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 1. INTRODUCTION

Canine ehrlichiosis is a crucial tick-borne disease of dog’s worldwide (Beall et al., 2012).
Canine ehrlichiosis is caused by gram-negative; obligate intracellular, pleomorphic bacteria of
the genus Ehrlichia (order Rickettsiales, family Anaplasmataceae). Ehrlichia species infect
primarily leukocytes, forming intracytoplasmic, membrane-bound bacterial aggregates, called
morulae (sainz et al., 2015). Ehrlichiosis in dogs is a rickettsial infection caused by the varied
species of genus Ehrlichia but most commonly by E.canis, E.chaffeensis, E.ewingii and possibly
E.ruminantium (Vieira et al., 2011). Ehrlichia canis was the primary species recognized to
infect dogs and is the principal cause of canine monocytic ehrlichiosis (CME) (Donatien and
Lestoguard, 1935, Neer., 2002, sainz et al., 2015). Εhrlichia chaffeensis, the reason behind of
human monocytic ehrlichiosis, has recently emerged as an infrequent cause of clinical disease
within the dog, indistinguishable from that caused by E. canis (Nair et al., 2016). Εhrlichia
ewingii, is that reason for canine granulocytic ehrlichiosis (Goodman et al., 2003)

Ehrlichia ruminantium, the reason behind of heartwater in cattle, has been molecularly detected
within the blood of healthy dogs or dogs presented with symptoms implicative of ehrlichiosis,
within the context of negative serological and molecular testing for E. canis (Allsop , 2001) The
three Ehrlichia species have the potential of zoonotic transmission through vectors (monocytic
canine ehrlichiosis, human monocytic ehrlichiosis, and canine granulocytic ehrlichiosis);
although the role of the dog isn’t yet within the epidemiology of the disease in humans(perez et
al., 2006). Ehrlichiosis can manifest in three phases Signs of the acute phase of the disease
usually include anemia, fever, depression, lethargy, and loss of appetite, shortness of breath, joint
pain and stiffness. In the subclinical phase the animal may appear normal or show only slight
anemia and may last for months or years.

The chronic phase can be either mild or severe and characterized by weight loss, anemia,
neurological signs, bleeding, inflammation of the eye, edema within the hind legs, and fever.
Blood tests show that one or all of the various blood cell types are decreased. One cell type, the

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lymphocyte may increase and be abnormal in appearance (Skotarczak, 2003). The distribution of
ehrlichiosis correlates with the presence of the vector (Stich et al., 2008)

The distribution of canine ehrlichiosis is associated to the distribution of the vector ticks,
Rhipicephalus sanguineus, the brown dog tick and vector for E.canis throughout the world in
addition as Amblyoma americanum, the lone star tick and first vector for E.chaffeensis and
E.ewingii in the U.S (Ettinger and Feldman, 2005). The disease is reported in many countries,
being more common in tropical and subtropical regions (Neer and Harrus, 2006). Even if, studies
in Africa lacks to recognize Ehrlichia canis, the causative agent of canine ehrlichiosis or tropical
canine Pancytopaenia (TCP) has been identified as stated by Kamijolo et al, (1976) in Kenya,
Nidp et al, (2000) in Cameroon and Matjila et al. (2008) in South Africa. The canine
ehrlichiosis a gents are maintained in nature through enzootic ticks and, wild and domestic
animals. Because transovarial transmission is inefficient in ticks, animals seem to play a
significant role in propagation and as reservoir of these pathogens.

Dogs are competent reservoir hosts of several zoonotic agents and can serve as a readily
available source of nutrition for several blood-feeding arthropods. Therefore, the growing
medical interest in canine vector-borne diseases is directly associated with public health. Despite
being considered rare, human infestation with brown dog tick varies regionally and R.
sanguineus feed on humans way more commonly than previously thought.

This may imply that the tick is becoming more anthropophilic or that a more human adapted
population of R. sanguineous has been introduced. There after the canine ehrlichiosis are subject
to increasing interest from veterinary and public health perspectives (Paddock and Childs, 2003).

Diagnosis can be done by direct identification of inclusion bodies or morulae of E. canis in

leucocytes from blood smears (Elias, 1991), or from buffy coat smears and lymph node
aspiration (Mylonakis, 2003). Detection of specific antibodies by the immunofluorescent
antibody test (IFAT) and Dot-ELISA (Oliveira, 2000, Cadman, 2004 and Nakaghi, 2008), and by
molecular techniques like nPCR (Wen, 1997, Nakaghi, 2008) are also used as diagnostic
methods.

