title: Human monocytotropic ehrlichiosis, Missouri.
abstract: To determine the incidence, clinical and laboratory characteristics, and utility of molecular diagnosis of human monocytotropic ehrlichiosis (HME) in the primary care setting, we conducted a prospective study in an outpatient primary care clinic in Cape Girardeau, Missouri. One hundred and two patients with a history of fever for 3 days (>37.7 degrees C), tick bite or exposure, and no other infectious disease diagnosis were enrolled between March 1997 and December 1999. HME was diagnosed in 29 patients by indirect immunofluorescent antibody assay and polymerase chain reaction (PCR). Clinical and laboratory manifestations included fever (100%), headache (72%), myalgia or arthralgia (69%), chills (45%), weakness (38%), nausea (38%), leukopenia (60%), thrombocytopenia (56%), and elevated aspartate aminotransferase level (52%). Hospitalization occurred in 41% of case-patients. PCR sensitivity was 56%; specificity, 100%. HME is a prevalent, potentially severe disease in southeastern Missouri that often requires hospitalization. Because clinical presentation of HME is nonspecific, PCR is useful in the diagnosis of acute HME.
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0747, USA. jolano@utmb.edu
authors.forename: Juan P
authors.initials: JP
authors.lastname: Olano
authors.forename: Edwin
authors.initials: E
authors.lastname: Masters
authors.forename: Wayne
authors.initials: W
authors.lastname: Hogrefe
authors.forename: David H
authors.initials: DH
authors.lastname: Walker
mesh_terms: D000217:Acyltransferases / Q000737:chemistry / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D001426:Bacterial Proteins; D016022:Case-Control Studies; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D018469:Ehrlichia chaffeensis / Q000235:genetics / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000453:epidemiology* / Q000382:microbiology*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012336:RNA, Ribosomal, 16S / Q000737:chemistry / Q000235:genetics; D017422:Sequence Analysis, DNA; D016036:Seroepidemiologic Studies; D017282:Tick-Borne Diseases / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D012336:RNA, Ribosomal, 16S; D000217:Acyltransferases; C060770:NodA protein, Rhizobiales