Potomac horse fever

Potomac Horse Fever (PHF) is a potentially-fatal febrile illness affecting horses caused by the intracellular bacterium Neorickettsia risticii. PHF is also known as Shasta River Crud and Equine Monocytic Ehrlichiosis. It was first described in areas surrounding the Potomac River northwest of Washington, D.C., in the 1980s, but cases have been described in many other parts of the United States, such as Minnesota, California, and Pennsylvania. Currently, it is found in more than 40 U.S. states and Canada.

The causative agent of PHF is Neorickettsia risticii (formerly Ehrlichia risticii), an intracellular rickettsial bacterium.

The vector of Neorickettsia risticii is believed to be a trematode (fluke). The life cycle of the fluke takes it through freshwater snails and back into water, where it is ingested by the larval stages of several aquatic insects, including caddis flies and mayflies. It is thought that the main mode of infection is by accidental ingestion of infected adult insects, who may fly into barns and die in stalls or on pastures after enclosure. Experimental infection has been produced with oral administration of infected insects and subcutaneous inoculation of N. risticii. All attempts to transmit the disease using ticks have failed.

Several outbreaks of PHF have been found to coincide with mass emergences of burrowing mayflies of the genus Hexagenia; these insects hatch en masse and may be found littering the ground in nearby stables, where they are attracted by light. The entire natural history and life cycle of N. risticii has yet to be elucidated, but bats and birds may be wild reservoirs of infection. Unlike other causes of acute colitis in horses, such as Salmonella and Clostridium, PHF is not spread directly from horse to horse.

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