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The objective of this seminar paper is to highlight available information on canine Ehrlichiosis
with special focus on its etiology, epidemiology, pathologic significance, control methods and its
public health importance

2. LETRATURE RVIEW

It is also known as canine rickettsiosis, canine hemorrhagic fever, canine typhus, tracker dog
disease, and tropical canine pancytopenia. The disease was first described in Algeria in 1935 by
Donatien and Lestoquard. Ehrlichiae are a group of small, gram-negative, pleiomorphic, obligate
intracellular cocci that infect different blood cells in various animal species and in human
(Lauren et al., 2003)

2.1. Etiology

Ehrlichiosis in dogs is a rickettsial infection caused by the many species of genus Ehrlichia but
most ordinarily by E.canis, E.chaffeensis, E.ewingii, and possibly E.ruminantium (Vieira et al.,
2011). The organisms are considered as leukocytophilic bacteria and that they multiply within
the cytoplasmic vacuoles of circulating monocyte and tissue macrophages (Chakrabarti et al.,
2012). Ehrlichia is a type of bacteria that have tropism for hematopoietic cells and causes mainly
two kinds of canine ehrlichiosis namely monocytic ehrlichiosis by E. canis (Harrus and Waner,
2011) and granulocytic ehrlichiosis by E. ewingii (Anderson et al., 1992).

The diseases caused by these pathogens have traditionally been categorized by the sort of blood
cell most ordinarily infected. For instance, E.chaffeensis and E.canis reside primarily in
monocytes, and also the disease caused by these agents is usually called

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monocytic (or monocytotropic) ehrlichiosis and E. ewingii reside primarily in granulocytes, and
also the disease caused by these agents is usually observed to as granulocytic (or
granulocytotropic) ehrlichiosis with their respective vectors (Jennifer, 2003)

2.2. Taxonomy and its characteristics

Previously, Ehrlichia spp. lived in family Rickettsiaceae and Anaplasma spp. lived in family
Anaplasmataceae in the order Rickettsiales (Moulder, 1974). At the present these two genera
belong to family Anaplasmataceae (Dumler et al., 2001). The Ehrlichia and Anaplasma genera
are classified as small, gram-negative, and obligate intracellular cocci that infect leukocytes in
humans and various animal species. They range from 1 to three µm in diameter and largely
divide within white blood cells to make morulae, characteristic of this bacterial pathogen (CDC,
2007, Cunha, 2007 and MedlinePlus Medical Encyclopedia, 2007). They need distinguished
from gram-negative organisms in this they are doing not cause endotoxemia and that they require
a vector for transmission (Williams et al., 2007). These organisms are found in membrane-lined
vacuoles within the cytoplasm of infected eukaryotic host cells, most frequently leukocytes. The
obligate intracellular location of these organisms makes a good host immunologic response
difficult, and this complicates antimicrobial therapy (Murphy et al., 2002).

The major characteristics of Ehrlichia species, the genus consists of five recognized species
including E. canis, E. Chaffeensis, E. ewingii, E. muris, and E. ruminantium(Dumler et al .,
2001), all of which are a minimum of 97.7% similar in 16Sr RNA gene sequences ( Van Vliet
et al.,1992, Wen et al., 1995). Ehrlichia chaffeensis and E. ewingii (the etiologic agent of
granulocytic ehrlichiosis in dogs) are significant agents of emerging human ehrlichioses in North
America (Paddock and Childs, 2003, Ndip et al., 2007). Whereas E. ruminantium, the etiologic
agent of heartwater in sheep, goats, and cattle, is recognized as a significant agricultural biothreat
(McBride et al., 2009)

Ehrlichia canis, the causative agent of canine monocytic ehrlichiosis (CME), could be a globally
distributed pathogen known to infect dogs (Unver et al., 2001, Ndip et al., 2005). Ehrlichia
canis, E. Chaffeensis, and E. muris, have a predilection for macrophages and monocytes in their
susceptible hosts (Dumler et al., 2001, Dawson et al., 1991). E . Ewingii encompasses a

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predilection for peripheral blood neutrophils and sometimes eosinophil (Ewing et al., 1997,).
Whereas E. Ruminantium infects preferentially endothelial cells and, occasionally, neutrophils
of ruminants (Yu et al., 2007).

