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Ehrlichia Chaffeensis


Presentation

  • We present a patient whose clinical presentation fulfilled the diagnostic criteria for HLH but whose illness was caused by infection with Ehrlichia chaffeensis, emphasizing the need to explore all possible etiologies during evaluation of patients presenting[ncbi.nlm.nih.gov]
  • We present a case of Ehrlichiosis due to Ehrlichia chaffeensis whose predominant presenting symptom was localized bilateral anterior thigh pain. Copyright 2012 Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • E. chaffeensis was found to be present in 9.8% of adult A. americanum ticks (57 of 579) and 6.7% of D. variabilis ticks (eight of 120).[ncbi.nlm.nih.gov]
  • The present study examined the sensitivity of the nested reverse transcription (RT)-PCR based on the 16S rRNA gene relative to that of the nested PCR for detection of E. chaffeensis in infected DH82 cells, experimentally infected dog peripheral blood[ncbi.nlm.nih.gov]
  • Scattered lobular lymphohistiocytic foci and diffuse lymphohistiocytic infiltration and Kupffer cell hyperplasia with increased phagocytosis frequently were present. Various degrees of liver cell injury and death were observed.[ncbi.nlm.nih.gov]
Fever
  • Rocky Mountain spotted fever has long been known to be endemic in North Carolina; cases of human ehrlichial infection were recognized there soon after Ehrlichia chaffeensis was recognized as an important cause of tick-borne disease in the southeastern[ncbi.nlm.nih.gov]
  • The 12 patients who were PCR-positive for E. chaffeensis suffered from fever (100%), headache (67%), myalgia (42%), arthralgia (58%), pulmonary involvement (17%) and/or a diffuse rash (17%).[ncbi.nlm.nih.gov]
  • Abstract Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition that is characterized by fever, splenomegaly, and cytopenia in 2 or more peripheral blood lineages, hypertriglyceridemia, hypofibrinogenemia, and hemophagocytosis[ncbi.nlm.nih.gov]
  • The clinical features of both forms of human ehrlichiosis are identical and include nonspecific constitutional manifestations, such as fever, headache, malaise, nausea, vomiting, myalgia, and anorexia; however, rare patients develop neurologic symptoms[ncbi.nlm.nih.gov]
  • These sera were collected from patients with symptoms of high fever. The rate of seropositivity for Orientia tsutsugamushi was 50.9% by IFA at the Public Health & Environmental Research Institute and National Institute of Health in South Korea.[ncbi.nlm.nih.gov]
Fatigue
  • Fever, fatigue, malaise, headache, and other "flu-like" symptoms occur most commonly. Central nervous system involvement can result in seizures and coma.[neurology.testcatalog.org]
Cough
  • Some patients may also have myalgias or arthralgias, and an estimated 10–40% of patients may develop coughing, pharyngitis, diarrhea, vomiting, abdominal pain, and changes in mental status.[en.wikipedia.org]
  • Although some infections are asymptomatic, most cause abrupt onset of an influenza-like illness with nonspecific symptoms such as fever, chills, myalgias, weakness, nausea, vomiting, cough. headache, and malaise, usually beginning about 12 days after[merckmanuals.com]
  • Patients infected with E. chaffeensis were more likely to present with 1 gastrointestinal symptom, cough, or rash than were persons infected with E. ewingii ( table 2 ).[academic.oup.com]
  • Fatal outcomes were significantly associated with being elderly; no administration of ribavirin; and the presence of a cough, hemorrhaging, and unconsciousness.[doi.org]
Respiratory Insufficiency
  • Abstract We report a case of ehrlichiosis in a 72-year-old man who developed extreme lethargy, acute renal failure requiring hemodialysis, and respiratory insufficiency requiring intubation.[ncbi.nlm.nih.gov]
Nausea
  • The clinical features of both forms of human ehrlichiosis are identical and include nonspecific constitutional manifestations, such as fever, headache, malaise, nausea, vomiting, myalgia, and anorexia; however, rare patients develop neurologic symptoms[ncbi.nlm.nih.gov]
  • A 45-year-old man with a history of ankylosing spondylitis taking methotrexate presented to a community hospital with acute onset of nausea, vomiting and diarrhea.[jim.bmj.com]
  • Common clinical signs and symptoms of patients with HME (n 32) included fever (100%), headache (69%), myalgia (69%), rash (66%), nausea/vomiting (56%), altered mental status (50%) and lymphadenopathy (47%).[doi.org]
  • Early Illness Early signs and symptoms (the first 5 days of illness) are usually mild or moderate and may include: Fever, chills Severe headache Muscle aches Nausea, vomiting, diarrhea, loss of appetite Confusion Rash (more common in children) Rash Up[cdc.gov]
Fracture
  • Using a freeze fracture technique and biochemical analysis, these bacteria were found to contain significant levels of membrane cholesterol. These bacteria lack genes for cholesterol biosynthesis or modification.[ncbi.nlm.nih.gov]
Suggestibility
  • The central role of MyD88, but not Toll-like receptors, suggests that Ehrlichia species have unique inflammatory molecules.[ncbi.nlm.nih.gov]
  • This is the first report of detection of antibodies to A. phagocytophila and E. chaffeensis in Korea and suggests the presence of A. phagocytophila and E. chaffeensis or antigenically similar species.[ncbi.nlm.nih.gov]
  • In the absence of infected hepatocytes or biliary epithelial cells, these findings suggest that host inflammatory or immune responses contribute to the liver injury seen in HME.[ncbi.nlm.nih.gov]
  • Findings of this case provide the first definitive evidence that E. chaffeensis is capable of establishing persistent human infection and suggest a role for this obligate intracellular bacterium in the induction of immune compromise associated with a[ncbi.nlm.nih.gov]
  • Our data suggest that in Drosophila, E. chaffeensis replicates within the hemocytes, the insect homolog of mammalian macrophages, and in the fat body, the liver homolog of mammals. Copyright 2012 Elsevier GmbH. All rights reserved.[ncbi.nlm.nih.gov]
Headache
  • The clinical features of both forms of human ehrlichiosis are identical and include nonspecific constitutional manifestations, such as fever, headache, malaise, nausea, vomiting, myalgia, and anorexia; however, rare patients develop neurologic symptoms[ncbi.nlm.nih.gov]
  • The 12 patients who were PCR-positive for E. chaffeensis suffered from fever (100%), headache (67%), myalgia (42%), arthralgia (58%), pulmonary involvement (17%) and/or a diffuse rash (17%).[ncbi.nlm.nih.gov]
  • Clinical findings include fever, headache, myalgia, leukopenia, thrombocytopenia, and hepatic inflammatory injury. Whereas Ehrlichia chaffeensis (HME) often causes meningoencephalitis, this is rare with Anaplasma phagocytophilum infection.[ncbi.nlm.nih.gov]
  • We report two cases of rapidly fatal Ehrlichia chaffeensis infection in patients who presented to our institution in early June.A 22-year-old man was hospitalized with hypotension after a one-week illness characterized by fever, headache, . . .[nejm.org]
  • Case Presentation: A 47year old Caucasian man came to the emergency room with of fever, severe headaches, severe body aches and pain for 4days. Headaches worsened and he developed photophobia on day 5.[shmabstracts.com]
Anterior Thigh Pain
  • Author information 1 Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA. bacunha@winthrop.org Abstract Bilateral anterior thigh pain may indicate bacteremia (Louria's Sign).[ncbi.nlm.nih.gov]
Paresis
  • We describe a patient with HME who developed a trochlear nerve paresis associated with evidence of lymphocytic meningitis during the course of her illness.[ncbi.nlm.nih.gov]
Encephalopathy
  • Patients developed characteristic manifestations of severe disease due to E. chaffeensis, including marked thrombocytopenia, pulmonary insufficiency, and encephalopathy. Primary isolation was achieved in DH82 cells; the Jax and St.[ncbi.nlm.nih.gov]

