Cases reported "Ehrlichiosis"

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1/10. Gastrointestinal and hepatic manifestations of human ehrlichiosis: 8 cases and a review of the literature.

    BACKGROUND: ehrlichiosis has emerged as an increasingly recognized tick-borne rickettsial disease. It can affect multiple organs including the gastrointestinal tract and liver. signs and symptoms include abdominal pain, nausea, vomiting, diarrhea, jaundice, and hepatosplenomegaly. patients commonly have elevated liver transaminases early in the course of illness as well as leukopenia and thrombocytopenia. If not diagnosed and treated in a timely fashion, ehrlichiosis can progress to multiorgan failure. methods: Between 1992 and 1998, 8 patients meeting the CDC criteria for ehrlichiosis were diagnosed and treated at the John L. McClellan Memorial veterans Hospital and University Hospital in Little Rock, Ark. These cases and English-language articles relating to gastrointestinal and hepatic manifestations of ehrlichiosis, identified by searching medline and manually reviewing bibliographies of retrieved articles, are reviewed. RESULTS: Seven of the eight patients had elevated transaminases on presentation which increased rapidly initially and slowly returned to normal. Three of our patients had hyperbilirubinemia. One of the eight patients presented with hepatomegaly. Three had hyperbilirubinemia with a peak bilirubin of 13.8 mg/dl. Two patients (25%) had a rash on presentation. All 8 patients were treated with and responded to doxycycline. One developed multiorgan failure but eventually recovered with intensive medical care and doxycycline. CONCLUSION: To avoid treatment delay and serious complications, in the appropriate clinical setting ehrlichiosis should be considered as a cause of elevated liver transaminases.
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2/10. Minimal change nephrotic syndrome: a possible complication of ehrlichiosis.

    Ehrlichiae are rickettsial organisms recently shown to be human pathogens. Infections often cause fever, myalgia, and hematological abnormalities, and sometimes mild elevation in transaminases, creatinine, and urinary protein. We report a teenager with nephrotic syndrome from minimal change glomerulonephritis and serological evidence of ehrlichiosis. In the appropriate clinical setting, Ehrlichiae should be considered in the etiological assessment of patients with minimal change disease.
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3/10. Evidence of rickettsial spotted fever and ehrlichial infections in a subtropical territory of Jujuy, argentina.

    Between November 1993 and March 1994, a cluster 6 pediatric patients with acute febrile illnesses associated with rashes was identified in Jujuy Province, argentina. Immunohistochemical staining of tissues confirmed spotted fever group rickettsial infection in a patient with fatal disease, and testing of serum of a patient convalescing from the illness by using an indirect immunofluorescence assay (IFA) demonstrated antibodies reactive with spotted fever group rickettsiae. A serosurvey was conducted among 16 households in proximity to the index case. Of 105 healthy subjects evaluated by IFA, 19 (18%) demonstrated antibodies reactive with rickettsiae or ehrlichiae: 4 had antibodies reactive with rickettsia rickettsii, 15 with ehrlichia chaffeensis, and 1 with R. typhi. Amblyomma cajennense, a known vector of R. rickettsii in south america, was collected from pets and horses in the area. These results are the first to document rickettsial spotted fever and ehrlichial infections in argentina.
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keywords = rickettsia
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4/10. Isolation and characterization of an Ehrlichia sp. from a patient diagnosed with human ehrlichiosis.

    A new disease was recognized in the United States in 1986. The etiologic agent, although not previously isolated from a human, appeared to be serologically related to ehrlichia canis, a canine leukotropic rickettsia. We obtained blood specimens from 27 febrile patients with a history of tick exposure. leukocytes from 24 patients not treated with tetracycline were placed onto a monolayer of DH82 cells. We performed indirect immunofluorescence on sera from all 27 febrile patients as well as sera from 12 patients with previously diagnosed ehrlichiosis. Intractoplasmic inclusions were first observed in culture 35 days after the addition of infected blood from one patient. Partial sequencing of the rRNAs from the human isolate and E. canis indicated that they are 98.7% related. Positive indirect immunofluorescence reactions to the human isolate were obtained for all 12 previously diagnosed patients and for 33% of the 27 febrile patients. Two patients were seropositive for the human isolate but not for E. canis. No sera were positive for E. canis and negative for the human isolate. We report the isolation of a previously unrecognized Ehrlichia sp. that appears to be the etiologic agent of human ehrlichiosis. Serologic data (range of antibody titers, 256 to 32,768) in combination with rRNA sequencing indicated that the newly isolated Ehrlichia sp. is similar, but not identical, to E. canis.
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5/10. ehrlichiosis mimicking thrombotic thrombocytopenic purpura. Case report and pathological correlation.

