Coinfection with multiple tick-borne pathogens - Veterinary Medicine
Medicine Center
DVM Veterinary Medicine Featuring Information from:


Coinfection with multiple tick-borne pathogens
It's not always cut-and-dried—a single tick bite delivering a single pathogen. Sometimes ticks carry more than one infective agent, and sometimes a pet has been bitten by multiple ticks carrying different microorganisms.So when should you suspect that your patient is infected with more than one tick-borne pathogen?



1. Kordick SK, Breitschwerdt EB, Hegarty BC, et al. Coinfection with multiple tick-borne pathogens in a Walker Hound kennel in North Carolina. J Clin Microbiol 1999;37:2631-2638.

2. Ogunkoya AB, Adeyanju JB, Abduhllahi R. Experimental and clinical trials of long acting oxytetracycline in the treatment of canine ehrlichiosis. Vet Q 1985;7:158-161.

3. de Castro MB, Machado RZ, de Aquino LP, et al. Experimental acute canine monocytic ehrlichiosis: clinicopathological and immunopathological findings. Vet Parasitol 2004;119:73-86.

4. Hess PR, English RV, Hegarty BC, et al. Experimental Ehrlichia canis infection in the dog does not cause immunosuppression. Vet Immunol Immunopathol 2006;109:117-125.

5. Breitschwerdt EB, Hegarty BC, Maggi R, et al. Bartonella species as a potential cause of epistaxis in dogs. J Clin Microbiol 2005;43:2529-2533.

6. Adelson ME, Rao RV, Tilton RC, et al. Prevalence of Borrelia burgdorferi, Bartonella spp., Babesia microti, and Anaplasma phagocytophila in Ixodes scapularis ticks collected in Northern New Jersey. J Clin Microbiol 2004;42:2799-2801.

7. Halos L, Jamal T, Maillard R, et al. Evidence of Bartonella sp. in questing adult and nymphal Ixodes ricinus ticks from France and co-infection with Borrelia burgdorferi sensu lato and Babesia sp. Vet Res 2005;36:79-87.

8. Belongia EA. Epidemiology and impact of coinfections acquired from Ixodes ticks. Vector Borne Zoonotic Dis 2002;2:265-273.

9. Levin ML, Fish D. Acquisition of coinfection and simultaneous transmission of Borrelia burgdorferi and Ehrlichia phagocytophila by Ixodes scapularis ticks. Infect Immun 2000;68:2183-2186.

10. Thomas V, Anguita J, Barthold SW, et al. Coinfection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis alters murine immune responses, pathogen burden, and severity of Lyme arthritis. Infect Immun 2001;69:3359-3371.

11. Harrus S, Waner T, Friedmann-Morvinski D, et al. Down-regulation of MHC class II receptors of DH82 cells, following infection with Ehrlichia canis. Vet Immunol Immunopathol 2003;96:239-243.

12. Pappalardo BL, Correa MT, York CC, et al. Epidemiologic evaluation of the risk factors associated with exposure and seroreactivity to Bartonella vinsonii in dogs. Am J Vet Res 1997;58:467-471.

13. Zeidner NS, Dolan MC, Massung R, et al. Coinfection with Borrelia burgdorferi and the agent of human granulocytic ehrlichiosis suppresses IL-2 and IFN gamma production and promotes an IL-4 response in C3H/HeJ mice. Parasite Immunol 2000;22:581-588.

14. Willadsen P, Jongejan F. Immunology of the tick-host interaction and the control of ticks and tick-borne diseases. Parasitol Today 1999;15:258-262.

15. Hilton E, DeVoti J, Benach JL, et al. Seroprevalence and seroconversion for tick-borne diseases in a high-risk population in the northeast United States. Am J Med 1999;106:404-409.

16. Mitchell PD, Reed KD, Hofkes JM. Immunoserologic evidence of coinfection with Borrelia burgdorferi, Babesia microti, and human granulocytic Ehrlichia species in residents of Wisconsin and Minnesota. J Clin Microbiol 1996;34:724-727.