Workup

  • Recipient A underwent an extensive infectious workup that revealed positive E. chaffeensis DNA from polymerase chain reaction on peripheral blood.[ncbi.nlm.nih.gov]
Candida
  • ., Pneumocystis carinii pneumonia, Candida esophagitis, tuberculosis, or disseminated infection with Mycobacterium avium ) had occurred in 5 patients (24%) before the onset of their infection with an Ehrlichia species.[academic.oup.com]

Treatment

  • A number of E. chaffeensis genes, including the six TCS genes, were downregulated within 5-60 min post closantel treatment.[ncbi.nlm.nih.gov]
  • Identification of underlying etiology of HLH is important as proper treatment can completely resolve the disease process.[ncbi.nlm.nih.gov]
  • Treatment of the bacteria with cholesterol extraction reagent methyl-beta-cyclodextrin caused their ultrastructural changes.[ncbi.nlm.nih.gov]
  • Mild cases present with flu-like symptoms including fevers, headaches, myalgias and arthralgias, but can progress to severe multi-system disease without prompt treatment.[shmabstracts.com]
  • Closantel treatment induced lysosomal fusion of the E. chaffeensis inclusion in a human monocytic leukemia cell line, THP-1 cells, implying that functional TCSs are essential in preventing lysosomal fusion of the E. chaffeensis inclusion compartment.[ncbi.nlm.nih.gov]

Etiology

  • HLH may be primary or may be triggered by numerous etiologies, including infections. Identification of underlying etiology of HLH is important as proper treatment can completely resolve the disease process.[ncbi.nlm.nih.gov]
  • Abstract Ehrlichia chaffeensis is an obligatory intracellular bacterium of monocytes and macrophages and the etiologic agent of human monocytic ehrlichiosis, an emerging zoonosis.[ncbi.nlm.nih.gov]
  • It is the etiologic agent of human monocytotropic ehrlichiosis (HME), an emerging life-threatening tick-borne zoonosis.[ncbi.nlm.nih.gov]
  • Ehrlichia chaffeensis is the etiologic agent of human monocytotropic erlichiosis (HME), a potentially life-threatening tick-borne infection. HME is endemic in the United States from the southern states up to the eastern seaboard.[ncbi.nlm.nih.gov]
  • Abstract Ehrlichia chaffeensis, the etiologic agent of human monocytic ehrlichiosis, replicates in early endosomes by avoiding lysosomal fusion in monocytes and macrophages.[ncbi.nlm.nih.gov]

Epidemiology

  • Ehrlichiosis may be a life-threatening illness in HIV-infected persons, and the influence of multiple factors, including recent changes in the epidemiology and medical management of HIV infection, may increase the frequency with which ehrlichioses occur[ncbi.nlm.nih.gov]
  • We conducted a serologic study to determine the epidemiology of HME in HIV-positive patients residing in an HME-endemic area.[ncbi.nlm.nih.gov]
  • Results suggest that E. chaffeensis infections are common in free-ranging coyotes in Oklahoma and that these wild canids could play a role in the epidemiology of human monocytotropic ehrlichiosis.[ncbi.nlm.nih.gov]
  • Knowledge of the biology and natural history of E. chaffeensis, and of the epidemiology, clinical features, and laboratory diagnosis of the zoonotic disease it causes (commonly referred to as human monocytic ehrlichiosis [HME]) has expanded considerably[ncbi.nlm.nih.gov]
  • Diagnosis of E. chaffeensis infection by indirect immunofluorescence assay (IFA) is the reference standard due to its presumed high sensitivity and specificity, but IFA is impractical, variably reproducible, and cumbersome for large epidemiologic studies[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Ehrlichiosis is an emerging zoonotic infection caused by obligate intracellular, gram-negative rickettsia that infects leukocytes[mayomedicallaboratories.com]

Prevention

  • Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee.[ncbi.nlm.nih.gov]
  • Trypsin pretreatment of monocytes prevented the inhibition of O(2)(-) generation by E. chaffeensis.[ncbi.nlm.nih.gov]
  • Sumner , Centers for Disease Control and Prevention Joseph Singleton , Centers for Disease Control and Prevention Karen C. Bloch , Vanderbilt University Medical Center Yi-Wei Tang , Vanderbilt University Medical Center Steven M.[digitalcommons.unl.edu]
  • Closantel treatment induced lysosomal fusion of the E. chaffeensis inclusion in a human monocytic leukemia cell line, THP-1 cells, implying that functional TCSs are essential in preventing lysosomal fusion of the E. chaffeensis inclusion compartment.[ncbi.nlm.nih.gov]
  • Massung , Casey Barton Behravesh View Affiliations Hide Affiliations * Address correspondence to Kristen Nichols Heitman, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A30, Atlanta, GA 30329.[ajtmh.org]

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