Human monocytic ehrlichiosis: An emerging pathogen in transplantation

The spectrum of disease caused by Ehrlichia spp. ranges from asymptomatic to fatal. Awareness and early diagnosis of the infection is paramount because appropriate therapy leads to rapid defervescence and cure. If left untreated, particularly in immunosuppressed patients, ehrlichioses may result in...

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Veröffentlicht in:Transplantation 2001-06, Vol.71 (11), p.1678-1680
Hauptverfasser: TAN, Henkie P, DUMLER, J. Stephen, MALEY, Warren R, KLEIN, Andrew S, BURDICK, James F, POORDAD, F. Fred, THULUVATH, Paul J, MARKOWITZ, Jay S
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Sprache:eng
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Zusammenfassung:The spectrum of disease caused by Ehrlichia spp. ranges from asymptomatic to fatal. Awareness and early diagnosis of the infection is paramount because appropriate therapy leads to rapid defervescence and cure. If left untreated, particularly in immunosuppressed patients, ehrlichioses may result in multi-system organ failure and death. We report the second case of human monocytic ehrlichiosis (HME) in a liver transplant recipient, and review the literature. The patient presented with fever and headache, had negative cultures, and despite broad-spectrum antimicrobial coverage appeared progressively septic. After eliciting a history of tick exposure we treated the patient empirically with doxycycline. The diagnosis of HME was confirmed by 1) polymerase chain reaction (PCR) for Ehrlichia chaffeensis, 2) acute and convalescent serum titers, and 3) in vitro cultivation of E chaffeensis from peripheral blood. Although human ehrlichioses are relatively uncommon, they are emerging as clinically significant arthropod-borne infections. Although epidemiological exposure is responsible for infection, immunosuppression makes patients more likely to succumb to disease. A high index of suspicion and early treatment results in a favorable outcome.
ISSN:0041-1337
1534-6080
DOI:10.1097/00007890-200106150-00030