Ehrlichiosis

Ehrlichiosis

EtioEhrlichiosisdemiology

Rickettsia that causes ehrlichiosis and anaplasmosis is classified as bacteria in the group alpha-proteobacteria. (Green). Gram-negative intracellular bacteria that infect leukocytes are sensitive to pleomorphic acid of about 0.5 um. It is aerobic in diameter and has a glycolytic pathway.

There are different types of Ehrlichia, such as Ehrlichia canis, Ehrlichia chaffeensis, Ehrlichia ewingii and Ehrlichia muris. Let us not forget that there is also Ehrlichia Ruminantium, which causes disease in cattle in Africa. (Green) .As the disease has several types of species, some infect dogs and others that affect men, such as E. chaffeensis and E. ewingii, not to mention E. muris-like Agents.

Vectors must be present, such as arthropods, for transmission of the disease in canines.  Rhipicephalus sanguineus and Dermacentor variabilis are known to cause the disease. (Couto). Products such as Isopropyl, have been ineffective over time due to their misapplication and also have caused resistance against these ectoparasites. (Frontline)

That said, we can determine that some breeds of dogs are predisposed to the development of the disease than others. An American military dog, a German Shepherd, died during the Vietnam war. E. canis received suspicion to infect humans. However, in 1991 the Ehrlichia mentioned before was found to be the cause of human monocytotropic ehrlichiosis disease (Green) The disease would not have been considered dangerous and transmissible to humans until new cases appeared in Minnesota

In the United States, the CDC initially detected the disease in the blood of four patients in Minnesota and Wisconsin in 2009. Periods betweeEhrlichiosis, the annual average incidence of ehrlichiosis was 3.2 cases per millions of people.

The canine disease has been reported on different continents, including Japan. The vertebrate host for E. canis includes members of the family Canidae e.g., the coyote, fox, Jackal, and domestic dogs. (Green). These gram-negative bacteria affect not only domestic animals but also wild mammals, and therefore has a sizeable epidemiological expansion.

The arthropod vector of E.  Canis is the brown dog tick, Rhipicephalus sanguineus. (Green) This arthropod prefers places with high humidity and high temperatures, such as the space inside a house. The tick fulfills a unique biological cycle in which the dog must have this type of ectoparasite to be a carrier, common in shelters. Stray dogs are also carriers due to the carelessness of the owner.

The mode of transmission is transstadial, the infection is transmitted to subsequent tick stages, but not to the maternal eggs of the next generation. Ticks acquire the E. Canis as larvae or nymphs and spread for at least 155 days. (Green). The cycle of transmission of the disease has an interesting mechanism. The eggs laid by the arthropods wait to hatch in the summer. This event does not mean that the disease between dogs is transmitted only in summer; it occurs throughout the year due to the efficiency of cutting the reproduction cycle of ticks.

In my experience in the field of veterinary medicine, the incidence of ehrlichiosis cases was projected in areas with high humidity and sun throughout the year. Insect prevention systems in Latin America and North America are based on health education and pet care.

Pathogenesis.

When lice bite the host, they become infected. The period may vary from 1-3 weeks from the incubation period. The inoculated organism multiplies in mononuclear cells and disseminate throughout the body. The clinical disease can be classified into acute, subclinical, and chronic. (Merrill) .The acute phase comprises a dog with fever and anorexic body estimation. Sometimes, it can present nasal discharge, enlargement of the lymph nodes, and petechiae in the abdomen. It usually lasts for about 2-4 weeks in an untreated dog.

The subclinical phase in internal medicine is usually one of the most dangerous because it has no noticeable symptoms and can lead to a misdiagnosis. It is possible to appear as Thrombocytopenia in a blood test. Dogs in this phase can remain immunocompetent. Finally, there are multiple system failures in the chronic phase. (Merrill).A subclinical phase; there are different tests that measure antibodies present in the blood against E. canis that help in the diagnosis of the disease. Usually, due to multiple system failures, patients are often infected with septic shock and marked anemia during veterinary emergencies in the chronic phase.

Symptomatolo

Ehrlichiosisfindings in Canine monocytotropic ehrlichiosis (CME)

Common clinical signs include; depression from high fever, lethargy, marked anorexia, weight loss, bleeding tendency, unilateral or bilateral nasal bleeding, 20% increased spleen size. Because it is transmitted by R.sanguineus the infection is concomitant with other diseases such as Babesia Canis vogeli and Hepatozoon canis.(Green). The most common CME pattern is fever above 40 degrees Celsius.

The disease may have ocular symptoms such as albuminemia, blindness, high blood pressure, anterior chamber hemorrhage, and subretinal hemorrhage. Most neurological symptoms are caused by meningitis. (Green). Evaluation of patients with the disease includes signs of infection from other diseases, depending on the extent of their immune system. This event depends on the degree of the immune system that it has. This means that bacterial, fungal, and protozoal diseases can infect the host.