    Human ehrlichiosis is a tick-borne zoonosis caused by the newly described human hematotropic rickettsiae, ehrlichia chaffeensis. The pathology and pathogenesis of human ehrlichiosis have not been adequately studied. Even with immunoperoxidase, the only previously known method to detect these organisms in tissue, ehrlichae are difficult or impossible to identify. This led many investigators to speculate that the pathogenesis of ehrlichiosis was not caused directly by the organism but could be caused by host-mediated injury. In this case study, a patient presented with rapidly progressive central nervous system symptoms and severe thrombocytopenia, prompting a presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP). Despite corticosteroids, and later, antibiotics, the patient rapidly deteriorated and died. Postmortem examination showed hemorrhages in multiple organs and mononuclear inclusions of infection with a monocytic ehrlichia. Other findings included widespread lymphohistiocytic perivascular infiltrates, focal hepatic necroses, interstitial pneumonitis, interstitial nephritis, mononuclear phagocyte invasion and proliferation in splenic, liver, and bone marrow, and hemophagocytosis. The diagnosis was proven by serology, immunohistology with both polyclonal and monoclonal anti E chaffeensis, and polymerase chain reaction on paraffin-embedded tissues using E chaffeensis-specific oligonucleotide primers. The presence of numerous ehrlichia with notable tissue and cellular injury but without a marked host response indicate that unlike other cases of documented human ehrlichiosis, this patient died after significant direct ehrlichia-mediated injury, and that immune mechanisms initiated after ehrlichiosis played little if any role in the pathogenesis.
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6/10. Human ehrlichiosis--maryland, 1994.

    ehrlichiosis is an emerging tickborne infectious disease caused by obligate intracellular, gram-negative rickettsia that infect leukocytes. Human monocytic ehrlichiosis (HME) is caused by ehrlichia chaffeensis and is believed to be transmitted by Amblyomma americanum (the Lone Star tick). Most HME cases have been reported in southeastern and south-central states. During May-July 1994, five cases of serologically confirmed HME were identified among residents of maryland. All five persons lived near the Chesapeake Bay and had antecedent histories of tick exposure. This report summarizes the clinical and epidemiologic features of these cases and the results of serologic testing at CDC of specimens from maryland residents with suspected tickborne infection.
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7/10. A case of acute monocytic ehrlichiosis with prominent neurologic signs.

    Human monocytic ehrlichiosis is a recently described tick-borne infection with the rickettsial organism ehrlichia chaffeensis. We describe a patient with documented E chaffeensis infection and multiple organ system involvement. Prominent neurologic symptoms and signs included severe headache, meningismus, and altered mental status. Additional neurologic findings included unilateral arm weakness and a Bell's palsy. biopsy of brain and meninges demonstrated an infiltrate of atypical lymphoid cells in the leptomeninges with involvement of blood vessel walls and extension into the Virchow-Robin spaces. bone marrow biopsy revealed fibrin-ringed granulomas. The patient also developed a nonspecific increase in immunoglobulin production. Host immune response may play a critical role in the pathophysiology of ehrlichiosis.
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8/10. Dual infection with ehrlichia chaffeensis and a spotted fever group rickettsia: a case report.

    Well-documented cases of simultaneous human infection with more than one tick-borne pathogen are rare. To our knowledge only two dual infections have been reported: simultaneous human infection with the agent of human granulocytic ehrlichiosis and borrelia burgdorferi and simultaneous human infection with B. burgdorferi and babesia microti (1-2). 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 united states. Because both rocky mountain spotted fever and ehrlichiosis are prevalent in north carolina, occasional cases of simultaneous human infection by rickettsial and ehrlichial agents would not be surprising; however, no such cases seem to have been reported.
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keywords = rickettsia
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9/10. Identification of a granulocytic Ehrlichia strain isolated from a horse in switzerland and comparison with other rickettsiae of the Ehrlichia phagocytophila genogroup.

    This case report describes a 12-year-old Arabian mare with granulocytic ehrlichiosis. Clinical signs included fever, apathy, anorexia, icterus, limb edema, and reluctance to move. Examination of buffy coat smears revealed Ehrlichia organisms in neutrophils and eosinophils. A band of 1,428 bp was amplified from dna of leukocytes via nested PCR and was identified as part of the Ehrlichia 16S rRNA gene. It differed from the gene sequences of Ehrlichia phagocytophila and E. equi at two and three positions, respectively. Interestingly, the nucleotide sequence of the 16S rRNA was 100% identical to that of the agent of human granulocytic ehrlichiosis.
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ranking = 4
keywords = rickettsia
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10/10. ehrlichiosis.

    A case of human ehrlichiosis is presented. This case review emphasizes the need for a thorough history and physical examination in all patients who present with relatively non-specific complaints such as headaches, chills, myalgias, and arthralgias. These complaints should elicit the question of recent tick exposure from the clinician, particularly if the area is endemic for various rickettsial diseases. Laboratory findings such as leukopenia, thrombocytopenia, and increased hepatic enzymes should strongly suggest the disease.
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