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]
Entire Body System
-
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]
-
Fatigue
Fever, fatigue, malaise, headache, and other "flu-like" symptoms occur most commonly. Central nervous system involvement can result in seizures and coma. [mayomedicallaboratories.com]
-
High Fever
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]
Respiratoric
-
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]
Gastrointestinal
-
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]
Musculoskeletal
-
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]
-
Thigh Pain
Author information 1 Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA. [email protected] Abstract Bilateral anterior thigh pain may indicate bacteremia (Louria's Sign). [ncbi.nlm.nih.gov]
Neurologic
-
Headache
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]
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]
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]
-
Anterior Thigh Pain
Author information 1 Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA. [email protected] 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]
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]
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]
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]
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]
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]
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]
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]