Treatment

Tetracicline, doxycycline, Chloramphenicol, and imidocarb dipronate protocols haven been used. ACVIM recommends doxycycline 10mg/kg PO q24 for at least 28 days or 5mg/kg PO 12h has also been effective. (Couto). This treatment protocol can be associated depending on the condition of the patient. Some dogs that have bone marrow that have been suppressed have a difficult time recovering from the anemia, requiring complete blood transfusions.

Erythropoietin and granulocyte colony-stimulaEhrlichiosiswith prednisone in severe chronic ehrlichiosis. (Wiebe). The protocol could be varEhrlichiosisclinical case, depends on the type of ehrlichiosis suffered by the patient.

Zoonotic aspects and Prevention

The best prevention measure for this disease is to remove all ectoparasites. Administration of imidacloprid 10% and permethrin 50% could be effective in young dogs. The clue of prevention of this disease is tick control, because they are the principal vector that transmits the disease to every host. (Couto) Additionally, on the environmental preventions, we should have screen serologically yearly all donor dogs in the animal clinic.

Ehrlichiosis

The aspects of Ehrlichiosis in Ehrlichiosistext

Just like any other disease, Ehrlichiosis can be transmitted from one person to anotheEhrlichiosis most of the contagious diseases, Ehrlichiosis is transmitted through a vector, which is the tick. This makes it easy to treat as well as containing it from spreading. Different societies have different cultures, as well as various social perspectives. These are significant concerns that medical practitioners need to consider as they try to combat the disease in all regions of the world. With keen follow-ups, good results will be manifested in the health of the treated patients. A community’s cultural connotation structure is serene of mutual cultural schemas. These cultural schematics formulate the reality-defining organization and deliver info on what conditions of the realm can be and should be followed.¹ (Zaina, 2019, 3)

Communication with patients about their cultural background and social perspectives is critical. There are numerous descriptions of cultural competency-each one of them stressing on the necessity for healthcare structures and providers to be mindful of, and receptive to all patients’ cultural standpoints and upbringings.²(Diana,2013,3). A good example would be the mistake of contemplating that working with animals that are prone to be tick carriers is a mistake to the patients and that they should seize coming in contact with them. It might be the right solution, but the question is, how is the patient going to perceive the suggestion. Sometimes, it is good to check on the norms and perception of a disease in that precise community. How a particular health ailment is intellectualized (e.g., healthy child development) will be contingent on the cultural significance structures of every society ³(Zaina, 2019, 3).

1.Mchome, Zaina; Bailey, Ajay;: Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry. PLoS ONE. 9/11/2019, Vol. 14 Issue 9, p1-22. 22p. DOI: 10.1371/journal.pone.0222231.

2.Diana Salas Coronado Cultural Competency in Health Care: Framework, Training and Evaluation – A Review of the Literature (University of Massachusetts Boston, 2013)3

3.Zaina

A good health outcome is the focus of all healthcare workers towards their patients. Every health worker is promoting this with new suggestions on how to handle the patients rather than administering drugs to them. This is what has come to be known as having cultural and social competency. There are three conceptual tactics related to cultural competence training curriculums that help much in treating patients.⁴ (Diana,2013,3). Having the basic knowledge of the cultures and social perspectives of the patients will help create a bond that gives the patient a positive attitude that the person treating them share a common feature in cultural and social understanding. They feel being part of the health program.

Attitude‐ based training emphasis on refining provider’s awareness of the influence of socio‐cultural aspects on patient’s morals and deeds, and in what way these may affect patient’s care.⁵ (Diana, 2013, 3).sometimes, people are shaped by their cultures and remain rigid even after several attempts of changing them. This is one of the issues most care providers face in their field of work. This doesn’t mean because of the culture, the patient will not receive treatment. Care providers should learn about these and get to know that they don’t have to judge a bad attitude or start judging the patients based on their socio-cultural perspective. A good example is in the Muslim community in some regions where a female doctor cannot treat a man.

The last point on social perspective and cultural competency in patient care is building your skills as per the culture in concern. Skill‐building preparations concentrate on learning the prevalent communication skills with both the patient as well as culturally precise communities.⁶(Diana, 2013, 3).language is essential when it comes to patient care. You cannot treat any patient without communicating with them. Symptoms, diagnosis, and even prescriptions are provided through communication.it is among the most crucial aspect of cultural competency. Though some rare studies discover straight acquaintances amid cultural competency exercises and healthcare enhancement, evidence proposes these exercises affect knowledge, attitudes, as well as skills of health specialists, and patient satisfaction.⁷ (Diana, 2013, 3).

4, 5, 6, 7.Diana 3

The widespread transmission of diseases depends on the systematic and often interdependent complications. There are various socio-cultural, economic, and political forces that will drive the community in causing and contributing to the above. Health is dictated by numerous features including genetic heritage, private behaviors, access to eminent health upkeep, and the universal exterior environment e.g., the value of air, water as well as accommodation situations.⁶ (Hernandez, 2006, 1).a good example in our case study is communities endowed with livestock as their main livelihood. These communities are either pastoralists or private ranches that hold as many animals as possible for commercial purposes or as assets.

