Journal of Clinical Microbiology

ABSTRACT “ Candidatus Neoehrlichia mikurensis” is the tick-borne agent of neoehrlichiosis, an infectious disease that primarily affects immunocompromised patients. So far, the genetic variability of “ Ca . Neoehrlichia” has been studied only by comparing 16S rRNA genes and groEL operon sequences. We describe the development and use of a multilocus sequence analysis (MLSA) protocol to characterize the genetic diversity of clinical “ Ca . Neoehrlichia” strains in Europe and their relatedness to other species within the Anaplasmataceae family. Six genes were selected: ftsZ , clpB , gatB , lipA , groEL , and 16S rRNA. Each MLSA locus was amplified by real-time PCR, and the PCR products were sequenced. Phylogenetic trees of MLSA locus relatedness were constructed from aligned sequences. Blood samples from 12 patients with confirmed “ Ca . Neoehrlichia” infection from Sweden ( n = 9), the Czech Republic ( n = 2), and Germany ( n = 1) were analyzed with the MLSA protocol. Three of the Swedish strains exhibited identical lipA sequences, while the lipA sequences of the strains from the other nine patients were identical to each other. One of the Czech strains had one differing nucleotide in the clpB sequence from the sequences of the other 11 strains. All 12 strains had identical sequences for the genes 16S rRNA, ftsZ , gatB , and groEL . According to the MLSA, among the Anaplasmataceae , “ Ca . Neoehrlichia” is most closely related to Ehrlichia ruminantium , less so to Anaplasma phagocytophilum , and least to Wolbachia endosymbionts. To conclude, three sequence types of infectious “ Ca . Neoehrlichia” were identified: one in the west of Sweden, one in the Czech Republic, and one spread throughout Europe.

ABSTRACT In Europe, human infections with “ Candidatus Neoehrlichia mikurensis” have mainly been restricted to immunocompromised patients. We report here the first cases of asymptomatic “ Ca . Neoehrlichia mikurensis” infection in immunocompetent humans (5/316 [1.6%] were infected). Due to the potential threats of infections with “ Ca . Neoehrlichia mikurensis” in healthy persons to the safety of the blood supply, further study of this phenomenon is required.

ABSTRACT A recently described clinical isolate, “ Candidatus Bartonella ancashi,” was obtained from a blood sample of a patient presenting with verruga peruana in the Ancash region of Peru. This sample and a second isolate obtained 60 days later from the same patient were molecularly typed using multilocus sequence typing (MLST) and multispacer sequence typing (MST). The isolates were 100% indistinguishable from each other but phylogenetically distant from Bartonella bacilliformis and considerably divergent from other known Bartonella species, confirming their novelty.

ABSTRACT “ Candidatus Neoehrlichia mikurensis” ( Anaplasmataceae ) is an emerging pathogen transmitted by Ixodes ticks. Conventional PCR and the newly developed high-resolution melt PCR were used to detect and discriminate “ Candidatus Neoehrlichia mikurensis” and Anaplasma phagocytophilum . Both bacterial species were frequently found in Ixodes ricinus and Ixodes hexagonus but virtually absent from Dermacentor reticulatus . In rodents, “ Candidatus N. mikurensis” was significantly more prevalent than A. phagocytophilum , whereas in cats, only A. phagocytophilum was found.

ABSTRACT Neoehrlichiosis caused by “ Candidatus Neoehrlichia mikurensis” is an emerging zoonotic disease. In total, six patients have been described in Europe, with the first case detected in 2007. In addition, seven patients from China were described in a report published in October 2012. In 2009, we diagnosed the first human case of “ Ca . Neoehrlichia mikurensis” infection in the Zurich area (Switzerland). Here, we report two additional human cases from the same region, which were identified by broad-range 16S rRNA gene PCR. Both patients were immunocompromised and presented with similar clinical syndromes, including fever, malaise, and weight loss. A diagnostic multiplex real-time PCR was developed for specific detection of “ Ca . Neoehrlichia mikurensis” infections. The assay is based on the signature sequence of a 280-bp fragment of the “ Ca . Neoehrlichia mikurensis” 16S rRNA gene and incorporates a “ Ca . Neoehrlichia mikurensis” species, a “ Ca . Neoehrlichia” genus, and an Anaplasmataceae family probe for simultaneous screening. The analytical sensitivity was determined to be below five copies of the “ Ca . Neoehrlichia mikurensis” 16S rRNA gene. Our results show that the assay is suitable for the direct detection of “ Ca . Neoehrlichia mikurensis” DNA in clinical samples from, for example, blood and bone marrow. In addition, it allows for monitoring treatment response during antibiotic therapy. Using the same assay, DNA extracts from 1,916 ticks collected in four forests in close proximity to the patients' residences (<3 km) were screened. At all sampling sites, the minimal prevalence of “ Ca . Neoehrlichia mikurensis” was between 3.5 to 8% in pools of either nymphs, males, or females, showing a strong geographic association between the three patients and the assumed vector.

ABSTRACT To estimate the likelihood of people coming into contact with the recently described tick-borne agent “ Candidatus Neoehrlichia mikurensis,” we compared its prevalence to those of Lyme disease spirochetes and Anaplasma phagocytophilum in questing adult Ixodes ricinus ticks collected in various Central European sites and examined ticks, which had been removed from people, for the presence of these pathogens. Whereas spirochetes infected questing adult ticks most frequently (22.3%), fewer than a third as many ticks were infected by “ Ca . Neoehrlichia mikurensis” (6.2%), and about a sixth harbored A. phagocytophilum (3.9%). On average, every twelfth encounter of a person with an I. ricinus tick (8.1%) may bear the risk of acquiring “ Ca . Neoehrlichia mikurensis.” Although a fifth of the people (20%) had removed at least one tick infected by “ Ca . Neoehrlichia mikurensis,” none displayed symptoms described for this pathogen, suggesting that its transmission may not be immediate and/or that immunocompetent individuals may not be affected. Because immunosuppressed patients may be at a particular risk of developing symptoms, it should be considered that “ Ca . Neoehrlichia mikurensis” appears to be the second most common pathogen in I. ricinus ticks. In our survey, only Borrelia afzelii appears to infect Central European vector ticks more frequently.

ABSTRACT Recently, a new genus of Anaplasmataceae termed “ Candidatus Neoehrlichia” was discovered in ticks and rodents. Here, we report on two patients who suffered from febrile bacteremia due to “ Candidatus Neoehrlichia mikurensis” associated with thrombotic or hemorrhagic events. 16S rRNA and groEL gene sequencing provided evidence of three groups of sequence variants.