17. Carpenter CF, Gandhi TK, Kong LK, et al. The incidence of ehrlichial and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina. J Infect Dis 1999;180:900-903.

18. Steere AC, McHugh G, Suarez C, et al. Prospective study of coinfection in patients with erythema migrans. Clin Infect Dis 2003;36:1078-1081.

19. Krause PJ, Telford SR 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. J Am Med Assoc 1996;275:1657-1660.

20. Suksawat J, Xuejie Y, Hancock SI, et al. Serologic and molecular evidence of coinfection with multiple vector-borne pathogens in dogs from Thailand. J Vet Intern Med 2001;15:453-462.

21. Breitschwerdt EB, Hegarty BC, Hancock SI. Sequential evaluation of dogs naturally infected with Ehrlichia canis, Ehrlichia chaffeensis, Ehrlichia equi, Ehrlichia ewingii, or Bartonella vinsonii. J Clin Microbiol 1998;36:2645-2651.

22. Mylonakis ME, Koutinas AF, Baneth G, et al. Mixed Ehrlichia canis, Hepatozoon canis, and presumptive Anaplasma phagocytophilum infection in a dog. Vet Clin Pathol 2004;33:249-251.

23. Tuttle AD, Birkenheuer AJ, Juopperi T, et al. Concurrent bartonellosis and babesiosis in a dog with persistent thrombocytopenia. J Am Vet Med Assoc 2003;223:1306-1310, 1280-1281.

24. Suksawat J, Pitulle C, Arraga-Alvarado C, et al. Coinfection with three Ehrlichia species in dogs from Thailand and Venezuela with emphasis on consideration of 16S ribosomal DNA secondary structure. J Clin Microbiol 2001;39:90-93.

25. Smith BE, Tompkins MB, Breitschwerdt EB. Antinuclear antibodies can be detected in dog sera reactive to Bartonella vinsonii subsp. berkhoffii, Ehrlichia canis, or Leishmania infantum antigens. J Vet Intern Med 2004;18:47-51.

26. Hinrichsen VL, Whitworth UG, Breitschwerdt EB, et al. Assessing the association between the geographic distribution of deer ticks and seropositivity rates to various tick-transmitted disease organisms in dogs. J Am Vet Med Assoc 2001;218:1092-1097.

27. Chae JS, Kim CM, Kim EH, et al. Molecular epidemiological study for tick-borne disease (Ehrlichia and Anaplasma spp.) surveillance at selected U.S. military training sites/installations in Korea. Ann N Y Acad Sci 2003;990:118-125.

28. Neer TM. Canine monocytotropic ehrlichiosis and neorickettsiosis. In: Greene CE, ed. Infectious diseases of the dog and cat. 3rd ed. Philadelphia, Pa: WB Saunders Co, 2006;203-216.

29. Shaw SE, Day MJ, Birtles RJ, et al. Tick-borne infectious diseases of dogs. Trends Parasitol 2001;17:74-80.

30. Bulla C, Kiomi Takahira R, Pessoa Araujo J Jr, et al. The relationship between the degree of thrombocytopenia and infection with Ehrlichia canis in an endemic area. Vet Res 2004;35:141-146.

31. Mylonakis ME, Koutinas AF, Billinis C, et al. Evaluation of cytology in the diagnosis of acute canine monocytic ehrlichiosis (Ehrlichia canis): A comparison between five methods. Vet Microbiol 2003;91:197-204.

32. Mylonakis ME, Koutinas AF, Breitschwerdt EB, et al. Chronic canine ehrlichiosis (Ehrlichia canis): A retrospective study of 19 natural cases. J Am Anim Hosp Assoc 2004;40:174-184.

33. Baneth G, Shkap V, Samish M, et al. Antibody response to Hepatozoon canis in experimentally infected dogs. Vet Parasitol 1998;74:299-305.

