Case Of Human Monocytic Ehrlichiosis Research Articles

“Leopards do not change their spots:” tick borne disease symptomology case report

BackgroundHuman Monocytic Ehrlichiosis is caused by infection with the bacteria Ehrlichia chaffeensis through the bite of an infected lone star tick (Amblyomma americanum). Patients infected with Human Monocytic Ehrlichiosis often present with symptoms including fever, headache, myalgia, and occasionally a macular rash. The presence of other endemic tick-borne diseases with similar symptoms, such as Rocky Mountain Spotted Fever, complicate the diagnosis of Human Monocytic Ehrlichiosis.Case presentationA patient developed a fever, diffuse myalgia, headache, and a non-productive cough 5 days after a fishing trip in late May in central North Carolina. Over the course of the illness the patient’s symptoms worsened, with arthralgia, bilateral lower extremity erythema and edema, and a developing bilateral rash on the palms. With testing that revealed elevated liver enzymes, a potential for recent tick exposure (e.g., fishing trip), presentation during tick season, and the development of a rash, Rocky Mountain Spotted Fever and Human Monocytic Ehrlichiosis were considered. The patient was prescribed a seven-day course of oral doxycycline and cefalexin, which would provide coverage from Rickettsia, Ehrlichia and gram-positive bacteria typically responsible for cellulitis. Many of the patient’s symptoms resolved or improved, although the right shoulder remained painful to active movement. The patient was prescribed another seven-day course of doxycycline due to his perceived incomplete response to the first course. Approximately 5 weeks after symptom onset (D0 + 36), the patient followed up with a provider for convalescent testing and counseling. Convalescent Ehrlichia and Rickettsia serological tests were ordered. The acute Ehrlichia serology and acute Rickettsia serology were originally non-reactive with both titers measured at < 1:64. Convalescent serology, ordered 28 days after the acute sample collection, showed a greater than four-fold increase in the Ehrlichia IgG titer (1:256), satisfying clinical and laboratory case definitions for ehrlichiosis. In follow-up, 3 weeks later (D0 + 57), the patient reported that most of his pain had subsided, though he still occasionally got shooting nerve pain when exercising.ConclusionThis case of Human Monocytic Ehrlichiosis in North Carolina exemplifies the need for a knowledge of spatial epidemiological patterns and clinical manifestations in the diagnosis of tick-borne diseases.

The First Reported Case of Human Monocytic Ehrlichiosis (HME) in Jordan

Human Ehrlichiosis infrequently occurs and can be missed, but attention to history and a meticulous physical examination would raise the index for suspicion and is documented with proper investigations. We report the first case of human monocytic Ehrlichiosis (HME) in a young female patient who lives in the Suburb city of Madaba, Jordan. She presented with fever, severe headache, skin rash, and confusion. She rapidly deteriorated and was admitted to our hospital. She had arrhythmias, convulsions, lapsed into a coma and respiratory failure and needed non-invasive ventilation. In addition to her clinical and epidemiological characteristics, the diagnosis was confirmed by the buffy coat. She had a swift response to oral doxycycline and was discharged home.

214. Comparison of Clinical and Laboratory Findings of Human Monocytic Ehrlichiosis (HME) and Human Granulocytic Anaplasmosis (HGA) in Long Island, New York.

BackgroundSuffolk County reports to the Department of Health the highest absolute number of cases of tick-borne diseases (TBD) for NY State. While Lyme disease and Babesiosis are the most common TBD in this county with more than 600 and 100 cases reported every year, respectively; two other TBD, HME (due to Ehrlichia chaffeensis) and HGA (due to Anaplasma phagocytophilum) are also commonly reported in this county (63 and 37 every year, respectively). There is limited data directly comparing both diseases on acute presentation; the aim of this study was to compare the clinical features, laboratory findings and complications of HME and HGA in the epicenter of TBD in NY State.MethodsA retrospective study was designed to collect cases with the diagnosis of HME and HGA by using ICD9 or ICD10 codes from 2013 to 2018 at Stony Brook Medicine. Inclusion criteria were patients 18 years or older who had a positive PCR in blood for E. chaffeensis or A. phagocytophilum. Demographics, clinical features, laboratory results, and complications were extracted from patient charts. We used the chi-square test to compare the proportion of symptoms and a two-tailed unpaired student T-test to compare laboratory values.ResultsA total of 40 cases of HME (mean age 67 ± 13) and 27 with HGA (mean age 63 ± 12) met inclusion criteria. Only approximately 50% of cases had a documented history of tick exposure. Clinical presentations were similar in terms of frequency of fever, headache, arthralgia, and myalgia. In contrast, hypotension, confusion, and rash were more common in HME although only the latter was significantly more common. HME patients had significantly greater degrees of leukopenia and thrombocytopenia and elevated AST levels. The majority of patients with HME and HGA were hospitalized >1 day for management of their acute illness (HME, 30/40 and HGA 17/27). Several patients with HME had gastrointestinal (GI) complications including 3 with acute acalculous cholecystitis, 1 with duodenitis, and 1 with acute colitis; 1 patient with HGA had perforated diverticulitis.ConclusionPatients with acute HME tend to be more ill than those with acute HGA; however, a substantial proportion of both groups require hospitalization. GI complications were more commonly seen in HME (12.5%) than HGA (3.7%) which deserves further investigation. Disclosures All authors: No reported disclosures.

