Correspondence
Prevalence of the Rickettsial Agent of Human Granulocytic Ehrlichiosis in Ticks from a Hyperendemic Focus of Lyme Disease
N Engl J Med 1997; 337:49-50July 3, 1997
- Article
To the Editor:
Human granulocytic ehrlichiosis, a newly discovered tick-borne infection originally described in the upper Midwest,1 has recently been reported in 29 patients from Westchester County, New York.2 We used the polymerase chain reaction (PCR) to examine 173 host-seeking ticks (Ixodes scapularis) collected from vegetation in Westchester County for the presence of the agent of human granulocytic ehrlichiosis, as well as the agent of Lyme disease, Borrelia burgdorferi. After extracting DNA from dissected tissues, we used the 23S ribosomal DNA (rDNA) primers of Schwartz et al.3 for B. burgdorferi and the 16S rDNA primers of Pancholi et al.4 for the agent of human granulocytic ehrlichiosis and confirmed the presence of the latter by sequencing PCR products from 10 randomly selected samples. We also examined 100 adult specimens of I. scapularis collected similarly from the same site in 1984 and preserved in 70 percent ethanol.
We found the prevalence of the agent of human granulocytic ehrlichiosis in these ticks to be surprisingly high and approximately equal to that of B. burgdorferi in both nymphal and adult specimens (Table 1Table 1
Prevalence of B. burgdorferi and the Agent of Human Granulocytic Ehrlichiosis (HGE) in Specimens of I. scapularis, as Determined by PCR Analysis of Individual Ticks.). We also found that the agent of human granulocytic ehrlichiosis was present in this tick population in 1984 and at approximately the same prevalence. The similar prevalence of infection for both agents among ticks of each stage suggests a similar intensity of transmission in nature. However, the low prevalence of coinfection suggests that both pathogens are not maintained by the same reservoir hosts.5 The prevalence of infection with either B. burgdorferi or the agent of human granulocytic ehrlichiosis in I. scapularis from Westchester County is among the highest known for vector-borne diseases. As a result of the combined prevalence of these two infectious agents, 79 percent of adult ticks and 30 percent of nymphs are infected by pathogens infectious to humans. Westchester County is a recognized hyperendemic focus for Lyme disease, with more than 2000 cases reported annually. Assuming that infected ticks transmit both pathogens to humans with similar efficiency, our data suggest that this region will become a hyperendemic focus for human granulocytic ehrlichiosis as well. Increasing diagnostic efforts and awareness by physicians are likely to uncover additional cases of human granulocytic ehrlichiosis in Westchester County, giving the appearance of an emerging disease to what in reality has been firmly established in nature for more than a decade.
5 ReferencesIra Schwartz, Ph.D.
New York Medical College, Valhalla, NY 10595Durland Fish, Ph.D.
Yale University School of Medicine, New Haven, CT 06510Thomas J. Daniels, Ph.D.
Fordham University, Armonk, NY 105041
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