title: Severe ehrlichia infection in pediatric oncology and stem cell transplant patients.
abstract: Ehrlichiosis, a tickborne illness transmitted by tick vectors Amblyomma americanum and Ixodes scapularis, can be acquired in endemic areas. Clinical manifestations range from asymptomatic to fulminant in nature. We report three cases of ehrlichiosis in pediatric oncology patients, one of whom was a stem cell transplant recipient. Early symptoms included fever, malaise, and vague gastrointestinal symptoms. Laboratory abnormalities were initially attributed to chemotherapy toxicity. Illness was severe in all three patients and one patient died even after initiation of doxycycline. These cases emphasize the need for a high index of suspicion for tickborne illness in oncology patients, and the importance of a low threshold for starting empiric treatment before confirming the diagnosis.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. adam.esbenshade@vanderbilt.edu
authors.forename: Adam
authors.initials: A
authors.lastname: Esbenshade
authors.forename: Jennifer
authors.initials: J
authors.lastname: Esbenshade
authors.forename: Jennifer
authors.initials: J
authors.lastname: Domm
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
mesh_terms: D000293:Adolescent; D002648:Child; D057210:Delayed Diagnosis; D016873:Ehrlichiosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D019353:Endemic Diseases; D017809:Fatal Outcome; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000628:therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects*