Ehrlichiosis: making the diagnosis in the acute setting.
Human monocytic ehrlichiosis (HME) is a tick-borne disease transmitted during the summer months in the mid-Atlantic, southeastern and south-central United States. A large proportion of patients presenting with ehrlichiosis must be hospitalized because of the severity of their presenting signs, symptoms and lab abnormalities. We report a case of HME presenting with negative serologies and positive DNA PCR for Ehrlichia chaffeensis during the acute illness. The patient was empirically treated with doxycycline before the availability of diagnostic test results and had a rapid recovery. This report summarizes the common findings of ehrlichiosis on presentation, diagnostic strategies, and treatment options. This case emphasizes the importance of considering tick-borne diseases in the differential diagnosis for patients presenting with nonspecific febrile syndromes in endemic areas and using the clinical scenario to determine whether empiric treatment for a tick-borne disease is necessary. Delaying treatment while awaiting confirmatory tests is unnecessary, and may result in a less favorable patient outcome.
Prince
Lisa K
LK
Infectious Disease Department at Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307, USA.
Shah
Anita A
AA
Martinez
Luis J
LJ
Moran
Kimberly A
KA
D000208:Acute Disease; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000302:isolation & purification; D003937:Diagnosis, Differential; D004285:Dogs; D004318:Doxycycline / Q000627:therapeutic use; D018469:Ehrlichia chaffeensis / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D016873:Ehrlichiosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007150:Immunohistochemistry; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D013987:Ticks; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D004318:Doxycycline