E. chaffeensis has a biphasic developmental cycle involving two morphologically distinct forms
the infectious extracellular forms (dense core cells) first attach to the surface of host target cells
before entering by endocytosis. Inside the host cells, the bacteria differentiate into reticulate cells
within a membrane-bound vacuole where they create a secure niche for survival and replication
by binary fission to make large colonies, called morulae. after some days, the bacteria
redifferentiate into infectious forms to be released outside the cell and begin a new cycle of
infection (Zhang et al., 2007). A number of the Ehrlichia organisms are cultured in human
myeloblastic leukaemia cell lines with potential for monocytic or myelocytic variation. Canine
leukemia cell lines of histolytic origin even have been used to grow E. chaffeensis. Many
Ehrlichia remain uncultivable; however. These organisms stain blue with Romanov sky stain
(Taylor et al., 2007).

2.3. Epidemiological Factors

Ehrlichiosis is taken into account endemic in tropical and subtropical regions since these areas
present adequate climatic for the tick vector growth and development (Dantas-Torres et al.,
2010) The epidemiology of canine ehrlichiosis is closely related not only to the vector
distribution, which is more frequently related to tropical and subtropical zones, but also to animal
behavior, age, and its environment (Costa et al., 2007, Rodriguez-Vivas et al., 2005, S´ainz et
al ., 1996 )

Ehrlichia canis has a worldwide geographic distribution, occurring particularly in tropical and
subtropical areas (Harrus and Waner, 2011). Geographic distribution of tick vectors contains a
direct impact on disease prevalence in a given region (Hinrichsen et al.,2001), as an example,
prevalence rates of E. canis infection in dogs range from less than 1% up to 50% in Europe and
its higher in kennelled dogs and in dogs without external antiparasitic treatment. Indeed, E. canis
is endemic in all European countries bordering the Mediterranean, The prevalence of E.canis
infection in dogs varies according to several factors, but generally correlates with the extent of

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exposure to infected tick vectors. Studies have reported higher positivity rates among males as
compared to females and among older dogs as compared with young ones (Sainz et al.,2015) .

This is probably associated with behavioural characteristics of males, which increase their level
of exposure to the tick vectors as compared with females. The identical applies for age since the
probability of becoming infected increases because the dog ages. Breed related susceptibility has
also been suggested by epidemiological and experimental studies. Indeed, German shepherd
dogs and Siberian Huskies are predisposed to developing more severe clinical signs (Harrus et
al., 1997).

E. canis: Transmitted by Rhipicephalus sanguineus, E. canis is found world-wide. Within North

America, the highest seroprevalence rates are reported in the Southern US (Beall et al., 2012,
Qurollo et al. 2014). E. canis typically infects canine mononuclear cells. Canine monocytic
ehrlichiosis (CME) is characterized by 3 stages: acute, subclinical and chronic. Following an
incubation period of 1-3 weeks, infected dogs may remain subclinical or present with nonspecific
signs including fever, lethargy, lymphadenopathy, splenomegaly, lameness, edema, bleeding
disorders and mucopurulent ocular discharge. Less commonly reported nonspecific signs include
vomiting, diarrhea, coughing and dyspnea. Bleeding disorders can include epistaxis, petechiae,
ecchymoses, gingival bleeding and melena. Ocular abnormalities identified in E. canis infected
dogs have included anterior uveitis, corneal opacity, retinal hemorrhage, hyphema, chorioretinal
lesions and tortuous retinal vessels (Mylonakis et al., 2011)

E. chaffeensis: Transmitted by Amblyomma americanum, E. chaffeensis infects mononuclear

cells and infrequently causes clinical disease in naturally infected dogs. Fever and lethargy,
together with mild thrombocytopenia and monocytosis has been reported (Abusaada et al., 2016,
Starkey et al., 2014, Zhang et al. 2003)

E. ewingii: Transmitted by Amblyomma americanum, E. ewingii is the most seroprevalent

canine Ehrlichia spp. in North America, predominantly within the Southern and Midwestern
United States (Beall et al., 2012, Qurollo et al. 2014). It infects granulocytes, and
clinicopathologic abnormalities reported in dogs with canine granulocytic ehrlichiosis include
fever, lameness, neurological abnormalities, lymphadenomegaly, peripheral edema,
thrombocytopenia, leukopenia, and neutrophilic polyarthritis (Breitschwerdt et al., 1998,

