equine granulocytic anaplasmosis in a new...
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EQUINE GRANULOCYTIC ANAPLASMOSIS IN A NEW
BRUNSWICK HORSE
Joan Bourque and Dr. James P. GoltzProvincial Veterinary Laboratory,
Department of Agriculture, Aquaculture and Fisheries,Fredericton, New Brunswick
Canadian Animal Health Laboratorians Network Annual Meeting
Winnipeg, June 2012
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CLINICAL HISTORY•
12 year old Paint gelding horse, resident of Gagetown
for at
least 2 years•
Early November, 2011: Horse easily winded with exercise
•
Decreasing energy, progressively worsening over past week•
Examined by veterinarian on 15 November 2011:–
Dull but responsive–
Bilateral nasal discharge•
Clear and serous from right nostril•
Serosanguinous
from left nostril
–
Temperature 98.8oF, Heart rate 36 bpm, Respiratory rate 24 bpm
(↑)–
Mucous membranes tacky but pink–
Capillary refill time <2 sec
•
Blood sample submitted for CBC and chemistry profile
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BLOOD PARAMETERS•
Leukopenia
(moderate)
–
WBC –
2.17 X 109/L (Normal 5.5-12.5)•
Neutropenia
(marked)
–
Neutrophils
–
0.98 X 109/L (Normal 2.7-6.7)•
Anemia (mild)–
RBC –
5.19 X 1012/L (Normal 6.5-12.5)–
Hemoglobin –
92.0 g/L (Normal 110-190)–
Hematocrit
–
0.255 L/L (Normal 0.32-0.52)•
Hypoalbuminemia
(slight)
–
Albumin –
25 g/L (Normal 27-36)
•
AST –
mild decrease
–
173 IU/L (Normal 205-530)•
Hyperbilirubinemia
(mild)
–
Total bilirubin
–
49 μmol/L (Normal 10-43)•
Hyponatremia
(mild)
–
Sodium –
133.8 mmol/L (Normal 136-145)
Platelets: Low, but clumping
noted on smear
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DIAGNOSIS•
Confirmed at National Microbiology Laboratory in Winnipeg–
PCR +ve
for A. phagocytophilum–
PCR -ve
for Borrelia burgdorferi•
(Equine) Granulocytic Anaplasmosis
•
Cause: Anaplasma phagocytophilum–
A small obligate intracellular Gram negative bacillus–
Formerly Ehrlichia phagocytophilum–
First resides in an early endosome, where it acquires nutrients for binary fission and grows into small groups called morulae
–
Predilection for myeloid or granulocytic cells.–
A tick-borne rickettsial
disease
•
Main vector: Black-legged Tick(Ixodes scapularis)
brown.edu
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FOLLOW UP•
Treatment:
tetracycline (Oxymycine
LP) 7
mg/kg IV q24 hr for 7 days•
Catheter installed for duration of treatment
•
Outcome:–
One week after treatment stopped
•
improvement in energy and responsiveness, exercise intolerance regressing but still noted
–
3 weeks post treatment•
normal behaviour
and attitude restored
–
Completely recovered
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PREVALENCE DATA•
Unknown, not reportable in domestic animals in Canada
•
3rd
reported equine
case in Canada (1 Saskatchewan, 1 Nova Scotia)
•
Several dogs
in Canada with clinical disease•
Many more dogs seropositive
–
significance?
•
Only one human
case confirmed in Canada (Human Granulocytic Anaplasmosis) –
Alberta
•
Who is looking?•
1.5 to 1.6% of Black-legged Ticks in New Brunswick are infected with this organism
•
Infection rate in established populations of ticks is higher (roughly 2X greater in NB)
•
Has been associated with blood transfusions in humans
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5
New Brunswick Locations for Anaplasma-infected Ticks 1990 through 2011
1
1
Numbers indicate # of positive Ixodes scapularis tick submissions from each locality
Red dot indicates location of infected horse
1
1
1
1
1
1
6
3
1
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Ixodes scapularis COLLECTION LOCATIONS IN NB
•
2011 –
144 locations throughout New Brunswick
•
Mostly thought to be distributed (dropped off) by migrating birds
•
Also transported by people, pets, other wildlife
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http://www.phac-aspc.gc.ca/id-mi/tickinfo-eng.php
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# of adult Ixodes scapularis submissions, NB
by month (1994 to Sept. 2009)
0
20
40
60
80
100
120
140
160
180
Jan Mar May Jul Sep Nov
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EQUINE GRANULOCYTIC ANAPLASMOSIS: TYPICAL CLINICAL SIGNS
•
Initial–
Fever (38.5-41.5oC)–
Mild Depression
•
Later–
Fever, fluctuating (38.5-41.5oC)–
Anorexia–
Ataxia–
Lethargy–
Reluctance to move–
Anemia–
Icterus–
Swollen stiff legs (limb edema)–
Cardiac arrhythmias (ventricular tachycardia, premature ventricular contractions)
–
Petechiae
Hematology: Leukopenia
AnemiaThrombocytopenia
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EQUINE GRANULOCYTIC ANAPLASMOSIS: DIFFERENTIAL DIAGNOSES
•
Lyme
Disease (Borreliosis)•
Encephalitis
•
Hepatic disease•
Purpura
hemorrhagica
•
Equine Infectious Anemia (EIA)•
Equine Viral Arteritis
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SYMPTOMS OF HUMAN GRANULOCYTIC ANAPLASMOSIS
•
Symptoms appear 1 to 3 weeks after the bite of an infected
tick and may include:–
High fever–
Muscle aches–
Weakness–
Headache–
Maybe also•
Confusion•
Nausea•
Vomiting•
Joint Pain
•
Illness may be mild to moderately severe
•
Rash is not
common (unlike Lyme
disease)
•
Not
every exposure results in infection
No reported human cases yet in New Brunswick
ThrombocytopeniaLeukopenia
Elevated liver transaminases
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ONE HEALTH: DEFINITION AND VISION
•
the collaborative effort of multiple disciplines•
working locally, nationally, and globally
•
to attain optimal health for people, animals and the environment
•
“a movement to forge co-equal, all inclusive collaborations
between (among) physicians,
osteopaths, veterinarians, dentists, nurses and other scientific-health and environmentally related disciplines”
•
http://www.onehealthinitiative.com/•
Veterinary laboratories play crucial role in detection of emerging zoonotic
diseases
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ONE HEALTH NB GOVERNMENT-FUNDED LABORATORY RESOURCES
Resource Human Animal EnvironmentGovernment Funding
$82.7 million $954 thousand $1.7 million
# of Laboratory Technologists
660* 4* 1* (+19)
# of Laboratory Assistants
~300 0.25 1
# of Laboratories 23 (-2?) 1 1# of Pathologists 41 2 0
*registered licensed medical laboratory technologists
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PHILOSOPHICAL MUSINGS•
How can we more fully integrate and utilize all of our One Health resources? In New Brunswick? In Canada? In North America? Globally?
•
Does New Brunswick need a One Health super laboratory encompassing human, animal and environmental health?
•
How can we collectively gain access to resources of agencies that have better/more resources (RCMP, CFIA) but whose mandates are very restricted?
•
What can New Brunswick do to better contribute to One Health prevention at the national and global level?
•
What can Canada do to better contribute to One Health prevention at the global level?
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ACKNOWLEDGMENTS
•
Dr. Mike Rennick•
Justin Carr
•
Dr. Gale Hines•
Dr. L. Robbin
Lindsay
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QUESTIONS?????