Materiały źródłowe

• #1 Ehrlichiosis and anaplasmosis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ehrlichiosis/diagnosis-treatment/drc-20372147

  Tick-borne infections are difficult to diagnose based solely on signs and symptoms because they are similar to many other common conditions. Therefore, a history of a known tick bite or possible exposure to ticks is an important piece of information in making a diagnosis. Your doctor will also conduct a physical exam and order tests. […] If you have ehrlichiosis or anaplasmosis, the following results are likely found from blood tests: Low count of white blood cells, which are disease-fighting cells of the immune system; Low count of blood platelet cells, which are essential for blood-clotting; Elevated liver enzymes that may indicate abnormal liver function. […] Tests of your blood may also indicate a tick-borne infection by detecting one of the following: Specific genes unique to the bacteria; Antibodies to the bacteria created by your immune system. […] If your doctor diagnoses ehrlichiosis or anaplasmosis or suspects a diagnosis based on the symptoms and clinical findings you’ll begin treatment with the antibiotic doxycycline (Doryx, Vibramycin, others).

• #2 Clinical Testing and Diagnosis for Ehrlichiosis | Ehrlichiosis | CDC

  https://www.cdc.gov/ehrlichiosis/hcp/diagnosis-testing/index.html

  Never delay or withhold treatment pending the receipt of laboratory test results or an initially negative result. Early recognition and prompt treatment with doxycycline is critical. […] Ehrlichiosis can be identified by tests including serology, polymerase chain reaction, immunohistochemistry, culture, and blood-smear microscopy. […] Ehrlichiosis can be difficult to diagnose, particularly in the early stages of illness. Treatment should be started as soon as ehrlichiosis is suspected. […] Laboratory confirmation is helpful for disease surveillance and understanding burden of ehrlichiosis infection in the United States. […] Testing for ehrlichiosis should be considered for any person with a compatible illness and known risk factors, such as history of a tick bite. […] The optimal diagnostic test depends on the timing relative to symptom onset and the type of specimen(s) available for testing.

• #2 Clinical Testing and Diagnosis for Ehrlichiosis | Ehrlichiosis | CDC

  https://www.cdc.gov/ehrlichiosis/hcp/diagnosis-testing/index.html

  Ehrlichiosis is a nationally notifiable condition. Testing for and reporting of cases of ehrlichiosis are important to improve our understanding of disease prevalence, where it occurs, and how the incidence and geographic distribution change over time. […] Although a positive PCR result should be treated as clear evidence of active infection, a negative result does not rule out the diagnosis. Treatment should not be withheld due to a negative result. […] The reference standard serologic test for diagnosis of ehrlichiosis is the indirect fluorescent antibody (IFA) test for immunoglobulin G (IgG) antibodies directed against Ehrlichia spp. […] Antibody titers determined using IgG IFA tests are frequently negative (titer of less than 1:64) in the first week of illness. Ehrlichiosis cannot be confirmed using single acute antibody results. A single titer of 1:128 or greater is classified as presumptive laboratory evidence. […] Seroconversion provides the best evidence of recent infection. […] Most commercial labs are unable to differentiate between Ehrlichia species. […] Blood smear examination for morulae is insufficiently sensitive and should not be relied upon solely to diagnose ehrlichiosis.

• #3 Ehrlichiosis and anaplasmosis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/912

  Ehrlichiosis and anaplasmosis, of all types, are nationally notifiable diseases. […] Presumptive diagnosis is made in patients with potential tick exposure/demonstrated tick bite combined with fever and other characteristic constitutional symptoms plus leukopenia and/or thrombocytopenia and elevated LFTs. Serology or polymerase chain reaction confirms diagnosis. […] Key diagnostic factors include history of tick bite/exposure, history of immunosuppression, fever, headache, malaise, myalgia, arthralgia, nausea, small erythematous lesion with or without necrotic center, and nonspecific rash. […] 1st tests to order include CBC, LFTs, and peripheral blood smear. […] Tests to consider include immunofluorescence antibody assay and polymerase chain reaction. […] Emerging tests include Western immunoblotting, culture, and immunohistochemistry.