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Goodman et al,. 2003, Abusaaa et al., 2016). Geographic distribution of Ehrlichia species
distribution of ehrlichia canis is worldwide, primarily tropical and temperate climates. Because
of chronic infection, disease manifestation may develop years after tick transmission and after
the dog has been moved to a no endemic region where the disease might not be considered (Neer
et al., 2002). Ehrlichia chaffeensis resides primarily in the southeastern, south-central and mid-
Atlantic USA where its vector, the lone-star tick Amblyomma americanum, is endemic (Dawso,
2005). There is a lower prevalence of E. chaffeensis in nymphal ticks than adults (Parola et al.,
2005). There is no evidence for transovarial transmission of the pathogen, but trans-stadial
transmission has been demonstrated in the laboratory (Long et al., 2003)

2.3.1. Transmission

All currently defined Ehrlichia species are biologically transmitted by ticks of the family
Ixodidae (Bremer et al., 2005). The brown dog tick, Rhipicephalus sanguineous, acts as the
primary vector of E. canis transferring the pathogen between hosts during blood meals. Dogs,
both domestic and wild, act as reservoir hosts for this pathogen and are the first hosts of brown
dog ticks. Brown dog ticks become carriers of the pathogen after they take a blood meal from a
rickessemic dog. Stored in the midgut and salivary glands of an infected tick, E. canis is
transferred via the saliva of ticks carrying the pathogen to hosts during blood meals (Bowman et
al., 2009). E. chaffeensis is transmitted primarily by Amblyomma americanum ticks (Ndip et al.,
2010). Ehrlichia species also can be transmitted by blood transfusion and it is recommended to
observer for its presence in the blood of donor dogs (Nelson and Couto, 2003). The ticks can
transmit the disease for up to five months after engorgement. The infection can even be
transmitted through blood transfusions. The acute case occurs mostly in summer due to his
greatest activity of the tick vector during that period (Sharma et al., 2010).

Transmission, in the tick, occur transstadially, but not transovarialy. Larvae and nymphs become

infected while feeding on rickettsemic dogs and transmit the infection to the host after moultig to
nymphs and adults, respectively. Ehrlichiosis occurs mainly in the spring, early summer (Taylor
et al., 2007) Generally all breeds of dogs are equally predisposed to ehrlichiosis but German

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shepherd and Siberian Huskies develops more severe kind of ehrlichiosis because of reduced
cell-mediated immune response to E. Canis in these breeds therefore; these breeds have a worse
prognosis (Nyindo et al., 1980). The severity of the disease depends on the dog’s age (i.e., young
dogs are more susceptible), strain of the organism, the presence of concurrent disease, and breed
(example, German shepherds) are more likely to be infected (Nelson and Couto, 2003)

2.3.2. Vectors

In canine ehrlichiosis transmission; mainly two important tick species are involved those are
Rhipicephalus sanguineus and Amblyoma americanum from the genus Rhipicephalus and
Amblyoma respectively whether or not other are can also transmit. The brown dog tick is found
worldwide and is considered the most widespread tick species in the world. It’s more common in
warmer climates and is present throughout Florida. Brown dog ticks are found on dogs, in
kennels and houses, and sometimes on wildlife. The preferred attachment sites on a dog are the
head, ears, back, between toes, and axilla (the area directly under the joint where the legs hook
up with the body (Dantas-Torres, 2010)

The brown dog tick could be a three-host tick; meaning each active stage (larva, nymph, and
adult) feeds just one occasion, then leaves the host to digest the blood meal and molt to the next
stage or lay eggs .Mating of brown dog ticks occurs on the host following the stimulation of
blood ingestion. An adult female will feed on the host for about one week, then drop off the host
and find a secluded place for egg incubation for about one to two weeks. Cracks and crevices in
houses, garages and dog runs are ideal locations. She may start laying as soon as four days after
she completes feeding and drops off the host, and can continue to lay for 15 to 18 days. As she
lays the eggs, she passes them over her porose areas (specialized areas on the back of the basis
capituli) to coat them in secretions that protect the eggs from desiccation (Sonenshine and Roe
2014).