A society and its culture cannot be easily changed. An excellent example of this kind of community that upholds its culture is the famous Maasai society of Kenya. Being a pastoral society and entirely excluded from the civilized world can pose a significant threat if the Ehrlichiosis pandemic attacks their populations. Illiberal political regimes and which have been witnessed embezzling health funds in most countries, especially the third world countries, are significant contributors to the spreading or transmission of inevitable pandemics.

Without the necessary precautions set aside by the government and concerned institutions, it means that the pandemic is given a go forward to keep spreading. The inspiration of social as well as cultural variables on well-being encompasses magnitudes of both time, precarious phases in the life sequence, and the properties of collective exposure as well as place, numerous stages of interaction. The settings in which communal and cultural variables function to impact health aftermaths are termed, commonly, the social and cultural environment.⁷ (Hernandez, 2006, 1).

Hernandez LM, Blazer DG, Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate; The Impact of Social and Cultural Environment on Health Washington (DC): National Academies Press (US); 2006.1

Just like any other disease, Ehrlichiosis had its own social and ethical impacts. With its occurrence, crises were witnessed all over the globe, with the most affected being the ranch owners. The sickness did not know borders spreading even to the developing countries and causing deaths. Despite its financial influence, incomplete information was accessible on its epidemiology in Africa, particularly Kenya.⁸ (peter, 2019, 1).the diseases have been new to most parts of the world, and their precaution measures had to been known. Without this information, the spread has been witnessed over the days causing losses in animals while other minor infections to dogs and human beings seen.

Just like any other economy, the United States is also facing the threat of this disease. Luckily, much research has been done, and control measures are more prevalent here than in the developing countries. This has seen a decline in milk quantity and meat production in these countries hence affecting the economies. In most states, reported cases are treated with trimethoprim/sulfamethoxazole after tick bite, in which a myocarditis is consequently diagnosed. Recovery is entirely after a doxycycline therapy.⁹ (Nayak, 2013, 1).In most countries, the treatment for Erhlichiosis is through a dosage of doxycycline which have proved to work over the years.

Just like any other disease, Ehrlichiosis should be considered fatal. All the necessary precautions to stop the spread of the disease should be put in place while the infected diagnosed and treated immediately. All the discussed socio-cultural perspectives should be considered when treating patients while the reasonable precautions to prevent its widespread transmission put in place. Ehrlichiosis is curable and affected people should seek medical advice as soon as possible.

8.Shepelo Getrude Peter,1 Daniel Waweru Gakuya, Prevalence and risk factors associated with Ehrlichia infections in smallholder dairy cattle in Nairobi City County, Kenya, Published online 2019 Oct 24. doi: 10.14202/vetworld.2019.1599-1607

9. Seema U. Nayak and Gary L. Simon, Myocarditis after Trimethoprim/Sulfamethoxazole Treatment for Ehrlichiosis, Emerg Infect Dis. 2013 Dec; 19(12): 1975–1977. doi: 10.3201/eid1912.121459

References (Citation works)

Nelson, Richard W., and C. Guillermo Couto. Small Animal Internal Medicine. St. Louis, MO: Elsevier, 2020.

Greene, Craig E. Infectious Diseases of the Dog and Cat. Place of publication not identified: Saunders, 2013.

Wiebe, Valerie J. Drug Therapy for Infectious Diseases of the Dog and Cat. Ames, IA: Wiley, 2015.

Merrill, Linda. Small Animal Internal Medicine for Veterinary Technicians and Nurses. Ames, IA: Wiley-Blackwell, 2012.

“Ehrlichiosis Home.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, January 17, 2019. https://www.cdc.gov/ehrlichiosis/index.html.

Diana Salas Coronado Cultural Competency in Health Care: Framework, Training and Evaluation – A Review of the Literature (University of Massachusetts Boston, 2013)3

Hernandez LM, Blazer DG, Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate; The Impact of Social and Cultural Environment on Health Washington (DC): National Academies Press (US); 2006.1

Shepelo Getrude Peter,1 Daniel Waweru Gakuya, Prevalence and risk factors associated with Ehrlichia infections in smallholder dairy cattle in Nairobi City County, Kenya, Published online 2019 Oct 24. doi: 10.14202/vetworld.2019.1599-1607

Seema U. Nayak and Gary L. Simon, Myocarditis after Trimethoprim/Sulfamethoxazole Treatment for Ehrlichiosis, Emerg Infect Dis. 2013 Dec; 19(12): 1975–1977. doi: 10.3201/eid1912.121459

.Mchome, Zaina; Bailey, Ajay;: Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry. PLoS ONE. 9/11/2019, Vol. 14 Issue 9, p1-22. 22p. DOI: 10.1371/journal.pone.0222231.