Ehrlichiosis Canina y Felina
Ehrlichiosis Canina y Felina
Ehrlichiosis Canina y Felina
AND
FELINE EHRLICHIOSIS*
Nancy A. Vincent-Johnson, DVM, MS, DACVIM (Small Animal, Internal Medicine), DACVPM
Lieutenant Colonel, United States Army Veterinary Corps
Commander, National Capital District Veterinary Command
Fort Belvoir, VA
DIAGNOSTIC CRITERIA
Historical Information
Gender Predisposition: None.
Age Predisposition: None.
Breed Predisposition: All breeds are susceptible, but
German shepherds seem to elicit a poorer cell-mediated response and are predisposed to developing bone
marrow suppression that is more severe and less
responsive to treatment.
*The views expressed in this article are those of the author
and do not reflect the official policy or position of the
Department of the Army, the Department of Defense, or the
US Government.
Fever.
Depression, lethargy.
Weight loss.
Signs indicative of bleeding tendencies (epistaxis,
melena, petechial or ecchymotic hemorrhages,
hyphema, retinal hemorrhage, hematuria) occur in
25% to 60% of dogs.
Splenomegaly (25%).
Generalized lymphadenopathy (20%).
Central nervous system signs (hyperesthesia, stupor,
ataxia, paresis, seizures, head tilt, cerebellar dysfunction, vestibular signs, nystagmus, or other cranial nerve deficits).
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TA B L E 1
S o m e I m p o r t a n t Ve t e r i n a r y P a t h o g e n s o f t h e F a m i l y
Anaplasmataceae1
Pathogen
Associated Disease
Vector
Ehrlichia canis
Ehrlichia ewingii
Ehrlichia chaffeensis
Anaplasma phagocytophilum2
Anaplasma platys4
Neorickettsia helminthoeca
Neorickettsia risticii
Rhipicephalus sanguineus
Amblyomma americanum
A. americanum
Ixodes spp
R. sanguineus?
Nanophyetus salmincola
(nematode)
Trematode cercariae found
in snails and aquatic insects
The presence of a morula in a monocyte or granulocyte is not necessarily specific for the organism listed; the terms monocytic and
granulocytic ehrlichiosis reflect historical designations.
2
Formerly Ehrlichia equi, Ehrlichia phagocytophilum.
3
Formerly human granulocytic ehrlichiosis.
4
Formerly Ehrlichia platys.
Laboratory Findings
Thrombocytopenia (82%).
Mild to moderate anemia (82%; usually nonregenerative; may be Coombs positive).
Hyperproteinemia (33% to 75%), hyperglobulinemia (occasionally extreme).
Hypoalbuminemia.
Leukopenia, leukocytosis, or normal leukocyte count.
Lymphocytosis or lymphopenia, monocytosis.
Proteinuria.
Increases in alanine aminotransferase, alkaline phosphatase, amylase, blood urea nitrogen, creatinine.
Polyclonal or (rarely) monoclonal gammopathy on
protein electrophoresis.
Bone marrow aspirate:
Acute phase: Hyperplasia, especially of megakaryocytes.
Chronic phase: Hypoplasia of all three cell
lines, plasmacytosis.
Pancytopenia may be seen in chronic, severe cases
(less than 25%); occurs more often in German shepherds.
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A P R I L
2 0 0 4
CHECKPOINTS
Differential Diagnosis
Because ehrlichiosis can mimic so many different diseases, it is important to test for Ehrlichia and related
species when the following diseases are suspected:
Immune-mediated thrombocytopeniaAnimals
with thrombocytopenia should be thoroughly
screened for other causes before presuming it is
idiopathic. Testing should be done to check for
ehrlichiosis and other infectious causes. No specific
test exists for diagnosing immune-mediated thrombocytopenia. In fact, dogs with ehrlichiosis can
9
STANDARDS
of CARE: E M E R G E N C Y
AND
CRITICAL
CARE
MEDICINE
Initial Treatment
Dogs suspected of having ehrlichiosis should be
started on specific treatment immediately rather
than waiting for positive test results. Dramatic
improvement usually occurs within 24 to 48 hours
of initiating therapy. Dogs with chronic manifestations, including pancytopenia, glomerulonephritis,
and hyperviscosity syndrome, respond more slowly
and may have irreversible changes.