High infestation levels can cause skin irritation in dogs. The brown dog tick is a vector of
several pathogens causing dog diseases including canine ehrlichiosis (Ehrlichia canis) and

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canine babesiosis (Babesia canis) in the US. These rarely cause disease in humans; only some
cases are known. In dogs, symptoms of canine ehrlichiosis include lameness, depression, weight
loss, anorexia, and fever (Harrus et al. 1999). In Ethiopia R. sanguineous isn’t still identified
rather other Rhipicephalus species of ticks are recognized (Belew and Mekonnen, 2011).But
according to Jongejan (1987) and Ahmed et al (2005) tick Rhipicephalus sanguineous is
identified in southern Sudan from the border of Ethiopia.

2.3.3. Life Cycle

Ehrlichia spp. replicate in tick and trematode. The life cycle of Ehrlichia spp. goes through the
three developmental stages of elementary bodies, initial bodies and morulae (Forbes et al., 1998).
Within a cell small elementary bodies (0.2 to 0.5 µm) develop into larger initial bodies (1.0 to
1.5 µm) and eventually into intracytoplasmic inclusion bodies (morulae: 2 to 5 µm) containing
approximately 100 elementary bodies (Kruss et al., 2003). Elementary bodies are individual
Ehrlichia about 1 µm in diameter and usually coccoid or ellipsoid in shape. Once they are
captured inside the phagosomes, the pathogens replicate by binary fission, forming clusters of
tightly packed elementary bodies termed initial bodies. Additional growth and replication leads
to the formation of the morula, the configuration that typifies the genus. Rupture of the host cell
releases the elementary bodies to infect new cells (Nicholson et al., 2010)

2.4. Pathogenic Effects

Generally, the Ehrlichia species tend to infect leukocytes, where they enter the cell by
endocytosis and once inside the host cell, they inhibit the fusion of the phagosome and lysosome.
They develop within the host cell vacuoles first as reticulate cells and then as dense-core cells,
eventually being released by lysis of the cell. The inclusion body that contains the organism is

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called a morula, due to its “mulberry-shaped” appearance (CDC, 2007, stone et al 2004). On
entry organisms invade the monocyte, macrophages and epithelial cells. Monocytes multiply in
numbers and entire cytoplasm is filled with them, resulting into destruction of leukocytes and
thrombocytes. The severe chronic form is attributed as tropical canine pancytopenia. There is
impairment in the production of blood cells.
Thrombocytopenia is the most consistent blood abnormality. The causes for such reduction of
platelets have been put forth as increased platelets consumptions as a result of inflammatory
changes in blood vessels endothelium, increased splenic sequestrations of platelets and
immunologic destructions of platelets (Harrus et all., 1997).The pathogenesis consists of an
incubation period of 8 to 20 days, followed sequentially by acute, subclinical, and in some cases
chronic phases. As Ehrlichia do not contain pili the process of entering the host and facilitating
infection occurs once Ehrlichia bind to the host cell by way of its outer membrane.
After the bacteria are enveloped within the host cell, Ehrlichia form membrane bound
compartments (endosomes) that help to maintain their distinct cytoplasmic compartments. Once
transmitted, E. canis target and infect the mononuclear phagocytic cells. Most generally infected
are the monocytes, within the human or canine host. However, monocytes are not the only cells
that are susceptible to infection. Further studies have reported ehrlicial infection within
lumphocytes, promyelocytes and metamyelocytes as well. It is assumed however, that because of
their more frequent and higher rates of infection, mononuclear phagocytes are capable of
maintaining the productive infection within their cells (Paddock et al., 2003). Typically an
infected monocyte contains approximately 1 or 2 morulae. Ehrlichia maintain and ensure their
survival by multiplying within the host endosomes. Consequently, these pathogens are able to
guarantee their survival because they possess the capability to reprogram the systems and
mechanisms of defense employed by the host cell (Ismail et. al 2010).

Immunologic and inflammatory mechanisms are involved with increased platelet consumption.
Polyartheritis may arise from haemarthrosis and immune complex in to the joints and is often
accompanied by neutrophilic inflammation. Platelet-associated IgG and antibodies that recognize
platelet proteins in dogs with E.canis infection may play a role in the thrombocytopenia (Ettinger
and Feldman, 2005).

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2.5. Clinical finding

Clinical signs and the severity of illness seen with ehrlichiosis depend on the species of Ehrlichia
involved and the immune response of the dog. In general, all breeds of dogs are susceptible to E.
canis infection, but German shepherds seem to develop severe forms of the disease more
frequently than other breed (Nyindo et al., 1980)

CME is characterized by three stages, acute, subclinical and chronic. These can be difficult to
definitively distinguish in practice.

