title: Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus.
abstract: The clinical course and laboratory evaluation of 21 patients coinfected with human immunodeficiency virus (HIV) and Ehrlichia chaffeensis or Ehrlichia ewingii are reviewed and summarized, including 13 cases of ehrlichiosis caused by E. chaffeensis, 4 caused by E. ewingii, and 4 caused by either E. chaffeensis or E. ewingii. Twenty patients were male, and the median CD4(+) T lymphocyte count was 137 cells/microL. Exposures to infecting ticks were linked to recreational pursuits, occupations, and peridomestic activities. For 8 patients, a diagnosis of ehrlichiosis was not considered until > or =4 days after presentation. Severe manifestations occurred more frequently among patients infected with E. chaffeensis than they did among patients infected with E. ewingii, and all 6 deaths were caused by E. chaffeensis. Ehrlichiosis may be a life-threatening illness in HIV-infected persons, and the influence of multiple factors, including recent changes in the epidemiology and medical management of HIV infection, may increase the frequency with which ehrlichioses occur in this patient cohort.
authors.affiliation: Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. cdp9@cdc.gov
authors.forename: C D
authors.initials: CD
authors.lastname: Paddock
authors.forename: S M
authors.initials: SM
authors.lastname: Folk
authors.forename: G M
authors.initials: GM
authors.lastname: Shore
authors.forename: L J
authors.initials: LJ
authors.lastname: Machado
authors.forename: M M
authors.initials: MM
authors.lastname: Huycke
authors.forename: L N
authors.initials: LN
authors.lastname: Slater
authors.forename: A M
authors.initials: AM
authors.lastname: Liddell
authors.forename: R S
authors.initials: RS
authors.lastname: Buller
authors.forename: G A
authors.initials: GA
authors.lastname: Storch
authors.forename: T P
authors.initials: TP
authors.lastname: Monson
authors.forename: D
authors.initials: D
authors.lastname: Rimland
authors.forename: J W
authors.initials: JW
authors.lastname: Sumner
authors.forename: J
authors.initials: J
authors.lastname: Singleton
authors.forename: K C
authors.initials: KC
authors.lastname: Bloch
authors.forename: Y W
authors.initials: YW
authors.lastname: Tang
authors.forename: S M
authors.initials: SM
authors.lastname: Standaert
authors.forename: J E
authors.initials: JE
authors.lastname: Childs
mesh_terms: D000328:Adult; D004536:Ehrlichia / Q000276:immunology / Q000302:isolation & purification; D018469:Ehrlichia chaffeensis / Q000276:immunology / Q000302:isolation & purification; D016873:Ehrlichiosis / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D015497:HIV-1 / Q000276:immunology / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology