Human monocytotropic ehrlichiosis
|Human monocytic ehrlichiosis|
|Classification and external resources|
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.
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.
The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to human granulocytic ehrlichiosis, rash is more common. 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.
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.
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. Doxycycline is the treatment of choice.
Presentation during early pregnancy can complicate treatment.
- Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: 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.
- CDC Ehrlichiosis statistics
- 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.
- 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. 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.