Acute Phase The acute phase lasts between two to four weeks (Neer et al., 2006) and is
characterized by fever, weight loss, anorexia, depression, lymphadenomegaly, splenomegaly,
vasculitis, and ocular and musculoskeletal signs (Waner et al., 1995, Waner., 1999 and Dagnone
et al., 2001). Thrombocytopenia is the most common abnormality in naturally or experimentally
infected dogs in this phase of the disease (Harrus et al., 1997)

Subclinical Phase a duration that varies from months to years (Codner and Farris-smith, 1986,
Neer et al., 2006). Dogs in this stage are known to be carriers of E. canis and remain clinically
healthy for months or years (Harrus et al., 1998) until they spontaneously recover from infection
or develop severe illness. During this phase, the animal may show high anti E .canis antibody
titers, persistent thrombocytopenia, and leucopenia with no other clinical signs (Codner and
Farris-smith, 1986, waner et al., 1997 and Harrus et al., 1998). Generally, bacterial DNA is not
found in blood samples in this phase; spleen and bone marrow are the most appropriate tissues to
analyze (Mylonakis et al., 2003, Harrus et al., 2004)

Chronic Phase Some infected dog progress to a chronic phase, which can be mild or severe.
This is characterized by recurrent clinical and hematological signs including thrombocytopenia,
anemia, and pancytopenia. Dogs may have weight loss, depression, petechiae, pale mucous
membranes, edema, and lymphadenopathy among other signs. In severe cases, the response to
antibiotic therapy is poor and dogs often die from massive hemorrhage, severe debilitation, or
secondary infections. It is very likely that E. canis causes immunosuppression but currently little

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is known about the immune biology of this infection. A recent study in dogs was unable to
demonstrate a marked immunosuppression (Hess et al., 2006).

2.6. Diagnostic Techniques

Diagnosis of canine ehrlichiosis is routinely based on serology the indirect fluorescent antibody
test (IFAT) is usually recommended to verify a diagnosis of ehrlichiosis (waner et al., 2001).
Detection of specific IgG antibodies indicates previous exposure to the ehrlichial pathogen, and
during the acute disease two tests one to two weeks apart will show rising antibody titers.
However, there’s extensive serologic cross-reactivity between E. canis and E. chaffeensis and E.
ewingii (Cardens et al., 2007).

Enzyme-linked immunosorbent assays (ELISA) can also be used to confirm a diagnosis of

ehrlichiosis and different Dot-ELISA kits for the detection of E. canis-IgG antibodies are
commercially available. Western immunoblot is a more specific test, which can distinguish
between infections with the various organisms causing ehrlichiosis, anaplasmosis, or
neorickettsiosis as well as between Ehrlichia spp., as an example E. canis and E. ewingii. Dogs
will generally become seronegative following antibiotic treatment, but some dogs will show
stable antibody titers for years (Breitschwerdt, 2007).

Polymerase chain reaction may overcome several diagnostic limitations of serology

(confirmation of exposure instead of current infection) and cytology (overall low diagnostic
sensitivity). It’s a sensitive method for the first detection (usually 4-10 days post-inoculation),
molecular characterization and quantification (real-time PCR) of the ehrlichial organisms (Stich
et al., 2002, Baneth et al., 2009, Harrus and Waner,2011 and Sainz A et al., 2015). Also, PCR is
more useful than serology, for the documentation of concurrent infections with different
ehrlichial species and also the post-treatment monitoring (Iqbal and Rikihisa, 1994, Waner et al.,
1997and kordick SK et al., 1999)

Therefore, there’s no single method of diagnosis for this disease; instead, the diagnosis is
achieved to varying degrees of certainty through a combination of history, clinical and

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hematological indicators, serologic evidence, and molecular confirmation (Waner et al., 2001;
Neer et al., 2002).

2.7. Differential Diagnosis

The differential diagnosis for suspect canine ehrlichiosis is extensive and varies according to the
organ systems most affected. The nonspecific nature of the clinical presentation mimics
interstitial pneumonia, and glomerulonephritis, hepatitis, leptospirosis, gastroenteritis,
endocarditis, pneumonia, and meningo-encephalitis. Ehrlichiosis might also resemble non-
infectious diseases, like collagen vascular diseases and hematologic malignancies. But canine
ehrlichiosis is accompanied by pancytopaenia and thrombocytopenia (Ganguly et al., 2008)

Prognosis The prognosis is good for dogs with acute ehrlichiosis. For dogs that have reached
the chronic stage of the disease, the prognosis is guarded (Mylonakis et al., 2004) .When bone
marrow suppression occurs and there are low levels of blood cells, the animal may not respond
to treatment.

