Heartwater Disease
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Heartwater (also known as cowdriosis, nintas, and ehrlichiosis) is a tick-borne rickettsial disease. The name is derived from the fact that fluid can collect around the heart or in the lungs of infected animals. It is caused by ''Ehrlichia ruminantium'' (formerly ''Cowdria ruminantium'') - an intracellular Gram-negative coccal bacterium (also referred to as ''Rickettsia ruminantium''). The disease is spread by various Amblyomma ticks, and has a large economic impact on cattle production in affected areas. There are four documented manifestations of the disease, these are acute, peracute, subacute, and a mild form known as heartwater fever. There are reports of zoonotic infections of humans by ''E. ruminantium'', similar to other ''Ehrlichia'' species, such as those that cause human ehrlichiosis.


History

Heartwater disease was first described in 1838 within the personal journal of Louis Trichardt, a Voortrekker in South Africa. In Trichardt's notes he recorded that a majority of the surrounding sheep died approximately three weeks after a large tick infestation was observed. In an 1877 testimony to the Cape of Good Hope Commission on Diseases of Sheep and Goats livestock producer J Webb testified that the appearance of ticks on his farm 8 or 9 years earlier corresponded with an onset of fatal disease in his livestock. Webb reported opening the chest of the victims and discovering the "heart bag" to be full of "water." Heartwater first reached the Caribbean islands in 1980.


Distribution

The disease is common in
sub-Saharan Africa Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
, but can ultimately be found wherever Amblyomma ticks are present. Major areas of concern for the disease also include Madagascar, Mauritius, Zanzibar, the Comoros Islands, and
Sao Tomé SAO or Sao may refer to: Places * Sao civilisation, in Middle Africa from 6th century BC to 16th century AD * Sao, a town in Boussé Department, Burkina Faso * Saco Transportation Center (station code SAO), a train station in Saco, Maine, U.S. ...
. Heartwater has been observed on three of the Caribbean islands,
Guadeloupe Guadeloupe (; ; gcf, label=Antillean Creole, Gwadloup, ) is an archipelago and overseas department and region of France in the Caribbean. It consists of six inhabited islands—Basse-Terre, Grande-Terre, Marie-Galante, La Désirade, and the ...
, Marie-Galante, and
Antigua Antigua ( ), also known as Waladli or Wadadli by the native population, is an island in the Lesser Antilles. It is one of the Leeward Islands in the Caribbean region and the main island of the country of Antigua and Barbuda. Antigua and Bar ...
. In the Caribbean, at least, the cattle egret has been implicated in the spread of heartwater, since it colonized the islands in the 1950s.


Hosts

Nearly all members of Bovidae are susceptible to this disease, but vary in their susceptibility, Zubu and Water buffalo appearing to be most resistant. The most susceptible species to heartwater appears to be the various goats. The South African buffalo, bleskbok, black wildebeest, helmeted guinea fowl, leopard tortoise and scrub hare are known to host heartwater without symptoms and act as a tick reservoir.


Experimental hosts

In laboratory experiments non-ruminants such as
ferret The ferret (''Mustela furo'') is a small, Domestication, domesticated species belonging to the family Mustelidae. The ferret is most likely a domesticated form of the wild European polecat (''Mustela putorius''), evidenced by their Hybrid (biol ...
s, laboratory mice, and four-striped grass mice have demonstrated susceptibility to the disease.


Clinical signs

Clinical disease is more common in young animals and non-native breeds. The clinical signs of disease are caused by an increased vascular permeability and consequent oedema and
hypovolemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the los ...
. The symptoms include neurological signs such as
tremor A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, fa ...
s and head pressing, respiratory signs such as
coughing A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phas ...
and nasal discharge, and systemic signs such as fever and loss of appetite. Physical examination may reveal
petechiae A petechia () is a small red or purple spot (≤4 mm in diameter) that can appear on the skin, conjunctiva, retina, and mucous membranes which is caused by haemorrhage of capillaries. The word is derived from Italian , 'freckle,' of obscure origin ...
of the mucous membranes, tachycardia, and muffled heart sounds. Heartwater can also cause reproductive and gastrointestinal disease. It is frequently fatal.


Diagnosis

On ''post mortem'' examination, a light yellow transudate that coagulates on exposure to air is often found within the thorax, pericardium, and abdomen. Most fatal cases have the hydropericardium that gives the disease its common name. Pulmonary oedema and mucosal congestion are regularly seen along with frothy fluid in the airways and cut surfaces of the lungs. To definitively diagnose the disease, ''C. ruminantium'' must be demonstrated either in preparations of the hippocampus under Giemsa staining or by
histopathology Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Spe ...
of brain or kidney.


Treatment and control

During the early stages of disease, animals may be treated with
sulfonamides In organic chemistry, the sulfonamide functional group (also spelled sulphonamide) is an organosulfur group with the structure . It consists of a sulfonyl group () connected to an amine group (). Relatively speaking this group is unreactive. ...
and tetracyclines. In advanced disease, prognosis is poor. Tetracyclines can also be used
prophylactically Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
when animals are introduced into an area endemic with heartwater.
Ectoparasiticides An ectoparasiticide is an antiparasitic drug used in the treatment of ectoparasitic infestations. These drugs are used to kill the parasites that live on the body surface. Permethrin, sulfur, lindane, dicophane, benzyl benzoate Benzyl benzoate ...
, used as dips, can be used to reduce exposure the animals exposure to bont ticks. In areas endemic for heartwater, the use of dips against other ticks of domestic animals, such as ''Rhipicephalus (Boophilus)'' and ''Hyalomma'' species is likely, and this will usually contribute to control of vectors of ''E. ruminantium''.


Vaccines

A live blood vaccine is available for protection of young stock, but animals may require treatment for the disease after vaccination. Several experimental vaccines are currently being developed, examples include attenuated, recombinant and multi-epitope DNA vaccines.


Mortality

Depending on the species of the animal the mortality rate of the disease may vary from 5% to 90%. Mortality rates appear to be the highest within the various sheep and goat species, but this is not always the case, as some sheep species such as the
Afrikaner Afrikaners () are a South African ethnic group descended from Free Burghers, predominantly Dutch settlers first arriving at the Cape of Good Hope in the 17th and 18th centuries.Entry: Cape Colony. ''Encyclopædia Britannica Volume 4 Part 2: ...
have mortality rates only reaching as high as 6%.


Global status

Heartwater is notifiable to the World Organization for Animal Health.


United States

The U.S.
Department of Agriculture An agriculture ministry (also called an) agriculture department, agriculture board, agriculture council, or agriculture agency, or ministry of rural development) is a ministry charged with agriculture. The ministry is often headed by a minister f ...
believes that an outbreak in the U.S could cost the livestock industry up to $762 million in losses annually. The tick that carries the disease is thought to be capable of being transported by migratory birds from the Caribbean to at least Florida. The U.S has prepared an in-depth response plan to mitigate damages and contain any detected spread.


See also

* Zoonosis


References


Additional references

* * {{Taxonbar, from=Q1118366 Rickettsiales Bacteriology Ruminant diseases Tick-borne diseases