Human monocytic ehrlichiosis in children.
BACKGROUND
Human monocytic ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis. Data about disease in children have been largely derived from case reports or small case series.


METHODS
A retrospective review of all medical and laboratory records from 6 sites located in the "tick belt" of the Southeastern United States was carried out. Demographic, history and laboratory data were abstracted from the identified medical records of patients. Bivariate statistical comparisons were performed using Fisher exact test or Wilcoxon rank sum tests.


RESULTS
Common clinical signs and symptoms of patients with HME (n = 32) included fever (100%), headache (69%), myalgia (69%), rash (66%), nausea/vomiting (56%), altered mental status (50%) and lymphadenopathy (47%). Only 48% had a complaint of fever, headache and rash. Common laboratory abnormalities included thrombocytopenia (94%), elevated aspartate aminotransferase (90%), elevated alanine aminotransferase (74%), hypoalbuminemia (65%), lymphopenia (57%), leukopenia (56%) and hyponatremia (55%). The median number of days of illness before the initiation of antirickettsial therapy was 6. Patients who received sulfonamides before starting doxycycline therapy developed a rash, were admitted to the hospital, and started doxycycline at a later date. Twenty-two percent of patients were admitted to the intensive care unit with 12.5% of patients requiring ventilatory and blood pressure support.


CONCLUSIONS
Although HME has been recognized among children for almost 20 years, there is only a limited knowledge about its clinical course. Even among physicians practicing in endemic regions, few cases are diagnosed each year. More work is needed to understand the true burden of disease and the natural history among asymptomatically and symptomatically infected children.
Schutze
Gordon E
GE
University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA. schutze@bcm.edu
Buckingham
Steven C
SC
Marshall
Gary S
GS
Woods
Charles R
CR
Jackson
Mary Anne
MA
Patterson
Lori E
LE
Jacobs
Richard F
RF
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004318:Doxycycline / Q000627:therapeutic use; D016873:Ehrlichiosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia; D007010:Hyponatremia; D007970:Leukopenia; D008231:Lymphopenia; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D013449:Sulfonamides / Q000627:therapeutic use
D013449:Sulfonamides; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D004318:Doxycycline