2.8. Ehrlichia Treatment

Largely based on experimental infection studies, also as empirical data and clinical experience
with naturally infected dogs, the recommended treatment for Ehrlichia infections is doxycycline
at 5 mg/kg every 12 hours or 10 mg/kg every 24 hours for 30 days ( Eddlestone et al.,2007).
Tetracyclines are the treatment of choice for rickettsial diseases. For canine ehrlichiosis,
tetracycline (22 mg/kg given 3 times on a daily basis for 21 days) are recommended (Ettinger
and feldman, 2005) say lik this

Most dogs recover from the acute and subclinical phases when treated with doxycycline or other
tetracyclines at appropriate dosages for an adequate period of time (Harrus et al.,2004) but
many clinicians are now using doxycycline to treat ehrlichiosis in dogs due to better penetration
and higher concentration of the drug within the cell (Jim and Jerry ,2001) .Treatment must be
extended for several months through a minimum of one tick season if the endemic cycle is to be
successfully eliminated ( Kahn, 2005).

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2.9. Preventive and control Measures

Prevention in endemic areas is accomplished by maintaining strict tick control programs for dogs
and premises. Non-chemical methods include removal of ticks from dogs by hand with one slow
pressure movement near to the attachment site without twisting or crushing (Blagburn and
Dryden, 2009). There are no vaccines currently available to defend dogs from Ehrlichia spp.
infections, and further research is required to define the virulence factors and immunoprotective
antigens required to develop one. The most effective means of preventing canine ehrlichiosis is
by avoiding exposure to the tick vector. Treatments with ectoparasiticides that repel and kill ticks
reduce the danger of disease transmission. Spot-on products are applied topically to the dog’s
skin (Otranto et al., 2010).

In highly endemic areas, when adequate tick control is difficult to attain, prophylactic daily use
of low dose doxycycline during the tick season, reduces the chance of infection although this
practice may promote drug resistance. Incoming dogs during a non-endemic area should be
serologically screened and treated accordingly (Davoust et al., 2005)

Prophylaxis for travelling dogs involves tick control using fipronil, permethrin or deltamethrin
and owners should be encouraged to examine dogs daily to remove ticks before attachment
(Mark G and Susan S, 2005). Prevention in person is through avoidance of tick bites. Activity in
areas of high tick density should be avoided or minimized, particularly during months when tick
abundance is greatest. If exposure to tick habitat is unavoidable, measures like wearing long-
sleeved, light-colored clothing and application of approved repellants to clothing and skin are
effective means of reducing tick attachment. Thorough daily, whole-body examinations for, and
prompt removal of attached ticks should reduce one's risk considerably (Rohrbach et al., 1990)

3. ZOONOTIC IMPLICATION OF CANINE EHRLICHIOSIS

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Human ehrlichiosis is a zoonotic infection transmitted by ticks. The disease became nationally
notifiable to the Center of Disease Control and Prevention (CDC) in 1999. Since the initial
description of ehrlichiosis in 1986 (Paddock CD and Childs ,2003)

Ehrlichiae are obligate intracellular Gram-negative bacteria transmitted by ticks. The bacteria
primarily infect animal and human peripheral blood monocytes or granulocytes and are
responsible for life-threatening emerging human zoonosis and diseases of veterinary importance
worldwide (Ndip et al 2010)

