Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1997 Jan;41(1):76–79. doi: 10.1128/aac.41.1.76

Antibiotic susceptibility of the newly cultivated agent of human granulocytic ehrlichiosis: promising activity of quinolones and rifamycins.

M B Klein 1, C M Nelson 1, J L Goodman 1
PMCID: PMC163663  PMID: 8980758

Abstract

Human granulocytic ehrlichiosis (HGE) is a rapidly emerging tick-borne infection which presents as an acute febrile illness and is associated with hematologic abnormalities, elevated hepatic transaminase levels, and characteristic intracellular organisms in peripheral blood granulocytes. Although HGE has been successfully treated with tetracyclines, its susceptibility to other antibiotics remains unknown. No clear treatment alternative exist for young children, pregnant women, or allergic individuals, in whom tetracyclines are contra-indicated. We performed in vitro antibiotic susceptibility tests with this recently isolated agent grown in the human promyelocytic leukemia cell line HL-60. Doxycycline (MIC, 0.25 micrograms/ml), rifampin (MIC, 0.5 micrograms/ml), rifabutin (MIC, < or = 0.125 micrograms/ml), ciprofloxacin and ofloxacin (both with MICs of 2 micrograms/ml), and trovafloxacin (MIC, < or = 0.125 micrograms/ml) ciprofloxacin and ofloxacin (both with MICs of 2 micrograms/ml), and trovafloxacin (MIC, < or = 0.125 micrograms/ml) demonstrated significant activity against the HGE agent. These agents were also bactericidal. The HGE agent was resistant to clindamycin, trimethoprim-sulfamethoxazole, and imipenem-cilastatin, as well as to ampicillin, ceftriaxone, erythromycin, and azithromycin, antibiotics commonly used to treat Lyme disease. Both chloramphenicol and gentamicin had weak inhibitory activities but were not bactericidal. Our findings confirm the observed clinical efficacy of doxycycline and further suggest that the rifamycins and quinolones, particularly trovafloxacin, hold promise as alternative agents for treating this new infection.

Full Text

The Full Text of this article is available as a PDF (334.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bakken J. S., Dumler J. S., Chen S. M., Eckman M. R., Van Etta L. L., Walker D. H. Human granulocytic ehrlichiosis in the upper Midwest United States. A new species emerging? JAMA. 1994 Jul 20;272(3):212–218. [PubMed] [Google Scholar]
  2. Bakken J. S., Krueth J., Wilson-Nordskog C., Tilden R. L., Asanovich K., Dumler J. S. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA. 1996 Jan 17;275(3):199–205. [PubMed] [Google Scholar]
  3. Brouqui P., Raoult D. In vitro antibiotic susceptibility of the newly recognized agent of ehrlichiosis in humans, Ehrlichia chaffeensis. Antimicrob Agents Chemother. 1992 Dec;36(12):2799–2803. doi: 10.1128/aac.36.12.2799. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Brouqui P., Raoult D. In vitro susceptibility of Ehrlichia sennetsu to antibiotics. Antimicrob Agents Chemother. 1990 Aug;34(8):1593–1596. doi: 10.1128/aac.34.8.1593. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chen S. M., Dumler J. S., Bakken J. S., Walker D. H. Identification of a granulocytotropic Ehrlichia species as the etiologic agent of human disease. J Clin Microbiol. 1994 Mar;32(3):589–595. doi: 10.1128/jcm.32.3.589-595.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dumler J. S., Asanovich K. M., Bakken J. S., Richter P., Kimsey R., Madigan J. E. Serologic cross-reactions among Ehrlichia equi, Ehrlichia phagocytophila, and human granulocytic Ehrlichia. J Clin Microbiol. 1995 May;33(5):1098–1103. doi: 10.1128/jcm.33.5.1098-1103.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fishbein D. B., Dawson J. E., Robinson L. E. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med. 1994 May 1;120(9):736–743. doi: 10.7326/0003-4819-120-9-199405010-00003. [DOI] [PubMed] [Google Scholar]
  8. Goodman J. L., Nelson C., Vitale B., Madigan J. E., Dumler J. S., Kurtti T. J., Munderloh U. G. Direct cultivation of the causative agent of human granulocytic ehrlichiosis. N Engl J Med. 1996 Jan 25;334(4):209–215. doi: 10.1056/NEJM199601253340401. [DOI] [PubMed] [Google Scholar]
  9. Harkess J. R., Ewing S. A., Brumit T., Mettry C. R. Ehrlichiosis in children. Pediatrics. 1991 Feb;87(2):199–203. [PubMed] [Google Scholar]
  10. Jacobs R. F., Wilson C. B. Intracellular penetration and antimicrobial activity of antibiotics. J Antimicrob Chemother. 1983 Oct;12 (Suppl 100):13–20. doi: 10.1093/jac/12.suppl_c.13. [DOI] [PubMed] [Google Scholar]
  11. Krause P. J., Telford S. R., 3rd, Spielman A., Sikand V., Ryan R., Christianson D., Burke G., Brassard P., Pollack R., Peck J. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. 1996 Jun 5;275(21):1657–1660. [PubMed] [Google Scholar]
  12. Kubin R. Safety and efficacy of ciprofloxacin in paediatric patients--review. Infection. 1993 Nov-Dec;21(6):413–421. doi: 10.1007/BF01728929. [DOI] [PubMed] [Google Scholar]
  13. Magnarelli L. A., Dumler J. S., Anderson J. F., Johnson R. C., Fikrig E. Coexistence of antibodies to tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in human sera. J Clin Microbiol. 1995 Nov;33(11):3054–3057. doi: 10.1128/jcm.33.11.3054-3057.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Neu H. C., Chin N. X. In vitro activity of the new fluoroquinolone CP-99,219. Antimicrob Agents Chemother. 1994 Nov;38(11):2615–2622. doi: 10.1128/aac.38.11.2615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Pancholi P., Kolbert C. P., Mitchell P. D., Reed K. D., Jr, Dumler J. S., Bakken J. S., Telford S. R., 3rd, Persing D. H. Ixodes dammini as a potential vector of human granulocytic ehrlichiosis. J Infect Dis. 1995 Oct;172(4):1007–1012. doi: 10.1093/infdis/172.4.1007. [DOI] [PubMed] [Google Scholar]
  16. Prokesch R. C., Hand W. L. Antibiotic entry into human polymorphonuclear leukocytes. Antimicrob Agents Chemother. 1982 Mar;21(3):373–380. doi: 10.1128/aac.21.3.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Schaad U. B., abdus Salam M., Aujard Y., Dagan R., Green S. D., Peltola H., Rubio T. T., Smith A. L., Adam D. Use of fluoroquinolones in pediatrics: consensus report of an International Society of Chemotherapy commission. Pediatr Infect Dis J. 1995 Jan;14(1):1–9. doi: 10.1097/00006454-199501000-00001. [DOI] [PubMed] [Google Scholar]
  18. Telford S. R., 3rd, Lepore T. J., Snow P., Warner C. K., Dawson J. E. Human granulocytic ehrlichiosis in Massachusetts. Ann Intern Med. 1995 Aug 15;123(4):277–279. doi: 10.7326/0003-4819-123-4-199508150-00006. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES