Medicine:Human monocytotropic ehrlichiosis

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Human monocytic ehrlichiosis
Ehrlichia chaffeensis

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]

Signs and symptoms

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

Human monocytotropic ehrlichiosis is caused by infection with Ehrlichia chaffeensis, an obligate intracellular bacterium that primarily infects monocytes and macrophages.[6] Humans usually acquire the infection through the bite of infected ticks, particularly the lone star tick (Amblyomma americanum) in the United States.[7]

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.[8]

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.[9] Doxycycline is the treatment of choice.[citation needed]

Presentation during early pregnancy can complicate treatment.[10] Rifampin has been used in pregnancy and in patients allergic to doxycycline.[11]

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.[12][13][14]

Human monocytotropic ehrlichiosis occurs in California in Ixodes pacificus ticks and in Dermacentor variabilis ticks.[15] 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.[16]

See also

References

  1. ↑ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology. Mosby. pp. 1130. ISBN 978-1-4160-2999-1. https://archive.org/details/dermatologyvolum00mdje. 
  2. ↑ "Human monocytic ehrlichiosis in children". Pediatr. Infect. Dis. J. 26 (6): 475–9. June 2007. doi:10.1097/INF.0b013e318042b66c. PMID 17529862. 
  3. ↑ Zhang, Jian-zhi; Popov, Vsevolod L.; Gao, Si; Walker, David H.; Yu, Xue-jie (March 2007). "The developmental cycle of Ehrlichia chaffeensis in vertebrate cells". Cellular Microbiology 9 (3): 610–618. doi:10.1111/j.1462-5822.2006.00812.x. PMID 16987329. 
  4. ↑ "Human granulocytic anaplasmosis and Anaplasma phagocytophilum". Emerging Infectious Diseases 11 (12): 1828–34. December 2005. doi:10.3201/eid1112.050898. PMID 16485466. 
  5. ↑ "Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus". Clinical Infectious Diseases 33 (9): 1586–94. November 2001. doi:10.1086/323981. PMID 11568857. http://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1058&context=zoonoticspub. 
  6. ↑ Paddock, Christopher D.; Childs, James E. (2003). "Ehrlichia chaffeensis: a prototypical emerging pathogen". Clinical Microbiology Reviews 16 (1): 37–64. doi:10.1128/CMR.16.1.37-64.2003. PMID 12525424. 
  7. ↑ Biggs, Holly M.; Behravesh, Casey Barton; Bradley, Kristy K.; Dahlgren, F. Scott; Drexler, Nausheen A.; Dumler, J. Stephen; Folk, Sarah M.; Kato, Carol Y. et al. (2016). "Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States". MMWR Recommendations and Reports 65 (2): 1–44. doi:10.15585/mmwr.rr6502a1. PMID 27172113. 
  8. ↑ "Ehrlichiosis: making the diagnosis in the acute setting". Southern Medical Journal 100 (8): 825–8. August 2007. doi:10.1097/smj.0b013e31804aa1ad. PMID 17713310. 
  9. ↑ "The importance of early treatment with doxycycline in human ehrlichiosis". Medicine 87 (2): 53–60. March 2008. doi:10.1097/MD.0b013e318168da1d. PMID 18344803. 
  10. ↑ "Human granulocytic ehrlichiosis complicating early pregnancy". Infect Dis Obstet Gynecol 2008: 1–3. 2008. doi:10.1155/2008/359172. PMID 18509484. 
  11. ↑ "Successful treatment of human granulocytic ehrlichiosis in children using rifampin". Pediatrics 112 (3 Pt 1): e252–3. September 2003. doi:10.1542/peds.112.3.e252. PMID 12949322. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=12949322. 
  12. ↑ "Lone Star Ticks (Amblyomma americanum): An Emerging Health Threat in Delaware". Delaware Journal of Public Health 7 (1): 66–71. 2021. doi:10.32481/djph.2021.01.013. PMID 34467183. 
  13. ↑ "Ehrlichiosis: Transmission". 17 January 2019. https://www.cdc.gov/ehrlichiosis/transmission/index.html. 
  14. ↑ "Tickborne Diseases of the United States: Ehrlichiosis". 15 December 2023. https://www.cdc.gov/ticks/tickbornediseases/ehrlichiosis.html. 
  15. ↑ "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. doi:10.1603/0022-2585-40.4.534. PMID 14680123. 
  16. ↑ "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. https://www.cdc.gov/ehrlichiosis/stats/. 
Classification
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