Human monocytic ehrlichiosis |
Ehrlichia chaffeensis
|
Classification and external resources |
ICD-9 |
082.41 |
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
- 1 Ecology & Epidemiology
- 2 Symptoms
- 3 Diagnosis
- 4 Treatment
- 5 References
- 6 See also
Ecology & Epidemiology
In the USA, 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, Tennessee, 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.
Ehrlichia 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
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology. Mosby. p. 1130. ISBN 1-4160-2999-0.
- ^ 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.
- ^ Holden K, Boothby JT, Anand S, Massung RF (July 2003). "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. doi:10.1603/0022-2585-40.4.534. PMID 14680123.
- ^ "Statistics and Epidemiology: Annual Cases of Ehrlichiosis in the United States". Ehrlichiosis. Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention. 5 September 2013.
- ^ Dumler JS, Choi KS, Garcia-Garcia JC, et al. (December 2005). "Human granulocytic anaplasmosis and Anaplasma phagocytophilum". Emerging Infectious Diseases 11 (12): 1828–34. doi:10.3201/eid1112.050898. PMC 3367650. PMID 16485466.
- ^ 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 33 (9): 1586–94. doi:10.1086/323981. PMID 11568857.
- ^ 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. doi:10.1097/smj.0b013e31804aa1ad. PMID 17713310.
- ^ 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.
- ^ 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. PMC 2396214. PMID 18509484.
- ^ 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.
See also
- monocyte
- Human granulocytic anaplasmosis
- Human ewingii ehrlichiosis
- Infectious diseases
- Bacterial disease: Proteobacterial G−
- primarily A00–A79, 001–041, 080–109
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|
α |
Rickettsiales |
Rickettsiaceae/
(Rickettsioses) |
Typhus |
- Rickettsia typhi
- Rickettsia prowazekii
- Epidemic typhus, Brill–Zinsser disease, Flying squirrel typhus
|
|
Spotted
fever |
Tick-borne |
- Rickettsia rickettsii
- Rocky Mountain spotted fever
- Rickettsia conorii
- Rickettsia japonica
- Rickettsia sibirica
- Rickettsia australis
- Rickettsia honei
- Flinders Island spotted fever
- Rickettsia africae
- Rickettsia parkeri
- Rickettsia aeschlimannii
- Rickettsia aeschlimannii infection
|
|
Mite-borne |
- Rickettsia akari
- Orientia tsutsugamushi
|
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Flea-borne |
|
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Anaplasmataceae |
- Ehrlichiosis: Anaplasma phagocytophilum
- Human granulocytic anaplasmosis, Anaplasmosis
- Ehrlichia chaffeensis
- Human monocytotropic ehrlichiosis
- Ehrlichia ewingii
- Ehrlichiosis ewingii infection
|
|
|
Rhizobiales |
Brucellaceae |
|
|
Bartonellaceae |
- Bartonellosis: Bartonella henselae
- Bartonella quintana
- either henselae or quintana
- Bartonella bacilliformis
- Carrion's disease, Verruga peruana
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|
|
|
β |
Neisseriales |
M+ |
- Neisseria meningitidis/meningococcus
- Meningococcal disease, Waterhouse–Friderichsen syndrome, Meningococcal septicaemia
|
|
M- |
- Neisseria gonorrhoeae/gonococcus
|
|
ungrouped: |
- Eikenella corrodens/Kingella kingae
- Chromobacterium violaceum
- Chromobacteriosis infection
|
|
|
Burkholderiales |
- Burkholderia pseudomallei
- Burkholderia mallei
- Burkholderia cepacia complex
- Bordetella pertussis/Bordetella parapertussis
|
|
|
γ |
Enterobacteriales
(OX-) |
Lac+ |
- Klebsiella pneumoniae
- Rhinoscleroma, Klebsiella pneumonia
- Klebsiella granulomatis
- Klebsiella oxytoca
- Escherichia coli: Enterotoxigenic
- Enteroinvasive
- Enterohemorrhagic
- O157:H7
- O104:H4
- Hemolytic-uremic syndrome
- Enterobacter aerogenes/Enterobacter cloacae
|
|
Slow/weak |
- Serratia marcescens
- Citrobacter koseri/Citrobacter freundii
|
|
Lac- |
H2S+ |
- Salmonella enterica
- Typhoid fever, Paratyphoid fever, Salmonellosis