• #4 Ehrlichiosis and anaplasmosis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/912

  Ehrlichiosis and anaplasmosis, of all types, are nationally notifiable diseases. […] Presumptive diagnosis is made in patients with potential tick exposure/demonstrated tick bite combined with fever and other characteristic constitutional symptoms plus leukopenia and/or thrombocytopenia and elevated LFTs. Serology or polymerase chain reaction confirms diagnosis. […] Key diagnostic factors include presence of risk factors, fever, headache, malaise, myalgia, arthralgia, nausea, small erythematous lesion with or without necrotic centre, and non-specific rash. […] 1st investigations to order include FBC, LFTs, and peripheral blood smear. […] Investigations to consider include immunofluorescence antibody assay and polymerase chain reaction. […] Emerging tests include Western immunoblotting, culture, and immunohistochemistry.

• #5 Tickborne Diseases: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p530.html

  Tickborne diseases that affect patients in the United States include Lyme disease, Rocky Mountain spotted fever (RMSF), ehrlichiosis, anaplasmosis, babesiosis, tularemia, Colorado tick fever, and tickborne relapsing fever. […] The incidence of tickborne diseases is increasing in the United States. Diagnosis can be challenging because most patients do not recall being bitten by a tick, initial symptoms are similar and nonspecific, and ticks transmit multiple diseases in the same geographic area. […] The diagnosis of erhlichiosis and HGA should be considered in patients with flulike symptoms with gastrointestinal predominance and associated laboratory findings of leukopenia, thrombocytopenia, and elevated transaminases. […] Confirmative testing should not delay treatment. […] The preferred method for confirming either disease is IFA. […] The treatment of choice for ehrlichiosis and anaplasmosis is doxycycline for a minimum of 10 days, continuing for at least three days after resolution of the fever. […] Early treatment is imperative.

• #6 Ehrlichiosis and anaplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ehrlichiosis/symptoms-causes/syc-20372142

  Ehrlichiosis and anaplasmosis are similar tick-borne illnesses that cause flu-like symptoms, including fever, muscle aches and headache. […] Signs and symptoms of ehrlichiosis and anaplasmosis usually appear within 14 days after a tick bite. […] If treated quickly with appropriate antibiotics, you’ll likely recover within a few days. […] The best way to prevent these infections is to avoid tick bites. […] The time from getting a bite to showing signs and symptoms is usually five to 14 days. If you develop any of the signs or symptoms after a tick bite or after a possible exposure to ticks, see your doctor. […] Ehrlichiosis and anaplasmosis are caused by different bacteria. […] The ehrlichia and anaplasma species belong to the same family of bacteria. […] Although each bacterium appears to have a specific target among immune system cells in the host, all of these infectious agents generally cause the same symptoms.

• #6 Ehrlichiosis and anaplasmosis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ehrlichiosis/symptoms-causes/syc-20372142

  Without prompt treatment, ehrlichiosis and anaplasmosis can have serious effects on an otherwise healthy adult or child. […] Complications of an untreated infection may include: Kidney failure, Respiratory failure, Heart failure, Damage to the central nervous system, Seizures, Coma, Severe secondary infections. […] The best way to steer clear of ehrlichiosis or anaplasmosis is to avoid tick bites when you are outdoors.

• #7 Ehrlichiosis | Lyme Disease

  https://www.columbia-lyme.org/ehrlichiosis

  The potential severity of ehrlichial infections makes early diagnosis critical. Common findings on conventional blood tests include leukopenia, thrombocytopenia, and elevated serum transaminases, and this triad, which is also found in Rocky Mountain spotted fever, should prompt physicians to seriously consider empiric antibiotic treatment, especially if the patient is from an endemic area and has had recent tick exposure. […] From the standpoint of timeliness, the most useful diagnostic test for ehrlichiosis is probably polymerase chain reaction (PCR). Sensitivity has been reported to range between 60-85% for E. chaffeensis; the sensitivity for E. ewingii infections is not known, but PCR is the only definitive diagnostic test for E. ewingii, which has so far never been cultured in vitro.

• #8 Clinical Testing and Diagnosis for Anaplasmosis | Anaplasmosis | CDC

  https://www.cdc.gov/anaplasmosis/hcp/diagnosis-testing/index.html

  During the first week of illness, a microscopic examination of a peripheral blood smear might reveal morulae (microcolonies of anaplasmae) in the cytoplasm of granulocytes. If these morulae are identified, anaplasmosis should be strongly suspected. […] Blood smear examination for morulae is insufficiently sensitive and should not be relied upon solely to diagnose anaplasmosis.

• #8 Clinical Testing and Diagnosis for Anaplasmosis | Anaplasmosis | CDC

  https://www.cdc.gov/anaplasmosis/hcp/diagnosis-testing/index.html

  Never delay or withhold treatment pending the receipt of laboratory test results, or an initially negative result. Early recognition and prompt treatment with doxycycline is critical. […] Polymerase chain reaction on whole blood is best for confirming anaplasmosis if testing is done in the first week of illness. […] Anaplasmosis can be difficult to diagnose, particularly in the early stages of illness. […] Treatment should be started as soon as anaplasmosis is suspected without waiting for confirmatory laboratory testing. […] Anaplasmosis is often a clinical diagnosis. It can later be confirmed using specialized confirmatory laboratory tests. Treatment should not be delayed pending the receipt of test results or withheld on the basis of an initial negative laboratory result. […] Testing for anaplasmosis should be considered for any person with a compatible illness especially in endemic regions and for those with known risk factors, such as history of a tick bite or exposure to tick habitat.

• #8 Clinical Testing and Diagnosis for Anaplasmosis | Anaplasmosis | CDC

  https://www.cdc.gov/anaplasmosis/hcp/diagnosis-testing/index.html

  The reference standard serologic test for diagnosis of anaplasmosis is the indirect fluorescent antibody (IFA) test for immunoglobulin G (IgG) using Anaplasma phagocytophilum antigen. […] IgG IFA tests should be performed on paired acute and convalescent serum samples, with the acute specimen collected during the first two weeks of illness and the convalescent collected 2-10 weeks later. […] A single IgG titer of 1:128 or greater is classified as supportive laboratory evidence. […] Anaplasmosis cannot be confirmed using single acute antibody results. […] Most commercial labs are unable to differentiate between Anaplasma species. […] In areas endemic for ehrlichiosis and anaplasmosis, IFA using antigen from both Ehrlichia and Anaplasma species should be run side-by-side. […] Culture isolation and IHC assays of A. phagocytophilum are only available at specialized laboratories; routine hospital blood cultures cannot detect the organism.

• #9 Anaplasmosis | Lyme Disease

  https://www.columbia-lyme.org/anaplasmosis

  The clinical course of HGA ranges from asymptomatic infection to fatal disease. […] Standard blood tests in HGA usually reveal findings similar to those seen in HME: leukopenia, thrombocytopenia, and liver function abnormalities (elevated transaminases). […] For specific diagnosis, Wright or Giemsa-stained blood smears have a slightly higher yield than with HME, but are still not optimal for general clinical utility, given that there appears to be a wide variation (25-75%) in the sensitivity of these tests in visualizing morulae in host neutrophils. […] More helpful, but not always available, are polymerase chain reaction (PCR) tests, which are estimated to have a sensitivity of 67-90%. […] Serologic testing is useful to confirm the diagnosis of anaplasmosis.

• #10 Guideline for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe | Parasites & Vectors | Full Text

  https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-015-0649-0

  Canine ehrlichiosis and anaplasmosis are important tick-borne diseases with a worldwide distribution. The goal of this article was to provide a practical guideline for veterinary practitioners on the diagnosis, treatment, and prevention of ehrlichiosis and anaplasmosis in dogs from Europe. This guideline is intended to answer the most common questions on these diseases from a practical point of view. […] To date, three species have been clearly identified in dogs in Europe; Ehrlichia canis, A. phagocytophilum, and A. platys. […] It is rare to detect an E. canis morula (an aggregate of E. canis organisms) in a blood smear. It occurs in about 4-6% of clinical cases. The highest likelihood of detecting morulae can be achieved by performing a buffy coat smear. […] The diagnostic usefulness of evaluating a blood smear depends on the pathogen species that has infected the dog.

• #10 Guideline for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe | Parasites & Vectors | Full Text

  https://parasitesandvectors.biomedcentral.com/articles/10.1186/s13071-015-0649-0

  A positive serologic result indicates a past or current infection, but it does not always denote an ongoing disease condition. […] PCR is very useful in diagnosing these infectious diseases for several reasons. First, PCR detection is more sensitive than a direct microscopic examination. Second, the detection of DNA for a specific pathogen in a clinical setting should be considered evidence of an active infection. […] The sample of choice for a PCR assay is peripheral blood, buffered with EDTA. […] Coinfections with Ehrlichia and/or Anaplasma spp. are common, because some species are transmitted in the same arthropod vector. […] CME is usually successfully treated with antibiotics that belong to the tetracycline family. The treatment of choice is doxycycline at 5 mg/kg twice daily or 10 mg/kg once daily for 4 weeks. […] Doxycycline is an effective drug against ehrlichiosis and/or anaplasmosis in dogs. […] In general, most acutely ill dogs infected with Ehrlichia or Anaplasma species heal after a specific, effective treatment of appropriate length.

