Tick-borne diseases: Ehrlichiosis and Rocky Mountain spotted fever (Proceedings)
Apr 01, 2010
CVC IN WASHINGTON, D.C. PROCEEDINGS
Interpreting test results for agents of ehrlichiosis and RMSF
Tick-borne disease testing often involves detection of antibodies to different organisms of interest. Antibodies may be detected on a patient-side assay such as the 3Dx/4Dx SNAP tests (ehrlichosis) or may require a diagnostic laboratory to perform an IFA (RMSF). The E. canis component of the 3Dx/4Dx assay indicates that antibodies are present, and thus prior or current infection, but not necessarily disease, has occurred. Thus, when positives occur, a complete blood count with platelet count should be performed. If a low platelet count is present then treatment is indicated. Treatment is also indicated in any clinically ill dog. A positive also may be generated on the E. canis spot when exposure to E. chaffeensis has occurred; indeed, recent research shows that the majority of E. canis SNAP-positive dogs in some areas actually have exposure to E. chaffeensis. Antibodies may also be detected on IFA using E. canis infected cells as antigen. This approach allows determination of a titer. However, cross-reactivity among different Ehrlichia spp., including E. canis, E. chaffeensis, and E. ewingii is common. Regardless of the cause of antibody production, positives do indicate that there has been a breach in the tick control program and that the dog is being bitten by ticks and at risk of contracting a tick-borne disease. For detecting antibodies to RMSF, IFA using R. rickettsii infected cells as antigen is performed. Rapid patient-side assays for RMSF are not available. The IFA also detects antibodies generated against other Rickettsia spp. and so specificity for R. rickettsii is not assured. Dogs with RMSF can develop severe disease and die prior to seroconversion; treatment should not be delayed pending confirmation with serologic testing.Other tests for ehrlichiosis and RMSF include polymerase chain reaction, examination of stained blood smears, and culture. Testing by PCR, which detects DNA of causative agents, can be quite useful to diagnose acute ehrlichiosis or RMSF, so long as circulating organisms are present. Ehrlichia spp. are found in circulating monocytes (E. canis, E. chaffeensis) or neutrophils (E. ewingii). Rickettsia rickettsii may be present in circulation and thus detected by PCR in sloughed infected endothelial cells. Ehrlichiosis can also be diagnosed by finding organisms within blood cells on stained blood smears. However, the organisms are often present in low numbers, particularly with the monocytic forms, and specialized training is required to identify them accurately. A negative result on PCR or blood smear examination does not rule-out the possibility of infection. Culture for Ehrlichia spp. can be performed but is challenging and largely reserved for specialized research laboratories. Culture of R. rickettsii is only performed in high level biosafety laboratories (BL-3) due to the risk of severe human disease.