Abstract
To determine the incidence, clinical and laboratory characteristics, and utility of molecular diagnosis of human monocytotropic ehrlichiosis (HME) in the primary care setting, we conducted a prospective study in an outpatient primary care clinic in Cape Girardeau, Missouri. One hundred and two patients with a history of fever for 3 days (>37.7°C), tick bite or exposure, and no other infectious disease diagnosis were enrolled between March 1997 and December 1999. HME was diagnosed in 29 patients by indirect immunofluorescent antibody assay and polymerase chain reaction (PCR). Clinical and laboratory manifestations included fever (100%), headache (72%), myalgia or arthralgia (69%), chills (45%), weakness (38%), nausea (38%), leukopenia (60%), thrombocytopenia (56%), and elevated aspartate aminotransferase level (52%). Hospitalization occurred in 41% of case-patients. PCR sensitivity was 56%; specificity, 100%. HME is a prevalent, potentially severe disease in southeastern Missouri that often requires hospitalization. Because clinical presentation of HME is nonspecific, PCR is useful in the diagnosis of acute HME.
Highlights
To determine the incidence, clinical and laboratory characteristics, and utility of molecular diagnosis of human monocytotropic ehrlichiosis (HME) in the primary care setting, we conducted a prospective study in an outpatient primary care clinic in Cape Girardeau, Missouri
Ehrlichioses were recognized as causing human infectious diseases relatively recently
Other tick-borne human granulocytotropic infections are caused by Anaplasma phagocytophilum and E. ewingii
Summary
Clinical and laboratory characteristics, and utility of molecular diagnosis of human monocytotropic ehrlichiosis (HME) in the primary care setting, we conducted a prospective study in an outpatient primary care clinic in Cape Girardeau, Missouri. Ehrlichioses were recognized as causing human infectious diseases relatively recently. In the United States, the first human case of ehrlichiosis was reported in 1987 [4]. The clinical spectrum of human monocytotropic ehrlichiosis (HME) ranges from mild to a life-threatening multisystem disease [7,8,9,10,11] with a case-fatality rate of 2% to 3%. The clinical manifestations are neither sensitive nor specific for the diagnosis of HME. The present investigation describes the first office-based, prospective study of HME in the primary care setting, an investigation over a period of 3 years in southeast Missouri
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