• #11 Ehrlichiosis and Anaplasmosis – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/ehrlichiosis-and-anaplasmosis

  Ehrlichiosis and anaplasmosis are caused by rickettsial-like bacteria. […] Diagnosis of Ehrlichiosis and Anaplasmosis […] Diagnostic serologic tests are available for ehrlichiosis and anaplasmosis, but PCR of blood is more sensitive and specific and can result in an earlier diagnosis because serologic tests require comparison of serial titers. […] Do PCR testing of blood, which is more sensitive and specific than serologic tests and can result in an early diagnosis. […] Treat with doxycycline, best started before laboratory results return.

• #12 Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood – Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog

  https://microbiology.testcatalog.org/show/EPCRB

  Test ID: EPCRB Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood […] Evaluating patients suspected of acute anaplasmosis or ehrlichiosis […] Diagnosis may be difficult since the patient’s clinical course is often mild and nonspecific. This symptom complex is easily confused with other illnesses (such as influenza) or other tick-borne zoonoses (such as Lyme disease, babesiosis, and Rocky Mountain spotted fever). Clues to the diagnosis of ehrlichiosis in an acutely febrile patient after tick exposure include laboratory findings of leukopenia or thrombocytopenia and elevated serum aminotransferase levels. However, while these abnormal laboratory findings are frequently seen, they are not specific. Rarely, intra-granulocytic or monocytic morulae may be observed on peripheral blood smear, but this is not a reliable means of diagnosing cases of human ehrlichiosis or anaplasmosis.

• #12 Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood – Mayo Clinic Laboratories | Microbiology and Infectious Disease Catalog

  https://microbiology.testcatalog.org/show/EPCRB

  Definitive diagnosis is usually accomplished through polymerase chain reaction (PCR) and serologic methods. Serologic testing is done primarily for confirmatory purposes by demonstrating a 4-fold rise or fall in specific antibody titers to Ehrlichia species or Anaplasma antigens. […] PCR techniques allow direct detection of pathogen-specific DNA from patients’ whole blood and is the preferred method for detection during the acute phase of illness. The Mayo Clinic PCR assay is capable of detecting and differentiating A phagocytophilum, E chaffeensis, E ewingii, and E muris eauclairensis. […] Positive results indicate presence of specific DNA from Ehrlichia chaffeensis, Ehrlichia ewingii, Ehrlichia muris eauclairensis organism, or Anaplasma phagocytophilum and support the diagnosis of ehrlichiosis or anaplasmosis. Negative results indicate absence of detectable DNA from any of these 4 pathogens in specimens but do not exclude the presence of these organisms or active or recent disease.

• #13 Ehrlichiosis Workup: Approach Considerations, Diagnostic Workup, Laboratory Studies

  https://emedicine.medscape.com/article/235839-workup

  Polymerase chain reaction: Detection of the organism with polymerase chain reaction (PCR) assay is now becoming widely available. Sensitivity and specificity of assays may vary but has been reported as high as 95-100 percent by some laboratories. […] Immunohistochemical stains: Although not a preferred method, immunohistochemical stains have been used to make the diagnosis of ehrlichiosis and anaplasmosis in a few patients through bone marrow staining tissue or autopsy tissue such as spleen, lymph nodes, liver, or lung. […] Culture: The infecting organism is extremely difficult to culture from blood and therefore is not recommended.

• #14 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Ehrlichiosis-Diagnosis.aspx

  The use of PCR is especially important in the detection of early stages of infection, when antibody levels are low or undetectable. […] A large number of kits are commercially available for whole blood PCR testing, which enables rapid diagnosis in up to 85% of infected individuals. […] Although the possibility of culturing Ehrlichia and Anaplasma species is also available to clinicians and researchers, the isolation of these organisms requires cell lines and typically takes 2-6 weeks of incubation. […] The major pitfall of the laboratory culture approach is the paucity of competent laboratories, since this technique necessitates unique and antibiotic-free cell culture methods that are not usually available in clinical microbiology laboratories. […] This is another confirmatory technique and is especially valuable when the diagnosis is to be made before antibiotic treatment is begun, or at least within 48 hours of its initiation. […] All those factors have to be taken into account when assessing patients with suspected ehrlichiosis, which is the reason why some propose combining different diagnostic methods to increase the likelihood of early diagnosis.

