Skip to main content
NCBI home page
Journal of Clinical Microbiology logoLink to Journal of Clinical Microbiology
. 1997 Sep;35(9):2198–2205. doi: 10.1128/jcm.35.9.2198-2205.1997

Serological responses to Ehrlichia equi, Ehrlichia chaffeensis, and Borrelia burgdorferi in patients from New York State.

S J Wong 1, G S Brady 1, J S Dumler 1
PMCID: PMC229939  PMID: 9276387

Abstract

Serological testing at the New York State Department of Health for human granulocytic ehrlichiosis in the residents of Westchester County, N.Y., was performed with specimens from 176 patients by the indirect fluorescent-antibody (IFA) technique with Ehrlichia equi MRK-infected neutrophils. To understand whether human monocytotropic ehrlichiosis also occurs in this northeastern geographic region, specimens were also tested for antibodies to Ehrlichia chaffeensis Arkansas. Screening tests and immunoblots for Lyme disease (Borrelia burgdorferi infection) were also performed. Thirty-two patients had antibodies only to E. equi and 21 patients had antibodies to both E. equi and E. chaffeensis, whereas 12 patients had only E. chaffeensis antibodies by the IFA technique. The remaining patients did not have antibodies to either ehrlichia. Eighteen serum samples from 13 of these patients were coded and sent to the Ehrlichia Research Laboratory (Baltimore, Md.) for repeat analysis by the IFA test and for E. equi and E. chaffeensis immunoblots. Immunoblot analysis for E. equi in samples with positive IFA test results confirmed the results for eight of the nine specimens. Immunoblot analyses for E. chaffeensis were negative for all 18 serum samples. Borrelia-reactive antibodies were found in sera both from patients with granulocytic ehrlichiosis and from patients with monocytotropic ehrlichiosis from New York State. Our results suggest that E. equi antigen is an appropriate substrate for identifying human granulocytic ehrlichiosis. E. chaffeensis antigen lacks appropriate sensitivity to serve as a surrogate substrate for the detection of human granulocytic ehrlichiosis and should be used solely for the diagnosis of human monocytotropic ehrlichiosis. Heat shock proteins may, in some cases, cause cross-reactivity between B. burgdorferi and ehrlichiae.

Full Text

The Full Text of this article is available as a PDF (1.6 MB).