A P R I L
2 0 0 4
THE
NEWS
FRONT
Alternative/Optional
Treatments/Therapy
Imidocarb dipropionate (5 mg/kg IM or SC followed
by a second injection 2 weeks later) is an alternative
treatment, but some variability in its efficacy is
reported. It can be used in animals whose owners
are unable to administer daily oral doxycycline or
for those animals that cannot tolerate doxycycline.
The most common adverse effects of imidocarb
injection are pain at the injection site and mild
cholinergic signs (salivation, nasal drip, vomiting).
Pretreatment with atropine at 0.022 mg/kg IM or SC
20 minutes before the imidocarb injection can prevent cholinergic effects.
Enrofloxacin and other quinolones are not effective
in treating ehrlichiosis.
Supportive Treatment
TREATMENT
RECOMMENDATIONS
10
ON
Patient Monitoring
Platelet counts begin to improve within 24 to 48
hours of initiating therapy and are usually normal
within 14 days. To monitor efficacy, platelet counts
should be rechecked 48 to 72 hours after initiating
therapy and again at 7 and 14 days. Platelet counts
should be checked 4 to 8 weeks after therapy to
ensure that a relapse of thrombocytopenia has not
occurred.
Most dogs undergo a decline in antibody titer following treatment and become antibody negative
over a course of 6 to 9 months. Some treated dogs
maintain high titers for years yet appear clinically
healthy. It is not known whether this is because of
continued infection, reinfection, or simply persistence of antibodies. Therefore, titers are not the best
method to assess treatment efficacy. The antibodies
are not protective against reinfection.
PCR may prove to be useful in distinguishing clinically cured animals that retain high posttreatment
IFA titers from unsuccessfully treated animals with
persistent infection. If PCR is used, testing should
take place 2 weeks after discontinuing antibiotic
treatment. If PCR is positive, the animal should be
re-treated for an additional 4 weeks and retested
after discontinuing the antibiotic for 2 weeks. If the
results are positive after these two treatment cycles,
the alternative drug, imidocarb dipropionate,
should be given. If PCR results are negative, the test
should be repeated in 2 months. If still negative,
treatment was likely successful.
The organism may be sequestered in the spleen,
even in animals that are clinically cured and test
negative on PCR or blood culture. One study
showed that of four dogs subclinically infected with
E. canis, one remained PCR positive following a 42day course of doxycycline at 10 mg/kg PO q24h.
RESOURCE LIST
ELISAIn-house combination test for E. canis,
Borrelia burgdorferi, and heartworm: SNAP 3Dx,
IDEXX Laboratories, Inc., Westbrook, ME. $
PCR and serology are available through the North
Carolina State University College of Veterinary
Medicine Tick Borne Disease Laboratory. Phone:
919-513-6357; Web: www.cvm.ncsu.edu/docs/
tickbornediseaselab.html. $
Treatment Contraindications
Although immunosuppressive doses of glucocorticoids
are sometimes indicated to treat severe thrombocytopenia or other complications of ehrlichiosis, they
should not be given without concurrently initiating
specific treatment with doxycycline or imidocarb
dipropionate. When used, corticosteroids should be
tapered rapidly while sequentially monitoring platelet
counts. Doxycycline should be administered for a full
4 weeks following corticosteroid administration.
PROGNOSIS
Favorable Criteria
Home Management
Because of the marked improvement following initiation of doxycycline, no special home management
is normally needed other than routine observation.
Prior infection does not infer immunity following
doxycycline treatment; thus tick control is important to prevent reinfection. In addition to environmental control, the use of amitraz-impregnated
collars, fipronil, or permethrin products is recommended for dogs.
In highly endemic areas during tick season, dogs
can be maintained on 3 mg/kg doxycycline PO
q24h to prevent infection.
Unfavorable Criteria
Lack of significant clinical and hematologic improvement within 48 hours.
Severe pancytopenia and bone marrow suppression
(may be irreversible).
Irreversible renal damage and proteinuria.
RECOMMENDED READING
Breitschwerdt EB: Ehrlichiosis: A new zoonosis? Compend Contin
Educ Pract Vet 24(suppl 1A):1014, 2002.
Milestones/Recovery
Time Frames
Marked clinical improvement within 24 to 48 hours
11
STANDARDS
of CARE: E M E R G E N C Y
AND
CRITICAL
CARE
MEDICINE