Human monocytotropic ehrlichiosis
| Human monocytic ehrlichiosis | |
|---|---|
Ehrlichia chaffeensis
|
|
| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-9-CM | 082.41 |
| DiseasesDB | 31131 |
| MedlinePlus | 001381 |
| eMedicine | med/3391 |
| Patient UK | Human monocytotropic ehrlichiosis |
| 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.
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
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