Selected References

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

  1. Aguero-Rosenfeld M. E., Horowitz H. W., Wormser G. P., McKenna D. F., Nowakowski J., Muñoz J., Dumler J. S. Human granulocytic ehrlichiosis: a case series from a medical center in New York State. Ann Intern Med. 1996 Dec 1;125(11):904–908. doi: 10.7326/0003-4819-125-11-199612010-00006. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. 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]
  4. Barbour A. G., Maupin G. O., Teltow G. J., Carter C. J., Piesman J. Identification of an uncultivable Borrelia species in the hard tick Amblyomma americanum: possible agent of a Lyme disease-like illness. J Infect Dis. 1996 Feb;173(2):403–409. doi: 10.1093/infdis/173.2.403. [DOI] [PubMed] [Google Scholar]
  5. Burkot T. R., Schriefer M. E., Larsen S. A. Cross-reactivity to Borrelia burgdorferi proteins in serum samples from residents of a tropical country nonendemic for Lyme disease. J Infect Dis. 1997 Feb;175(2):466–469. doi: 10.1093/infdis/175.2.466. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Dawson J. E., Anderson B. E., Fishbein D. B., Sanchez J. L., Goldsmith C. S., Wilson K. H., Duntley C. W. Isolation and characterization of an Ehrlichia sp. from a patient diagnosed with human ehrlichiosis. J Clin Microbiol. 1991 Dec;29(12):2741–2745. doi: 10.1128/jcm.29.12.2741-2745.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Dumler J. S., Bakken J. S. Ehrlichial diseases of humans: emerging tick-borne infections. Clin Infect Dis. 1995 May;20(5):1102–1110. doi: 10.1093/clinids/20.5.1102. [DOI] [PubMed] [Google Scholar]
  10. Dumler J. S., Bakken J. S. Human granulocytic ehrlichiosis in Wisconsin and Minnesota: a frequent infection with the potential for persistence. J Infect Dis. 1996 Apr;173(4):1027–1030. doi: 10.1093/infdis/173.4.1027. [DOI] [PubMed] [Google Scholar]
  11. Gerber M. A., Shapiro E. D. Diagnosis of Lyme disease in children. J Pediatr. 1992 Jul;121(1):157–162. doi: 10.1016/s0022-3476(05)82569-7. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Hardalo C. J., Quagliarello V., Dumler J. S. Human granulocytic ehrlichiosis in Connecticut: report of a fatal case. Clin Infect Dis. 1995 Oct;21(4):910–914. doi: 10.1093/clinids/21.4.910. [DOI] [PubMed] [Google Scholar]
  14. Hechemy K. E., Harris H. L., Wethers J. A., Stevens R. W., Stock B. R., Reilly A. A., Benach J. L. Fluoroimmunoassay studies with solubilized antigens from Borrelia burgdorferi. J Clin Microbiol. 1989 Aug;27(8):1854–1858. doi: 10.1128/jcm.27.8.1854-1858.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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]
  16. Magnarelli L. A., Stafford K. C., 3rd, Mather T. N., Yeh M. T., Horn K. D., Dumler J. S. Hemocytic rickettsia-like organisms in ticks: serologic reactivity with antisera to Ehrlichiae and detection of DNA of agent of human granulocytic ehrlichiosis by PCR. J Clin Microbiol. 1995 Oct;33(10):2710–2714. doi: 10.1128/jcm.33.10.2710-2714.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Masters E. J., Donnell H. D. Epidemiologic and diagnostic studies of patients with suspected early Lyme disease Missouri, 1990-1993. J Infect Dis. 1996 Jun;173(6):1527–1528. doi: 10.1093/infdis/173.6.1527. [DOI] [PubMed] [Google Scholar]
  18. Mitchell P. D., Reed K. D., Hofkes J. M. Immunoserologic evidence of coinfection with Borrelia burgdorferi, Babesia microti, and human granulocytic Ehrlichia species in residents of Wisconsin and Minnesota. J Clin Microbiol. 1996 Mar;34(3):724–727. doi: 10.1128/jcm.34.3.724-727.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. 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]
  20. Schulze T. L., Bowen G. S., Bosler E. M., Lakat M. F., Parkin W. E., Altman R., Ormiston B. G., Shisler J. K. Amblyomma americanum: a potential vector of Lyme disease in New Jersey. Science. 1984 May 11;224(4649):601–603. doi: 10.1126/science.6710158. [DOI] [PubMed] [Google Scholar]
  21. Scopio A., Johnson P., Laquerre A., Nelson D. R. Subcellular localization and chaperone activities of Borrelia burgdorferi Hsp60 and Hsp70. J Bacteriol. 1994 Nov;176(21):6449–6456. doi: 10.1128/jb.176.21.6449-6456.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Shrestha M., Grodzicki R. L., Steere A. C. Diagnosing early Lyme disease. Am J Med. 1985 Feb;78(2):235–240. doi: 10.1016/0002-9343(85)90432-2. [DOI] [PubMed] [Google Scholar]
  23. Spach D. H., Liles W. C., Campbell G. L., Quick R. E., Anderson D. E., Jr, Fritsche T. R. Tick-borne diseases in the United States. N Engl J Med. 1993 Sep 23;329(13):936–947. doi: 10.1056/NEJM199309233291308. [DOI] [PubMed] [Google Scholar]
  24. Sullivan T. J., Hechemy K. E., Harris H. L., Rudofsky U. H., Samsonoff W. A., Peterson A. J., Evans B. D., Balaban S. L. Monoclonal antibody to native P39 protein from Borrelia burgdorferi. J Clin Microbiol. 1994 Feb;32(2):423–429. doi: 10.1128/jcm.32.2.423-429.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sumner J. W., Sims K. G., Jones D. C., Anderson B. E. Ehrlichia chaffeensis expresses an immunoreactive protein homologous to the Escherichia coli GroEL protein. Infect Immun. 1993 Aug;61(8):3536–3539. doi: 10.1128/iai.61.8.3536-3539.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Telford S. R., 3rd, Dawson J. E., Katavolos P., Warner C. K., Kolbert C. P., Persing D. H. Perpetuation of the agent of human granulocytic ehrlichiosis in a deer tick-rodent cycle. Proc Natl Acad Sci U S A. 1996 Jun 11;93(12):6209–6214. doi: 10.1073/pnas.93.12.6209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Walker D. H., Dumler J. S. Emergence of the ehrlichioses as human health problems. Emerg Infect Dis. 1996 Jan-Mar;2(1):18–29. doi: 10.3201/eid0201.960102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Walker D. H. Human ehrlichiosis: more trouble from ticks. Hosp Pract (1995) 1996 Apr 15;31(4):47–57. [PubMed] [Google Scholar]
  29. Wong S., Grady L. J. Ehrlichia infection as a cause of severe respiratory distress. N Engl J Med. 1996 Jan 25;334(4):273–273. doi: 10.1056/NEJM199601253340418. [DOI] [PubMed] [Google Scholar]
  30. Wormser G. P., Horowitz H. W., Dumler J. S., Schwartz I., Aguero-Rosenfeld M. False-positive Lyme disease serology in human granulocytic ehrlichiosis. Lancet. 1996 Apr 6;347(9006):981–982. doi: 10.1016/s0140-6736(96)91475-0. [DOI] [PubMed] [Google Scholar]
  31. Wormser G. P., Horowitz H. W., Nowakowski J., McKenna D., Dumler J. S., Varde S., Schwartz I., Carbonaro C., Aguero-Rosenfeld M. Positive Lyme disease serology in patients with clinical and laboratory evidence of human granulocytic ehrlichiosis. Am J Clin Pathol. 1997 Feb;107(2):142–147. doi: 10.1093/ajcp/107.2.142. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES