title: Human ehrlichiosis in transplant recipients.
abstract: To characterize the impact of immunosuppression on human ehrlichiosis, we reviewed cases of ehrlichiosis occurring in transplant recipients and immunocompetent patients at three hospitals in Nashville, Tennessee. Between 1998 and 2006, 15 transplant patients were identified as having ehrlichiosis, diagnosed either by whole blood polymerase chain reaction (PCR) (n = 14) or serology (n = 1). They were compared with 43 immunocompetent patients diagnosed by whole blood PCR. We retrospectively collected demographic and clinical information. The species of Ehrlichia (E. ewingii or E. chaffeensis) was determined for patients diagnosed by PCR. The 15 transplant recipients with ehrlichiosis included 7 kidney recipients, 6 heart recipients, 1 liver recipient and 1 lung recipient. Transplant recipients had more infections with E. ewingii than immunocompetent patients (23% vs. 5%, p = 0.08). Transplant recipients experienced less rash (0% vs. 36%, p = 0.006) and presented with significantly lower hepatic enzymes, but more leukopenia and renal dysfunction than immunocompetent patients. Doxycycline therapy was started within 48 h of presentation in 73% of transplant recipients and 78% of immunocompetent patients (p = 0.7). No patient died in either group. Ehrlichia infections can occur in transplant recipients who live in an endemic area. With prompt treatment, the infected transplant recipients in our study had similar, favorable outcomes compared to immunocompetent patients.
authors.affiliation: Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Thomas
authors.forename: I
authors.initials: I
authors.lastname: Hongo
authors.forename: K C
authors.initials: KC
authors.lastname: Bloch
authors.forename: Y-W
authors.initials: YW
authors.lastname: Tang
authors.forename: S
authors.initials: S
authors.lastname: Dummer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D004536:Ehrlichia / Q000235:genetics / Q000302:isolation & purification; D016873:Ehrlichiosis / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007121:Immunocompetence; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013714:Tennessee