FROM TICK BITE TO HEART FAILURE

Cardiac involvement in tick borne infection is an uncommon complication. We present here an unusual case of Human Monocytic Ehrlichiosis resulting in myocarditis. A 58-year-old woman from Mississippi presented with altered mental status and difficulty breathing found to be hypotensive and hypoxic

An unusual case of Human Monocytic Ehrlichiosis

An unusual case of Human Monocytic Ehrlichiosis

Primer caso de ehrlichiosis monocítica humana reportado en Colombia

First case of human monocytic ehrlichiosis reported in Colombia Abstract Human ehrlichiosis is an infection that is neither suspected or recognized in our country. Certain epidemiologic clues should arouse suspicion for this entity when the symptoms are suggestive. We present a case of a young soldier with clear risk factors for zoonotic infection, with fever, a petechial rash, thrombocytopenia, hepatitis and multiple organ failure, for whom a diagnosis of Ehrlichia chaffeensis was confirmed by serology after ruling out common infections and other infections caused by vectors. There are important limitations in documenting these cases, because there is no mandatory public reporting and a significant proportion of these cases are asymptomatic, leading to

A case of human monocytic ehrlichiosis in Serbia

Ehrlichiosis is a bacterial zoonosis transmitted by hematophagous arthropods--ticks. In humans, it occurs as monocytic, granulocytic, and ewingii ehrlichiosis. Pathological process is based on parasitic presence of Ehrlichia organisms within peripheral blood cells--monocytes and granulocytes. Fifty-two year old patient was admitted to hospital due to high fever of over 40 degrees C that lasted two days, accompanied with chills, muscle aches, malaise, loss of appetite, headache, confusion, breathing difficulties, and mild dry cough. The history suggested tick bite that occurred seven days before the onset of disease. Doxycycline was introduced and administered for 14 days, causing the disease to subside. Indirect immunofluorescence assay was used to analyze three serum samples obtained from this patient for Ehrlichia chaffeensis antibodies, and peripheral blood smear was evaluated for the presence of Ehrlichia and Ehrlichia aggregation into morulae. Ehrlichiosis should be considered in each case where there is a history of tick bite together with the clinical picture (high fever, chills, muscle aches, headache, generalized weakness and malaise, and possible maculopapular rash). The presence of Ehrlichia chaffeensis antibodies was confirmed in a patient with the history of tick bite, appropriate clinical picture and indirect immunofluorescence assay. This confirmed the presence of human monocytotropic ehrlichiosis, a disease that is uncommonly identified in our country.

Macrophage Activation Syndrome Secondary to Human Monocytic Ehrlichiosis

To present a case of human monocytic ehrlichiosis (HME) that was complicated by macrophage activation syndrome (MAS), also known as secondary hemophagocytic lymphohistiocytosis (sHLH). Data was collected from patient's electronic medical records at the University of Alabama at Birmingham. The patient is a part of a larger cohort of patients with all-cause MAS treated at our center. A 63year old renal transplant recipient male on maintenance immunosuppressive therapy presented with high grade fever, leukopenia, thrombocytopenia and elevated transaminases and initially met clinical criteria for severe sepsis. On further investigation, clinical and laboratory criteria for MAS were met. He was treated with a combination of doxycycline for HME and a novel combination of anakinra (interleukin-1 receptor antagonist), and high dose corticosteroids. The discussion focuses on clinical presentation, pathogenesis and treatment of MAS with an emphasis on MAS secondary to HME. Macrophage activation syndrome or sHLH is a dysfunctional, hyperactive and potentially fatal immune system response that results in multi-organ dysfunction. With increasing incidence of Ehrlichia chaffeensis as an emerging pathogen, clinicians should be aware of this fulminant and potentially fatal complication of HME.

