1/22. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis.BACKGROUND: Human ehrlichiosis is a recently recognized tick-borne infection. Four species infect humans: ehrlichia chaffeensis, E. sennetsu, E. canis, and the agent of human granulocytic ehrlichiosis. methods: We tested peripheral-blood leukocytes from 413 patients with possible ehrlichiosis by broad-range and species-specific polymerase-chain-reaction (PCR) assays for ehrlichia. The species present were identified by species-specific PCR assays and nucleotide sequencing of the gene encoding ehrlichia 16S ribosomal rna. Western blot analysis was used to study serologic responses. RESULTS: In four patients, ehrlichia dna was detected in leukocytes by a broad-range PCR assay, but not by assays specific for E. chaffeensis or the agent of human granulocytic ehrlichiosis. The nucleotide sequences of these PCR products matched that of E. ewingii, an agent previously reported as a cause of granulocytic ehrlichiosis in dogs. These four patients, all from missouri, presented between May and August 1996, 1997, or 1998 with fever, headache, and thrombocytopenia, with or without leukopenia. All had been exposed to ticks, and three were receiving immunosuppressive therapy. serum samples obtained from three of these patients during convalescence contained antibodies that reacted with E. chaffeensis and E. canis antigens in a pattern different from that of humans with E. chaffeensis infection but similar to that of a dog experimentally infected with E. ewingii. Morulae were identified in neutrophils from two patients. All four patients were successfully treated with doxycycline. CONCLUSIONS: These findings provide evidence of E. ewingii infection in humans. The associated disease may be clinically indistinguishable from infection caused by E. chaffeensis or the agent of human granulocytic ehrlichiosis.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
2/22. ehrlichia chaffeensis in a renal transplant recipient.Since its first description in human beings in 1986, ehrlichiosis is now increasingly recognized as a cause of tick-borne febrile illnesses. However, the disease has been reported only rarely in immunosuppressed patients. We report a case of human ehrlichiosis in a patient with a cadaveric renal transplant. The diagnosis was confirmed initially by a positive polymerase chain reaction (PCR) for E. chaffeensis. The antibody titer became positive several weeks later. The patient responded promptly to treatment with doxycycline. ehrlichiosis should be considered in the differential diagnosis of an acute febrile illness in transplant recipients. PCR provides a rapid means to confirm the diagnosis, particularly in settings in which antibody response may be suppressed. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
3/22. Human granulocytic ehrlichiosis presenting as facial diplegia in a 42-year-old woman.neurologic manifestations of human ehrlichiosis are unusual and have been described almost exclusively in human monocytic ehrlichiosis associated with ehrlichia chaffeensis. We report here a case of a previously healthy 42-year-old woman who developed bilateral facial nerve palsies in association with infection by the agent of human granulocytic ehrlichiosis (aoHGE). The diagnosis was made by specific polymerase chain reaction amplification of aoHGE sequences from samples of the patient's blood and cerebrospinal fluid (CSF), as well as propagation of aoHGE in culture of HL60 cells inoculated with the patient's CSF. To our knowledge, this is the first report directly demonstrating the presence of aoHGE in CSF, and it underscores the importance of considering HGE in patients presenting with a nonspecific febrile illness and unexplained neurologic manifestations. HGE should also be considered in the differential diagnosis of bilateral facial palsy-a rare occurrence.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
4/22. Myopericarditis associated with central European tick-borne encephalitis.The case of an 11-year-old child with acute myopericarditis associated with central European tick-borne encephalitis is presented. Cardiac involvement was demonstrated by pericardial effusion, elevated serum concentration of troponin-I and cardiac arrhythmia. Co-infections with enteroviruses, borrelia burgdorferi or the agent of human granulocytic ehrlichiosis were excluded. Recovery was uneventful. CONCLUSION: Central European tick-borne encephalitis can be complicated by cardiac involvement.- - - - - - - - - - ranking = 74.404833410047keywords = burgdorferi (Clic here for more details about this article) |
5/22. First cases of acute human granulocytic ehrlichiosis in poland.The first three cases of acute human granulocytic ehrlichiosis in poland are described. blood samples were tested by an indirect immunofluorescence method to detect specific serum antibodies, and the polymerase chain reaction was used to detect ehrlichial dna. Additionally, peripheral blood smears were examined for the presence of morulae. According to criteria of the Centers for Disease Control and Prevention, all three cases can be classified as confirmed granulocytic ehrlichiosis. Using the criteria recommended by a consensus group, however, two cases can be classified as confirmed granulocytic ehrlichiosis and one case as probable granulocytic ehrlichiosis.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
6/22. Human monocytic ehrlichiosis: an emerging pathogen in transplantation.BACKGROUND: The spectrum of disease caused by Ehrlichia spp. ranges from asymptomatic to fatal. awareness and early diagnosis of the infection is paramount because appropriate therapy leads to rapid defervescence and cure. If left untreated, particularly in immunosuppressed patients, ehrlichioses may result in multi-system organ failure and death. methods: We report the second case of human monocytic ehrlichiosis (HME) in a liver transplant recipient, and review the literature. RESULTS: The patient presented with fever and headache, had negative cultures, and despite broad-spectrum antimicrobial coverage appeared progressively septic. After eliciting a history of tick exposure we treated the patient empirically with doxycycline. The diagnosis of HME was confirmed by 1) polymerase chain reaction (PCR) for ehrlichia chaffeensis, 2) acute and convalescent serum titers, and 3) in vitro cultivation of E chaffeensis from peripheral blood. CONCLUSION: Although human ehrlichioses are relatively uncommon, they are emerging as clinically significant arthropod-borne infections. Although epidemiological exposure is responsible for infection, immunosuppression makes patients more likely to succumb to disease. A high index of suspicion and early treatment results in a favorable outcome.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
