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.


CONCLUSIONS
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.
Tan
H P
HP
Department of Surgery, Johns Hopkins Hospital, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287-8611, USA.
Dumler
J S
JS
Maley
W R
WR
Klein
A S
AS
Burdick
J F
JF
Fred Poordad
F
F
Thuluvath
P J
PJ
Markowitz
J S
JS
D000818:Animals; D001733:Bites and Stings / Q000150:complications; D016873:Ehrlichiosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000382:microbiology*; D013987:Ticks