Ehrlichia chaffeensisin Child, Venezuela

<i>Ehrlichia chaffeensis</i>in Child, Venezuela

Human Monocytic Ehrlichiosis and Human Granulocytic Anaplasmosis in the United States, 2001–2002

The epidemiologic features are described of cases of human monocytic ehrlichiosis and human granulocytic anaplasmosis in the United States.

Old and New Human Rickettsiosis in Minas Gerais State, Brazil

The authors describe cases of Brazilian spotted fever (BSF) diagnosed in Minas Gerais state, Brazil, by the Minas Gerais Public Health Laboratory, Ezequiel Dias Foundation from 1995 to 2004. In addition they present three cases of human Rickettsia felis rickettsiosis from Minas Gerais diagnosed in France in 1999, and the first two suspected cases of human monocytic ehrlichiosis (HME) diagnosed in Ezequiel Dias Foundation in 2001. In both cases a differential diagnose was made with BSF.

EPIDEMIOLOGY OF HUMAN EHRLICHIOSIS AND ANAPLASMOSIS IN THE UNITED STATES, 2001–2002

During 2001 through 2002, 1,176 cases of the tick-borne diseases human monocytic ehrlichiosis (HME) and human granulocytic anaplasmosis (HGA) were reported to the Centers for Disease Control and Prevention (CDC) by 32 states through the National Electronic Telecommunications System for Surveillance. The average reported annual incidences for HME and HGA during 2001-2002 were 0.6 and 1.4 cases per million population, respectively; incidence was highest among men > 60 years of age. During this same interval, a total of 883 cases of HME and HGA were reported to CDC through a passive surveillance system of tick-borne disease case report forms (CRFs). The surveillance information retrieved from CRFs has allowed for qualitative evaluation of ehrlichiosis and anaplasmosis risk factors, severity, and diagnostic accuracy. Although these surveillance systems likely substantially under-represent the true burden of ehrlichiosis and anaplasmosis in the United States due to poor recognition and reporting, they represent the first compilation of national data since these diseases were made nationally notifiable. Continued and improved surveillance activities will progressively reinforce our understanding and awareness of these newly recognized zoonotic infections.

Outcome of diagnostic tests using samples from patients with culture-proven human monocytic ehrlichiosis: implications for surveillance.

We describe the concordance among results from various laboratory tests using samples derived from nine culture-proven cases of human monocytic ehrlichiosis (HME) caused by Ehrlichia chaffeensis. A class-specific indirect immunofluorescence assay for immunoglobulin M (IgM) and IgG, using E. chaffeensis antigen, identified 44 and 33% of the isolation-confirmed HME patients on the basis of samples obtained at initial clinical presentation, respectively; detection of morulae in blood smears was similarly insensitive (22% positive). PCR amplifications of ehrlichial DNA targeting the 16S rRNA gene, the variable-length PCR target gene, and the groESL operon were positive for whole blood specimens obtained from all patients at initial presentation. As most case definitions of HME require a serologic response with compatible illness for a categorization of even probable disease, PCR would have been required to confirm the diagnosis of HME in all nine of these patients without the submission of a convalescent-phase serum sample. These data suggest that many, if not most, cases of HME in patients who present early in the course of the disease may be missed and underscore the limitations of serologically based surveillance systems.

Minimum infection rate of Ambylomma americanum (Acari: Ixodidae) by Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) in southern Indiana.

In 1994 and 1995, 8 cases of human monocytic ehrlichiosis were confirmed. These cases originated from southern counties where the putative tick vector Ambylomma americanum (L.) is well established. To confirm the presence of Ehrlichia chaffeensis in ticks in southern Indiana and to determine the minimum infection rate, specimens of A. americanum were collected from 5 counties (7 sites). Nucleic acid was isolated from 88 pools of ticks (430 individuals) using an optimized phenol/CTAB (cetyltrimethylammonium bromide) extraction procedure and subjected to polymerase chain reaction analysis using species-specific 16S rRNA gene bacterial primers. Twenty-one of 88 pools (a minimum of 21 of 430 individuals) were positive for the presence of E. Chaffeensis, yielding an average minimum infection rate of 4.9%. Minimum infection rates at individual sites ranged from 0 to 9.4%. These data extend the known distribution of the bacterium to 3 southern counties of Indiana and suggest a higher prevalence of E. chaffeensis than previously reported for Missouri, North Carolina, or Kentucky.