A few decades ago, ehrlichioses were considered to only have veterinary relevance. The first
human infection with E. chaffeensis was diagnosed in 1986 raising the awareness of Ehrlichia
spp. as zoonotic pathogens (Maeda et al., 1987). Today, E. canis, E. chaffeensis, and E. ewingii
are all known to cause ehrlichiosis in humans. Most recently, E. ewingii – previously regarded as
canine specific – has been confirmed to cause human granulocytic ehrlichiosis (HGE)(Buller et
al., 1999). E. chaffeensis targets monocytes, and the disease in people is therefore mentioned as
human monocytic ehrlichiosis (HME). E. canis has been isolated in culture and detected in
several human patients with overt clinical signs in Venezuela (Perez et al., 1996, Perez et
al .,2006) . To date, there’s no evidence of direct transmission of Ehrlichia spp. from dogs to
humans (Fishbein., et al 1987pls inter) and dogs haven’t been established as a reservoir for
human infection. Moreover, the Brown Dog tick wouldn’t appear to be the main vector or
reservoir involved in zoonotic transmission because it rarely bites humans (Nelson, 1969). The
diseases in man infests in three forms (Chakrabarti, 2012). Because people can be infected with
ehrlichia organisms, the zoonotic potential of these infections must be considered. By virtue of
the need for a vector host, there’s no evidence that any of those infections are passed directly
from animals to people. Because pets are liable to infection with a number of the identical
organisms that people are, pets might serve as disease sentinels, or perhaps even as reservoirs of
infection ( Neer et al.,2002).

They grow as a cluster (morula) in neutrophils (Anaplasma phagocytophilum and E. ewingii)

and in monocytes (E. chaffeensis) (Reddy et al., 2007,Dumler,etal2001). The infection may

15
cause prolonged fever and general aches, and is characterized by leukopenia, cytopenia, and
elevated liver transaminases (MedlinePlus Medical Encyclopedia, 2007).

The disease can be life threatening in some patients (Walker and Dumle, 1996). The infection is
recorded in immunocompetent as well as immunosuppressed patients (Pal, 2015). The Infection
due to Ehrlichia may range from subclinical to fatal (Walker and Dumle, 1996). The symptoms
in the affected persons include fever, malaise, chills, loss of appetite, severe headache, nausea,
vomiting, abdominal pain, diarrhea, weight loss, myalgia, eye pain, cough, pharyngitis,
lymphadenopathy and maculopapular or petechial rashes on trunk and extremities (Fishben,
1994, Dumler, 2007 and Pal, 2007). Rashes are commonly observed in children. Severe
complications, like respiratory problems, renal insufficiency, and serious neurologic involvement
are observed in some patients. Death can occur in immunocompromised patients (Fishben,
1994).

3.1. Disease in human

3.1.1. Human Monocytic Ehrlichiosis and Human Granulocytic Ehrlichiosis

: 

Human monocytic ehrlichiosis is caused by E. chaffeensis appears as an undifferentiated febrile

illness. The most clinical signs include fever, headache, myalgias, vomiting, petecchiae, macular,
maculopapular or diffuse erythema cough, neurologic findings and
mental status changes. Malaise as well as various manifestations including lymphadenopathy,
gastrointestinal symptoms, pharyngitis or less frequently, conjunctivitis, dysuria, and peripheral
edema may occur. Leucopenia, thrombocytopenia, and elevated hepatic transaminases levels are
the most common laboratory findings. HME is most typically diagnosed in adults over 50 years
old. Severe or fatal HME has also been reported in immunocompromised patients (Paddock et
al., 2001).

16
Human granulocytic ehrlichiosis is caused by E. ewingii and E.phagocytophila; presented with
the most clinical signs included fever, malaise and myalgia, headache, nausea and vomiting,
leucopenia, thrombopenia and anemia (Paddock et al., 2001). Is an illness caused by an
Ehrlichia species that is closely associated with or conspecific with these species, but final
species designation for the HGE agent awaits description (Chen et al., 1994, Dumler and
Bakken, 1998). As the name implies, the preferred host cells for the HGE agent are the
granulocytic leukocytes, but non hematologic cell lines may also become infected in severe
disease (Bakken et al., 1994, Dumler and Bakken, 1995, Shea et al., 1996).

3.2. Human health risk factor

The frequency of reported cases of ehrlichiosis is highest among males and other people over 50
years of old. A compromised immune system (such as may occur through cancer treatments,
advanced human immunodeficiency virus infection, prior organ transplants, or some
medications) may increase the risk of severe outcome. Individuals who reside near or spend time
in wooded areas or areas with high grass may be at increased risk for infection. Although cases
of ehrlichiosis can occur during any month of the year, the majority of cases reported have an
illness onset during the summer months and a peak in cases typically occurs in the months of
June and July. This period is the season for increased numbers of adult and nymphal lonestar
ticks, which are the primary life stages of ticks that bite humans and if infected can transmit
disease (CDC, 2010).

17
4. CONCULISION AND RECOMENDATION

18
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