• #14 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Ehrlichiosis-Diagnosis.aspx

  The most sensitive method of infection confirmation is a seroconversion or a 4-fold change in antibody titers during the convalescent phase of the disease. […] Specific serologic testing of IgM and IgG antibodies to Ehrlichia chaffeensis or Anaplasma phagocytophilum by means of indirect immunofluorescence assay is considered the gold standard and thus the most frequently employed confirmatory test. […] Nonetheless, serology has its limitations, and these include a negative IgG test and uninformative levels of IgM titers in 80% of affected individuals during the first week of the disease, a high false positive rate, seroconversion failures due to weak immune function, as well as alteration of antibody response because of early antibiotic treatment. […] Due to high specificity and sensitivity values, as well as a very rapid turnaround time, polymerase chain reaction (PCR) became the preferred test for confirming serology findings indicative of human monocytic ehrlichiosis and human granulocytic anaplasmosis.

• #15 EPCRB – Overview: Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood

  https://www.mayocliniclabs.com/test-catalog/Overview/618301

  Evaluating patients suspected of acute anaplasmosis or ehrlichiosis. […] This test should not be used for screening asymptomatic individuals. […] Ehrlichiosis and anaplasmosis are emerging zoonotic tick-borne infections caused by Ehrlichia and Anaplasma species, respectively. […] Diagnosis may be challenging since the patient’s clinical course is often mild and nonspecific. […] Definitive diagnosis is usually accomplished through polymerase chain reaction (PCR) and serologic methods, with the preferred method varying based on the time of presentation in relation to the onset of clinical symptoms. […] The Mayo Clinic PCR assay is capable of detecting and differentiating A phagocytophilum, E chaffeensis, E ewingii, and E muris eauclairensis. […] A negative result does not indicate absence of disease. […] This assay should only be used to test patients with signs and symptoms of ehrlichiosis or anaplasmosis.

• #16 Ehrlichiosis and anaplasmosis

  https://dermnetnz.org/topics/ehrlichiosis-and-anaplasmosis

  Ehrlichiosis and anaplasmosis are both diagnosed using serological testing and polymerase chain reaction (PCR) testing on blood samples: […] Serological tests detect the presence of antibodies to Ehrlichia or A. phagocytophilum antigens indirect immunofluorescent antibody testing is the test of choice. […] PCR or polymerase chain reaction amplifies the bacterias DNA to enable detection, but few laboratories are currently capable of performing this test.

• #17 Companion Animal Parasite Council | Ehrlichia spp. and Anaplasma spp.

  https://capcvet.org/guidelines/ehrlichia-spp-and-anaplasma-spp/

  Patient-side enzyme-linked immunosorbent assays (ELISA) are available for identifying antibodies to Ehrlichia spp. and Anaplasma spp. […] In recent years, molecular diagnosis of Ehrlichia and Anaplasma infection in dogs and cats via polymerase chain reaction (PCR) of whole blood has become readily available. However, results should be interpreted with caution because the techniques used in different diagnostic laboratories vary.

• #18 ANAP – Overview: Anaplasma phagocytophilum (Human Granulocytic Ehrlichiosis) Antibody, Serum

  https://www.mayocliniclabs.com/test-catalog/Overview/81157

  As an adjunct in the diagnosis of human granulocytic ehrlichiosis (anaplasmosis) […] A positive result of an immunofluorescence assay (IFA) test (titer ≥1:64) suggests current or previous infection with human granulocytic ehrlichiosis (anaplasmosis). In general, the higher the titer, the more likely it is that the patient has an active infection. […] During the acute phase of the infection, serologic tests are often nonreactive, polymerase chain reaction (PCR) testing is available to aid in the diagnosis of these cases (see EPCRB / Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood). […] Previous episodes of human granulocytic ehrlichiosis (anaplasmosis) may produce a positive serologic result. […] In rare instances, clinical evidence of infection may also be derived by direct microscopic examination of Giemsa- or Diff-Quik-stained peripheral blood buffy coat smears, which may reveal clusters of round, dark-purple stained, small dots (morulae) in the cytoplasm of polymorphonuclear cells. However, this is a very insensitive method.

