1/7. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. 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.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. A case of human ehrlichiosis acquired in mali: clinical and laboratory findings.We report on the clinical, epidemiologic, and laboratory characteristics of the first case of human ehrlichiosis acquired outside the united states caused by an ehrlichia sp. other than E. sennetsu. The patient, a 24-year-old woman, presumably acquired the infection in mali in northern africa; the diagnosis was made when she returned to north america. The patient reported a fever and diarrhea a week before she left mali; the diarrhea resolved, but the fever and chills continued. She also reported intermittent tingling in both hands and feet and muscle discomfort. Her temperature was 37.8 degrees C and her pulse rate was 100 per minute. She had two erythematous maculopapules (0.5 x 0.7 mm) on her thigh and ankle that resembled infected insect bites. Her hemoglobin level was 148 g/l with normal indices, and her white blood cell count was 10, 500/mm3 with many atypical lymphocytes and platelets. This report is intended to increase physicians' awareness of ehrlichiosis in foreign travelers and other patients, and suggests the need for further research to determine the prevalence and distribution of this disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome.OBJECTIVE: To describe clinical and laboratory features of patients with severe ehrlichiosis, some of whom presented with toxic shock syndrome (TSS)-like illnesses, and to report, to our knowledge, the first documented fatal case of ehrlichiosis in a child. DESIGN: Case series. SETTING: Tertiary-care medical center. patients: All patients with documented ehrlichiosis during a 3-year period, August 1, 1989, to July 31, 1992. RESULTS: Eight patients (age range: 2 to 46 years) met clinical and serologic diagnostic criteria for ehrlichiosis. The mean interval from first contact with a physician to initiation of appropriate antibiotic therapy was 4.6 days (range: 1 to 11 days). All eight patients with ehrlichiosis had fever, chills, thrombocytopenia, and abnormal liver function test results. Most patients also had rash (seven), conjunctival hemorrhage or erythema (six), and leukopenia (six). Four cases met diagnostic criteria for TSS with fever, hypotension, rash, and multiorgan dysfunction. Two patients required mechanical ventilation, and one of these, a 6 1/2-year-old boy, died of complications of the infection. A ninth patient with probable ehrlichiosis also met diagnostic criteria for TSS. CONCLUSIONS: Human ehrlichiosis can present as a severe, life-threatening illness that may resemble TSS. The diagnosis of ehrlichiosis was not considered by the physicians who first cared for these patients. Greater awareness of the potential severity of ehrlichiosis is needed to ensure that proper treatment is initiated early in the course of the disease.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/7. Human disease in europe caused by a granulocytic ehrlichia species.Human granulocytic ehrlichiosis (HGE) was recently described in north america. It is caused by an ehrlichia species closely related to ehrlichia phagocytophila and ehrlichia equi, recognized to infect mostly ruminants and horses, respectively. The vector in north america is the tick ixodes scapularis, which is also the vector of the lyme disease agent, borrelia burgdorferi. Previous serologic studies in patients with a diagnosis of Lyme borreliosis indicate that HGE may exist in europe. We report the first documented case of HGE in europe. The diagnosis was established by seroconversion to E. equi and the HGE agent and by PCR with sequence analysis of the gene encoding the HGE agent 16S rRNA. Interestingly, the patient presented with a self-limited but moderately severe illness. Thus, European physicians need to be aware that HGE exists in europe and that the diagnosis should be considered in febrile patients with tick bites in areas where lyme disease is endemic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Human monocytic ehrlichiosis presenting as febrile diarrhea.I report a case of tick-borne ehrlichiosis in which the primary presentation suggested an infectious diarrhea, with impressive leukopenia and thrombocytopenia. ehrlichiosis must be included in the differential diagnosis of febrile diarrhea in endemic areas because delay in therapy allows complications and sometimes death. In patients with apparent febrile diarrhea, the presence of leukopenia and thrombocytopenia or elevated aminotransferase values should alert the physician to look for a history of tick bites and consider treatment with doxycycline or tetracycline.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |