Human monocytotropic ehrlichiosis explained

Human monocytic ehrlichiosis

Human monocytotropic ehrlichiosis[1] is a form of ehrlichiosis associated with Ehrlichia chaffeensis.[2] This bacterium is an obligate intracellular pathogen affecting monocytes and macrophages.[3]

Symptom and signs

The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to human granulocytic anaplasmosis, rash is more common.[4] 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.[5]

Cause

This disease is known to be caused by tick bites.[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. Ehrlichia serologies can be negative in the acute period. Polymerase chain reaction 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]

Epidemiology

In the US, human monocytotropic ehrlichiosis occurs across the south-central, southeastern, and mid-Atlantic states, regions where both the white-tailed deer (Odocoileus virginianus) and its ectoparasite, Lone Star ticks (Amblyomma americanum), thrive.[11] [12] [13]

Human monocytotropic ehrlichiosis occurs in California in Ixodes pacificus ticks and in Dermacentor variabilis ticks.[14] Nearly 600 cases were reported to the CDC in 2006. In 2001–2002, the incidence was highest in Missouri, Tennessee, and Oklahoma, as well as in people older than 60.[15]

See also

Notes and References

  1. Book: Rapini . Ronald P. . Bolognia . Jean L. . Jorizzo . Joseph L. . Dermatology . limited . Mosby . 2007 . 1130 . 978-1-4160-2999-1 .
  2. Schutze GE, Buckingham SC, Marshall GS, etal . 1191660 . Human monocytic ehrlichiosis in children . Pediatr. Infect. Dis. J. . 26 . 6 . 475–9 . June 2007 . 17529862 . 10.1097/INF.0b013e318042b66c .
  3. Zhang . Jian-zhi . Popov . Vsevolod L. . Gao . Si . Walker . David H. . Yu . Xue-jie . The developmental cycle of Ehrlichia chaffeensis in vertebrate cells . Cellular Microbiology . 610–618 . March 2007. 9 . 3 . 10.1111/j.1462-5822.2006.00812.x . 16987329 . 11384349 . free .
  4. Dumler JS, Choi KS, Garcia-Garcia JC, etal . Human granulocytic anaplasmosis and Anaplasma phagocytophilum . Emerging Infectious Diseases . 11 . 12 . 1828–34 . December 2005 . 16485466 . 10.3201/eid1112.050898. 3367650.
  5. Paddock CD, Folk SM, Shore GM, etal . Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus . Clinical Infectious Diseases . 33 . 9 . 1586–94 . November 2001 . 11568857 . 10.1086/323981 . free .
  6. Web site: Ehrlichiosis – Transmission . United States Center for Disease Control . 17 January 2019 . November 23, 2020.
  7. Prince LK, Shah AA, Martinez LJ, Moran KA . Ehrlichiosis: making the diagnosis in the acute setting . Southern Medical Journal . 100 . 8 . 825–8 . August 2007 . 17713310 . 10.1097/smj.0b013e31804aa1ad. 31487400 .
  8. Hamburg BJ, Storch GA, Micek ST, Kollef MH . 2632346 . The importance of early treatment with doxycycline in human ehrlichiosis . Medicine . 87 . 2 . 53–60 . March 2008 . 18344803 . 10.1097/MD.0b013e318168da1d . free .
  9. Muffly T, McCormick TC, Cook C, Wall J . Human granulocytic ehrlichiosis complicating early pregnancy . Infect Dis Obstet Gynecol . 2008 . 1–3 . 2008 . 18509484 . 2396214 . 10.1155/2008/359172. free .
  10. Krause PJ, Corrow CL, Bakken JS . Successful treatment of human granulocytic ehrlichiosis in children using rifampin . Pediatrics . 112 . 3 Pt 1 . e252–3 . September 2003 . 12949322 . 10.1542/peds.112.3.e252.
  11. Kennedy AC, Marshall E. Lone Star Ticks (Amblyomma americanum): An Emerging Health Threat in Delaware. Delaware Journal of Public Health. 7. 1. 66-71. 2021. 10.32481/djph.2021.01.013. 34467183. 8352541. 18 April 2024.
  12. Web site: Ehrlichiosis: Transmission. Centers for Disease Control and Prevention. 17 January 2019. 18 April 2024.
  13. Web site: Tickborne Diseases of the United States: Ehrlichiosis. Centers for Disease Control and Prevention. 15 December 2023. 18 April 2024.
  14. Holden K, Boothby JT, Anand S, Massung RF . Detection of Borrelia burgdorferi, Ehrlichia chaffeensis, and Anaplasma phagocytophilum in ticks (Acari: Ixodidae) from a coastal region of California . J. Med. Entomol. . 40 . 4 . 534–9 . July 2003 . 14680123 . 10.1603/0022-2585-40.4.534 . free .
  15. Web site: Statistics and Epidemiology: Annual Cases of Ehrlichiosis in the United States . Ehrlichiosis . 5 September 2013 . Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention .

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