Cases reported "ehrlichiosis"

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1/81. Near fatal acute respiratory distress syndrome in a patient with human ehrlichiosis.

    Human ehrlichiosis is not a common cause of acute respiratory distress syndrome (ARDS). physicians should be aware of this life-threatening but treatable entity. Progression to ARDS may be related to delay in diagnosis and treatment. fever, leukopenia, thrombocytopenia, and a history of tick exposure in an endemic area during the spring and summer months should alert the physician to the possibility of human ehrlichiosis, since a definitive diagnosis requires serologic testing that may take weeks to confirm. We describe a case of ARDS resulting from human ehrlichiosis. A unique feature in our case was that despite the early use of doxycycline, the patient had near fatal ARDS that responded dramatically to high doses of steroids. ( info)

2/81. ehrlichiosis with severe pulmonary manifestations despite early treatment.

    It is generally thought that if patients with ehrlichiosis are treated promptly, life-threatening illness can be avoided. We report a patient who sought medical attention 1 day after the onset of symptoms, was immediately given doxycycline, and still had serious illness with generalized edema, pulmonary infiltrates, acute respiratory distress syndrome, and noncardiogenic pulmonary edema, while receiving replacement intravenous fluids. This case alerts physicians to the serious end of the disease spectrum that can occur even though patients are given prompt, appropriate drug treatment at the onset of illness. Further studies are needed to clearly define the mechanisms involved in pulmonary complications and generalized edema, including noncardiogenic pulmonary edema, in patients with ehrlichiosis. ( info)

3/81. Clinical and laboratory evolution of a culture-confirmed case of human granulocytic ehrlichiosis.

    A 74-year-old man from suburban new york city, who was hospitalized because of chest pain and fever, was diagnosed as having human granulocytic ehrlichiosis on the eighth hospital day. Although leukocyte and platelet counts were normal on admission, they fell to abnormally low values then normalized prior to specific therapy against the human granulocytic ehrlichiosis agent. Intracytoplasmic inclusions suggestive of Ehrlichia were observed in up to six percent of granulocytes, and the human granulocytic ehrlichiosis bacterium was cultured in an HL 60 human promyelocytic cell line. The patient improved dramatically within 24 hours of doxycycline treatment, after failing to improve on various beta lactam antimicrobial agents. He was discharged from the hospital 14 days after admission. Because human granulocytic ehrlichiosis was not diagnosed until his eight hospital day, clinical and laboratory parameters prior to specific treatment were available. This case illustrates the clinical and laboratory evolution of the infection with human granulocytic ehrlichiosis agent in humans. ( info)

4/81. 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. ( info)

5/81. 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. ( info)

6/81. 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. ( info)

7/81. 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. ( info)

8/81. Human granulocytic ehrlichiosis in Northern california: two case descriptions with genetic analysis of the Ehrlichiae.

    We report two cases of human granulocytic ehrlichiosis (HGE) that occurred in northern california in summer 1998. patients had fever, malaise, and myalgia, reported tick bites, had moderate thrombocytopenia, and had normal or slightly elevated liver enzyme activities. Ehrlichial inclusions were observed in the blood of one patient, and HGE-agent dna was amplified by PCR from both patients. Genetically, the strains resembled horse isolates from northern california. The close spatial and temporal proximity of the two new cases may be due to a nidus of infection in the area or heightened surveillance by local physicians. ( info)

9/81. 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 ( info)

10/81. Human granulocytic ehrlichiosis presenting with acute renal failure and mimicking thrombotic thrombocytopenic purpura. A case report and review.

    We present the case of an elderly female patient presenting with recurrent acute renal failure, fever, altered mental status, abdominal pain, thrombocytopenia and a small number of fragmented red cells on peripheral smear mimicking recurrent thrombotic thrombocytopenic purpura (TTP). Eventually, however, she was diagnosed to have human granulocytic ehrlichiosis (HGE), and after treatment for HGE her clinical and laboratory abnormalities resolved. ehrlichiosis mimicking TTP, diagnosed at postmortem examination, has been described in a single prior case. As illustrated in this case, there are potential difficulties in diagnosing HGE after plasma exchange, blood transfusion and immunosuppressive therapy. ehrlichiosis, a potentially curable disease, should be considered in the differential diagnosis of thrombotic microangiopathic disorders. copyright copyright 1999 S. Karger AG, Basel ( info)
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