|
|
H2S- |
- Shigella dysenteriae/sonnei/flexneri/boydii
- Shigellosis, Bacillary dysentery
- Proteus mirabilis/Proteus vulgaris
- Yersinia pestis
- Yersinia enterocolitica
- Yersinia pseudotuberculosis
- Far East scarlet-like fever
|
|
|
|
Pasteurellales |
Haemophilus: |
- H. influenzae
- Haemophilus meningitis
- Brazilian purpuric fever
- H. ducreyi
- H. parainfluenzae
|
|
Pasteurella multocida |
- Pasteurellosis
- Actinobacillus
|
|
Aggregatibacter actinomycetemcomitans |
|
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Legionellales |
- Legionella pneumophila/Legionella longbeachae
- Coxiella burnetii
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Thiotrichales |
|
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Vibrionaceae |
- Vibrio cholerae
- Vibrio vulnificus
- Vibrio parahaemolyticus
- Vibrio alginolyticus
- Plesiomonas shigelloides
|
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Pseudomonadales |
- Pseudomonas aeruginosa
- Moraxella catarrhalis
- Acinetobacter baumannii
|
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Xanthomonadaceae |
- Stenotrophomonas maltophilia
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Cardiobacteriaceae |
|
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Aeromonadales |
- Aeromonas hydrophila/Aeromonas veronii
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|
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ε |
Campylobacterales |
- Campylobacter jejuni
- Campylobacteriosis, Guillain–Barré syndrome
- Helicobacter pylori
- Peptic ulcer, MALT lymphoma, Gastric cancer
- Helicobacter cinaedi
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Index of bacterial disease
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Description |
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Disease |
- Gram-positive firmicutes
- Gram-positive actinobacteria
- Gram-negative proteobacteria
- Gram-negative non-proteobacteria
- Cholera
- Tuberculosis
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Treatment |
- Antibiotics
- cell wall
- nucleic acid
- mycobacteria
- protein synthesis
- Antibodies
- Vaccines
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|
|
Tick-borne diseases and mite-borne diseases
|
|
Bacterial infection
(all G-) |
Rickettsiales
|
- Rocky Mountain spotted fever
- Ehrlichiosis (Human granulocytic, Human monocytic)
- Boutonneuse fever
|
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Spirochaete
|
- Lyme disease
- Relapsing fever
|
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Thiotrichales
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Viral infection |
- Colorado tick fever
- Tick-borne encephalitis
- Crimean-Congo hemorrhagic fever
- Omsk hemorrhagic fever
- Kyasanur forest disease
- Powassan encephalitis
- Heartland virus
- Kemerovo tickborne viral fever
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Protozoan infection |
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Neurotoxin |
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General |
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Vectors |
Ticks
|
- Ixodes: Ixodes scapularis
- Ixodes cornuatus
- Ixodes holocyclus
- Ixodes pacificus
- Ixodes ricinus
- Dermacentor: Dermacentor variabilis
- Dermacentor andersoni
- Amblyomma: Amblyomma americanum
- Amblyomma cajennense
- Amblyomma triguttatum
- Ornithodoros: Ornithodoros moubata
- Ornithodoros hermsi
- Ornithodoros gurneyi
- other: Rhipicephalus sanguineus
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Mites
|
- Leptotrombidium deliense
- Liponyssoides sanguineus
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Index of parasites and pests
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Description |
|
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Disease |
- Arthropod
- lice
- tick- and mite-born diseases
- flea
- Worms
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Treatment |
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