34. Egenvall A, Lilliehook I, Bjoersdorff A, et al. Detection of granulocytic Ehrlichia species DNA by PCR in persistently infected dogs. Vet Rec 2000;146:186-190.

35. Poitout FM, Shinozaki JK, Stockwell PJ, et al. Genetic variants of Anaplasma phagocytophilum infecting dogs in Western Washington State. J Clin Microbiol 2005;43:796-801.

36. Irwin PJ, Hutchinson GW. Clinical and pathological findings of Babesia infection in dogs. Aust Vet J 1991;68:204-209.

37. Waner T, Strenger C, Keysary A, et al. Kinetics of serologic cross-reactions between Ehrlichia canis and the Ehrlichia phagocytophila genogroups in experimental E. canis infection in dogs. Vet Immunol Immunopathol 1998;66:237-243.

38. Harrus S, Alleman AR, Bark H, et al. Comparison of three enzyme-linked immunosorbent assays with the indirect immunofluorescent antibody test for the diagnosis of canine infection with Ehrlichia canis. Vet Microbiol 2002;86:361-368.

39. O'Connor TP, Hanscom JL, Hegarty BC, et al. Comparison of an indirect immunofluorescence assay, western blot analysis, and a commercially available ELISA for detection of Ehrlichia canis antibodies in canine sera. Am J Vet Res 2006;67:206-210.

40. Levy S, O'Connor TP, Hanscom JL, et al. Utility of an in-office C6 ELISA test kit for determination of infection status of dogs naturally exposed to Borrelia burgdorferi. Vet Ther 2002;3:308-315.

41. Bell CA, Patel R. A real-time combined polymerase chain reaction assay for the rapid detection and differentiation of Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Ehrlichia ewingii. Diagn Microbiol Infect Dis 2005;53:301-306.

42. Martin AR, Dunstan RH, Roberts TK, et al. Babesia canis vogeli: a novel PCR for its detection in dogs in Australia. Exp Parasitol 2006;112:63-65.

43. Adeyanju BJ, Aliu YO. Chemotherapy of canine ehrlichiosis and babesiosis with imidocarb dipropionate. J Am Anim Hosp Assoc 1982;18:827-830.

44. Gillespie TN, Washabau RJ, Goldschmidt MH, et al. Detection of Bartonella henselae and Bartonella clarridgeiae DNA in hepatic specimens from two dogs with hepatic disease. J Am Vet Med Assoc 2003;222:47-51, 35.

45. Anadon A, Reeve-Johnson L. Macrolide antibiotics, drug interactions and microsomal enzymes: implications for veterinary medicine. Res Vet Sci 1999;66:197-203.

46. Conrad DA. Treatment of cat-scratch disease. Curr Opin Pediatr 2001;13:56-59.

47. Chia JK, Nakata MM, Lami JL, et al. Azithromycin for the treatment of cat-scratch disease. Clin Infect Dis 1998;26:193-194.

48. Mexas AM, Hancock SI, Breitschwerdt EB. Bartonella henselae and Bartonella elizabethae as potential canine pathogens. J Clin Microbiol 2002;40:4670-4674.

49. Maurin M, Gasquet S, Ducco C, et al. MICs of 28 antibiotic compounds for 14 Bartonella (formerly Rochalimaea) isolates. Antimicrob Agents Chemother 1995;39:2387-2391.

50. Sainz A, Tesouro MA, Amusategui I, et al. Prospective comparative study of 3 treatment protocols using doxycycline or imidocarb dipropionate in dogs with naturally occurring ehrlichiosis. J Vet Intern Med 2000;14:134-139.

51. Neer TM, Breitschwerdt EB, Greene RT, et al. Consensus statement on ehrlichial disease of small animals from the infectious disease study group of the ACVIM. J Vet Intern Med 2002;16:309-315.


Click here