• #19 Ehrlichiosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441966/

  Ehrlichiosis and anaplasmosis are emerging infections in the United States and worldwide. In the United States, these infections are the most frequently recorded tick-borne diseases after Lyme disease, with estimated case fatality rates of 2.7% and 0.3%, respectively. The first Ehrlichia species, E chaffeensis, was identified in the United States relatively recently in 1986 and in Europe in 1991 from Portugal. Diagnosing human monocytic ehrlichiosis and human granulocytic anaplasmosis should be strongly considered when patients have symptoms compatible with the disease and have the appropriate epidemiology, such as exposure to wooded areas in spring or summer. Laboratory confirmation is critical for a definite diagnosis, which can be performed through serology or polymerase chain reaction testing to detect DNA. Doxycycline is the preferred drug for treating ehrlichiosis. The differential diagnosis for ehrlichiosis includes any nonspecific flu-like syndrome. Early initiation of doxycycline is associated with improved outcomes.

• #20 Ehrlichia & Anaplasmosis Diseases | IGeneX Tick Talk

  https://igenex.com/tick-talk/ehrlichiosis-and-anaplasmosis-disease/

  Ehrlichia and Anaplasma are transmitted to humans by the bite of an infected tick. […] The diagnosis should be considered in patients bitten by a tick or have been in a tick-infested area and have any of the symptoms typical of these infections, even mild ones. […] Physicians will use this information along with laboratory tests to find out whether a patient has Ehrlichiosis or Anaplasmosis, or perhaps some other tick-borne infection. […] Patients diagnosed with Ehrlichia or Anaplasma should also be tested for Lyme disease due to the fact that co-infections have been documented in patients.

• #21

  https://scholars.duke.edu/individual/pub1497227

  Ehrlichioses and anaplasmosis have undergone dramatic increases in incidence, and the geographic ranges of their occurrence and vectors have also expanded. […] There is marked underreporting of these diseases owing to deficient physician awareness and knowledge of the illnesses as well as limited access to appropriate diagnostic tests. […] Currently available laboratory diagnostic methods are poorly utilized, and with the exception of nucleic acid amplification tests are not useful for diagnosis during the acute stage of illness when timely treatment is needed. […] The Ehrlichiosis and Anaplasmosis Subcommittee of the Tick-Borne Disease Working Group recommended active clinical surveillance to determine the true incidence, full clinical spectrum, and risk factors for severe illness, as well as standardized surveillance of ticks for these pathogens, and enhanced education of primary medical caregivers and the public regarding these diseases.

• #21

  https://scholars.duke.edu/individual/pub1497227

  The subcommittee identified the needs to develop sensitive, specific acute stage diagnostic tests for local clinical laboratories and point-of-care testing, to develop approaches for utilizing electronic medical records, data mining, and artificial intelligence for assisting early diagnosis and treatment, and to develop adjunctive therapies for severe disease.

• #22 Comparison of Anaplasma and Ehrlichia species–specific peptide ELISAs with whole organism–based immunofluorescent assays for serologic diagnosis of anaplasmosis and ehrlichiosis in dogs in: American Journal of Veterinary Research Volume 82 Issue 1 (2021)

  https://avmajournals.avma.org/abstract/journals/ajvr/82/1/ajvr.82.1.71.xml

  Because all diagnostic modalities have limitations, it is recommended that blood smear examination, PCR assay, and serologic testing all be performed, particularly for dogs with clinical signs of anaplasmosis or ehrlichiosis. […] Immunofluorescent assays for Anaplasma and Ehrlichia spp are reliant on the detection of fluorescence resulting from the binding of antibodies in a test sample to whole Anaplasma or Ehrlichia organisms grown in cell cultures and affixed to glass slides (ie, antibody reactivity). […] The objective of the study reported here was to compare the performance of 5 synthetic peptide-based ELISAs designed to detect canine antibodies against A phagocytophilum, A platys, E canis, E chaffeensis, and E ewingii with the performance of 3 commercially available IFAs that use cell culture-grown whole A phagocytophilum, E canis, and E chaffeensis to detect antibodies against those bacteria. […] Results of the present study indicated that, for dogs experimentally infected with a TBP, the specificity of TBP species-specific peptide-based ELISAs was superior to that of whole organism-based IFAs.

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