7/22. ehrlichiosis infection in a 5-year-old boy with neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly.ehrlichiosis should be considered in the differential diagnosis of any patient with recent fever, pancytopenia, hepatosplenomegaly, and history of tick exposure. We present a previously healthy 5-year-old boy who was referred to the hematology-Oncology Clinic to consider a bone marrow etiologic process after his pediatrician discovered progressive neutropenia, anemia, thrombocytopenia, and hepatosplenomegaly accompanied by 2 days of fever. bone marrow aspirate and biopsy were nonrevealing. Because of the history of a recent tick bite, a diagnosis of ehrlichiosis infection was considered and ultimately confirmed by IgG-specific serum testing. The patient's fever was treated symptomatically with acetaminophen, and symptoms resolved on their own without intervention. ehrlichiosis is a tick-borne infection that occurs throughout the spring and summer, often causing findings that mimic a malignancy or serious hematologic disorder. The diagnosis should be considered in any person living in tick-infested areas and can be confirmed by polymerase chain reaction or serum antibody titers. Treatment with doxycycline can lead to rapid clinical improvement if the diagnosis is made early.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
8/22. Tissue diagnosis of ehrlichia chaffeensis in patients with fatal ehrlichiosis by use of immunohistochemistry, in situ hybridization, and polymerase chain reaction.In the united states, human ehrlichiosis is a complex of emerging tick-borne diseases caused by 3 distinct Ehrlichia species: ehrlichia chaffeensis, Ehrlichia ewingii, and the human granulocytotropic ehrlichiosis agent. Ehrlichioses are characterized by a mild to severe illness, and approximately 4% of cases are fatal. Because these obligate intracellular bacteria are difficult to resolve with routine histologic techniques, their distribution in tissues has not been well described. To facilitate the visualization and detection of ehrlichiae, immunohistochemistry (IHC), in situ hybridization (ISH), and polymerase chain reaction (PCR) assays were developed by use of tissues from 4 fatal cases of E. chaffeensis infection. Evidence of E. chaffeensis via IHC, ISH, and PCR was documented in all 4 cases. Abundant immunostaining and in situ nucleic acid hybridization were observed in spleen and lymph node from all 4 patients. Significantly, in 2 of these patients, serologic evidence of infection was absent. Use of IHC, ISH, and PCR to visualize and detect Ehrlichia in tissues can facilitate diagnosis of ehrlichial infections.- - - - - - - - - - ranking = 5keywords = lyme (Clic here for more details about this article) |
9/22. Simultaneous infection with borrelia burgdorferi and human granulocytic ehrlichiosis.A 5-year-old child with simultaneous early lyme disease and human granulocytic ehrlichiosis (HGE) is described. Because of the shared vector, HGE and lyme disease are increasingly identified as coinfections in tick-exposed patients. Early recognition of concurrent lyme disease and HGE is important because amoxicillin, an antibiotic of choice for young children with early lyme disease, is ineffective for HGE.- - - - - - - - - - ranking = 297.61933364019keywords = burgdorferi (Clic here for more details about this article) |
10/22. In vivo and in vitro studies on anaplasma phagocytophilum infection of the myeloid cells of a patient with chronic myelogenous leukaemia and human granulocytic ehrlichiosis.AIMS: The occurrence of human granulocytic ehrlichiosis (HGE) in a patient with chronic myelogenous leukaemia (CML) provided an opportunity to study whether anaplasma phagocytophilum, the aetiological agent of HGE, infects mature or immature cells, both in vivo and in vitro. methods: Diagnosis of HGE was confirmed by culture, polymerase chain reaction (PCR), detection of intragranulocytic inclusions, and serology. The infection rates of different myelogenous stages of granulocytic differentiation were determined by microscopy. anaplasma phagocytophilum infection of the bone marrow was analysed by PCR, culture, and microscopy. In addition, the in vitro growth of A phagocytophilum in the patient's granulocytes and in hl-60 cells (a promyelocytic leukaemia cell line) was compared. RESULTS: Pretreatment blood smears showed that mature granulocytic cells had a higher infection rate with A phagocytophilum than did immature cells. In the original inoculation of the patient's cells into hl-60 cells to isolate A phagocytophilum, the bacterium grew faster in the patient's leukaemic cells than in hl-60 cells. anaplasma phagocytophilum inclusions were rarely seen in bone marrow granulocytes and PCR was negative. in vitro, two A phagocytophilum isolates grew faster in the patient's granulocytes than in HL-60 cells. CONCLUSIONS: The superior growth in CML cells compared with hl-60 cells suggests that A phagocytophilum preferentially infects mature granulocytes. The higher infection rate of the patient's mature versus immature granulocytes before treatment and the minimal level of infection of the patient's bone marrow support this. It is possible that the primary site of infection in HGE is the peripheral mature granulocytic population.- - - - - - - - - - ranking = 1keywords = lyme (Clic here for more details about this article) |
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