Frank Ashall M.D., PhD.               Washington University

Ehrlichiosis due to Ehrlichia Ewingii in a liver transplant patient

 

Human ehrlichiosis is a tick-borne disease that occurs in two forms: human monocytic ehrlichiosis, which is caused by Ehrlichia chaffeensis, and human granulocytic ehrlichiosis. Recently, four cases of human granulocytic ehrlichiosis caused by Ehrlichia ewingii, a known cause of ehrlichiosis in dogs, were described in patients from Missouri. Three of these individuals were immunocompromised. Symptoms of monocytic ehrlichiosis are similar to those of granulocytic ehrlichiosis, and include fever, myalgia, headache, nausea, vomiting, diarrhea, arthralgias, rash and confusion. Prominent laboratory findings are thrombocytopenia, leukopenia and mild-to-moderate elevations of liver transaminases.

This poster describes the case-presentation of a 51-year-old man who presented with findings suggestive of ehrlichiosis and who had removed a tick from his body three days prior to hospital admission. Previously he received a liver transplant and was on chronic cyclosporine and steroid immunosuppression. He was diagnosed with ehrlichiosis by polymerase chain reaction (PCR), which showed that he was infected with Ehrlichia ewingii, and he acknowledged that he was exposed to dogs on his farm and that the dogs had ticks. He responded excellently to doxycycline therapy.

Infection with Ehrlichia may be more common than previously thought. Many patients may be asymptomatic or mildly symptomatic and may not see a physician. Immunocompromised patients may be at particular risk for symptomatic infection. Early detection and treatment is imperative, because complications can be fatal.