihisa[SUP]*[/SUP]
  • Laboratory of Molecular, Cellular, and Environmental Rickettsiology, Department of Veterinary Biosciences, College of Veterinary Medicine, Infectious Diseases Institute, The Ohio State University, Columbus, OH, United States
Ehrlichia chaffeensis is an obligatory intracellular bacterium that causes human monocytic ehrlichiosis, an emerging, potentially fatal tick-borne infectious disease. The bacterium enters human cells via the binding of its unique outer-membrane invasin EtpE to the cognate receptor DNase X on the host-cell plasma membrane; this triggers actin polymerization and filopodia formation at the site of E. chaffeensis binding, and blocks activation of phagocyte NADPH oxidase that catalyzes the generation of microbicidal reactive oxygen species. Subsequently, the bacterium replicates by hijacking/dysregulating host-cell functions using Type IV secretion effectors....
...

1 Introduction


Ehrlichia chaffeensis is a tick-borne Gram-negative obligatory intracellular bacterium of the family Anaplasmataceae in the order Rickettsiales. Infection causes severe flu-like febrile disease called human monocytic ehrlichiosis (HME), which is often accompanied by hematologic abnormalities and signs similar to those of hepatitis (Dawson et al., 1991; Paddock and Childs, 2003). Tick-borne diseases are on the rise (Biggs et al., 2016; Madison-Antenucci et al., 2020; Alkishe et al., 2021). Discovered in 1986 (Maeda et al., 1987), HME is currently among the most prevalent life-threatening tick-borne zoonoses (Adams et al., 2017). HME diagnosis is challenging, as early signs and symptoms are indistinct or mimic other illnesses. No HME vaccine exists, and the only effective therapy is the broad-spectrum antibiotic doxycycline. However, treatment is often delayed (or even not initiated) owing to misdiagnosis or comorbidity with an unrelated underlying illness or injury, stress, immunosuppression, and/or co-infection with other tick-borne pathogens, which collectively can lead to severe complications or death, with a mortality rate of 1–5% among different populations (Paddock and Childs, 2003)....
 
https://journals.lww.com/infectdis/..._Infection_in_a.8.aspx?context=LatestArticles
  • Butterfield, Joseph H. MD[SUP]∗[/SUP]; Elliott, Michelle A. MD[SUP]†[/SUP] Fulminant Ehrlichia chaffeensis Infection in a Patient Discovered to Have Indolent Systemic Mastocytosis, Infectious Diseases in Clinical Practice: May 2022 - Volume 30 - Issue 3 - e1137 doi: 10.1097/IPC.0000000000001137
Abstract


Patients with systemic mastocytosis (SM) are at increased risk for anaphylaxis from vespid and honeybee stings. The response of mastocytosis patients to tick-borne infections has not been reported. A 77-year-old woman hospitalized for progressive symptoms of fever, chills, night sweats, and abdominal pain became obtunded and required intubation, support with pressors, treatment for disseminated intravascular coagulation, and resuscitation from 3 episodes of asystole. During her evaluation, bone marrow biopsy revealed heretofore undiagnosed SM. A history of a tick bite 3 weeks previously was elicited when Ehrlichia chaffeensis infection was diagnosed. Institution of treatment with doxycycline led to gradual recovery. Ehrlichia chaffeensis–induced mast cell degranulation was felt to be responsible for many of her symptoms. This case is a cautionary report of the potential danger of tick-borne infection in patients with SM. How widespread this problem occurs is unknown and will depend on future surveillance in endemic areas.
 
https://academic.oup.com/cid/article-abstract/74/5/918/6331335
Aditi Saha, Charles Browning, Raja Dandamudi, Kevin Barton, Kevin Graepel, Madeline Cullity, Wala Abusalah, Du Christine, Carla Rossi, Naomi Drexler, Sridhar V Basavaraju, Pallavi Annambhotia, Rodrigo Vazquez Guillamet, Albert J Eid, Joseph Maliakkal, Aaron Miller, Christopher Hugge, Vikas R Dharnidharka, Praveen Kandula, Michael J Moritz, Donor-derived Ehrlichiosis: 2 Clusters Following Solid Organ Transplantation, Clinical Infectious Diseases, Volume 74, Issue 5, 1 March 2022, Pages 918–923, https://doi.org/10.1093/cid/ciab667
Abstract

Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor-derived clusters of ehrlichiosis are described here. During the summer of 2020, 2 cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to the CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis. Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All 3 were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization and the OPTN for further investigation by public health authorities.
 
This is really tragic. The boy was still very ill when the article was written. Doctors waited until tests confirmed ehrlichiosis before treating with doxycycline. That is NOT what CDC recommends.
CONFIRMATION OF THE DIAGNOSIS IS BASED ON LABORATORY TESTING, BUT ANTIBIOTIC THERAPY SHOULD NOT BE DELAYED IN A PATIENT WITH A SUGGESTIVE CLINICAL PRESENTATION.
I hope he pulled through. This will be happening more and more. Ticks were once just a nuisance, but no more.

Boy, 6, suffers seizures and almost dies after developing less-known tick-borne illness

When Aiden complained of headaches and developed a fever, his parents felt worried. At hospital, he quickly deteriorated, experiencing a 6.5 hour seizure.


July 24, 2023, 11:06 AM CDT / Source: TODAY

By Meghan Holohan During the last weekend of June, Aiden Debusk, 6, and his brother, Anakin Debusk, 3, took a hike with their father, Steven Debusk. When they returned, mom Laiken Debusk examined them closely.
“(My husband said), ‘There were a lot of ticks,’” Laiken Debusk, 25, of Russellville, Arkansas, recalls to TODAY.com. “I start checking the boys, and I pull one from the nape of Aiden’s neck and then one off his underwear line, and then I pulled six or seven off Anakin.”

When Aiden complained of headache that wouldn’t go away and stopped eating, his parents knew something was wrong and took him to the local hospital. He was soon transferred to Arkansas Children’s Hospital, where they learned what happened: Aiden had the tick-borne illness ehrlichiosis and experienced a rare reaction to it, leading to hourslong seizures and a medically induced coma. His mom hopes to raise awareness of the dangers of ticks.

https://www.today.com/health/diseas...ss-ehrlichiosis-rcna95554?search=ehrlichiosis
 
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