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Human monocytic ehrlichiosis
Classification and external resources
ICD-9 082.4
DiseasesDB 31131
MedlinePlus 001381
eMedicine med/3391
MeSH D016873

Human monocytotropic ehrlichiosis[1] (HME) is a form of ehrlichiosis associated with Ehrlichia chaffeensis.[2]

This bacteria is an obligate intracellular pathogen affecting monocytes and macrophages.

Contents

Ecology & Epidemiology

HME occurs across the south-central, southeastern, and mid-Atlantic states, regions where both the white-tailed deer (Odocoileus virginianus) and lone star ticks (Amblyomma americanum) thrive.

HME occurs in California in Ixodes pacificus ticks and in Dermacentor variabilis ticks.[3]

Nearly 600 cases were reported to the CDC in 2006. In 2001-2002, the incidence was highest in Missouri, Tenessee, and Oklahoma, as well as in people older than 60.[4]

Symptoms

The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to Human Granulocytic Ehrlichiosis, rash is more common.[5] Laboratory abnormalities include thrombocytopenia, leukopenia, and elevated liver tests.

The severity of the illness can range from minor or asymptomatic to life-threatening. CNS involvement may occur. A serious septic or toxic shock-like picture can also develop, especially in patients with impaired immunity. [6]

Diagnosis

Tick exposure is often overlooked. For patients living in high-prevalence areas who spend time outdoors, a high degree of clinical suspicion should be employed.

Erlichia serologies can be negative in the acute period. PCR is therefore the laboratory diagnostic tool of choice.[7]

Treatment

If Ehrlichiosis is suspected, treatment should not be delayed while waiting for a definitive laboratory confirmation, as prompt doxycycline therapy has been associated with improved outcomes.[8] Doxycycline is the treatment of choice.

Presentation during early pregnancy can complicate treatment.[9]

Rifampin has been used in pregnancy and in patients allergic to doxycycline.[10]

References

  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1130. ISBN 1-4160-2999-0.  
  2. ^ Schutze GE, Buckingham SC, Marshall GS, et al. (June 2007). "Human monocytic ehrlichiosis in children". Pediatr. Infect. Dis. J. 26 (6): 475–9. doi:10.1097/INF.0b013e318042b66c. PMID 17529862. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006454-200706000-00005.  
  3. ^ http://www.ncbi.nlm.nih.gov/pubmed/14680123
  4. ^ CDC Ehrlichiosis statistics
  5. ^ Dumler JS, Choi KS, Garcia-Garcia JC, et al. (December 2005). "Human granulocytic anaplasmosis and Anaplasma phagocytophilum". Emerging infectious diseases 11 (12): 1828–34. PMID 16485466.  
  6. ^ Paddock CD, Folk SM, Shore GM, et al. (November 2001). "Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 33 (9): 1586–94. doi:10.1086/323981. PMID 11568857.  
  7. ^ Prince LK, Shah AA, Martinez LJ, Moran KA (August 2007). "Ehrlichiosis: making the diagnosis in the acute setting". Southern medical journal 100 (8): 825–8. PMID 17713310. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=100&issue=8&spage=825.  
  8. ^ Hamburg BJ, Storch GA, Micek ST, Kollef MH (March 2008). "The importance of early treatment with doxycycline in human ehrlichiosis". Medicine 87 (2): 53–60. doi:10.1097/MD.0b013e318168da1d. PMID 18344803.  
  9. ^ Muffly T, McCormick TC, Cook C, Wall J (2008). "Human granulocytic ehrlichiosis complicating early pregnancy". Infect Dis Obstet Gynecol 2008: 359172. doi:10.1155/2008/359172. PMID 18509484.  
  10. ^ Krause PJ, Corrow CL, Bakken JS (September 2003). "Successful treatment of human granulocytic ehrlichiosis in children using rifampin". Pediatrics 112 (3 Pt 1): e252–3. doi:10.1542/peds.112.3.e252. PMID 12949322. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=12949322.  

See also

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Human monocytic ehrlichiosis
Classification and external resources
ICD-9 082.4
DiseasesDB 31131
MedlinePlus 001381
eMedicine med/3391 
MeSH D016873

Human monocytic ehrlichiosis (HME) is a form of ehrlichiosis associated with Ehrlichia chaffeensis.[1]

This bacteria is an obligate intracellular pathogen affecting monocytes and macrophages.

Contents

Ecology & Epidemiology

HME occurs across the south-central, southeastern, and mid-Atlantic states, regions where both the white-tailed deer (Odocoileus virginianus) and lone star ticks (Amblyomma americanum) thrive.

Nearly 600 cases were reported to the CDC in 2006. In 2001-2002, the incidence was highest in Missouri, Tenessee, and Oklahoma, as well as in people older than 60.[2]

Symptoms

The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to Human Granulocytic Ehrlichiosis, rash is more common.[3] Laboratory abnormalities include thrombocytopenia, leukopenia, and elevated liver tests.

The severity of the illness can range from minor or asymptomatic to life-threatening. CNS involvement may occur. A serious septic or toxic shock-like picture can also develop, especially in patients with impaired immunity. [4]

Diagnosis

Tick exposure is often overlooked. For patients living in high-prevalence areas who spend time outdoors, a high degree of clinical suspicion should be employed.

Erlichia serologies can be negative in the acute period. PCR is therefore the laboratory diagnostic tool of choice.[5]

Treatment

If Ehrlichiosis is suspected, treatment should not be delayed while waiting for a definitive laboratory confirmation, as prompt doxycycline therapy has been associated with improved outcomes.[6] Doxycycline is the treatment of choice.

Presentation during early pregnancy can complicate treatment.[7]

Rifampin has been used in pregnancy and in patients allergic to doxycycline.[8]

References

  1. Schutze GE, Buckingham SC, Marshall GS, et al. (June 2007). "Human monocytic ehrlichiosis in children". Pediatr. Infect. Dis. J. 26 (6): 475–9. doi:10.1097/INF.0b013e318042b66c. PMID 17529862. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006454-200706000-00005. 
  2. CDC Ehrlichiosis statistics
  3. Dumler JS, Choi KS, Garcia-Garcia JC, et al. (December 2005). "Human granulocytic anaplasmosis and Anaplasma phagocytophilum". Emerging infectious diseases 11 (12): 1828–34. PMID 16485466. 
  4. Paddock CD, Folk SM, Shore GM, et al. (November 2001). "Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 33 (9): 1586–94. doi:10.1086/323981. PMID 11568857. 
  5. Prince LK, Shah AA, Martinez LJ, Moran KA (August 2007). "Ehrlichiosis: making the diagnosis in the acute setting". Southern medical journal 100 (8): 825–8. PMID 17713310. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=100&issue=8&spage=825. 
  6. Hamburg BJ, Storch GA, Micek ST, Kollef MH (March 2008). "The importance of early treatment with doxycycline in human ehrlichiosis". Medicine 87 (2): 53–60. doi:10.1097/MD.0b013e318168da1d. PMID 18344803. 
  7. Muffly T, McCormick TC, Cook C, Wall J (2008). "Human granulocytic ehrlichiosis complicating early pregnancy". Infect Dis Obstet Gynecol 2008: 359172. doi:10.1155/2008/359172. PMID 18509484. 
  8. Krause PJ, Corrow CL, Bakken JS (September 2003). "Successful treatment of human granulocytic ehrlichiosis in children using rifampin". Pediatrics 112 (3 Pt 1): e252–3. doi:10.1542/peds.112.3.e252. PMID 12949322. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=12949322. 

See also

Template:Bacterial diseases


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