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Section 3. Summaries of Infectious Diseases
Ehrlichia and Anaplasma Infections
(Human Ehrlichioses)
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Human ehrlichioses in the United States
are attributable to at least 3 distinct pathogens:
Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis [HME]),
Anaplasma phagocytophilum (human granulocytotrophic anaplasmosis [HGA],
formerly
Ehrlichia phagocytophila), and
Ehrlichia ewingii (
Ehrlichia ewingii ehrlichiosis) (Table 3.4, p 282). These 3 infections
have different causes but similar signs, symptoms, and clinical
courses. All are acute, systemic, febrile illnesses that are
similar clinically to Rocky Mountain spotted fever but differ
from Rocky Mountain spotted fever in that infections often demonstrate
(1) leukopenia, absolute lymphopenia, and neutropenia in HME;
(2) neutropenia in HGA; (3) anemia; (4) hepatitis; (5) lack
of vasculitis; and (6) rash less commonly. The febrile illness
often is accompanied by one or more systemic manifestations,
including headache, chills or rigors, malaise, myalgia, arthralgia,
nausea, vomiting, anorexia, and acute weight loss. Rash is variable
in appearance and location, typically develops approximately
1 week after onset of illness, and occurs only in approximately
60% of children and 25% of adults with reported
E chaffeensis infection and less than 10% of people with
A phagocytophilum infection. Diarrhea, abdominal pain, cough, or change in mental
status occur less frequently. More severe manifestations of
these diseases include pulmonary infiltrates, bone marrow hypoplasia,
respiratory failure, encephalopathy, meningitis, disseminated
intravascular coagulation, spontaneous hemorrhage, and renal
failure. These agents do not cause the vasculitis or endothelial
damage characteristic of rickettsial diseases. Anemia, hyponatremia,
thrombocytopenia, increased serum hepatic transaminase concentrations,
and cerebrospinal fluid abnormalities (ie, pleocytosis with
a predominance of lymphocytes and increased total protein concentration)
are common. Symptoms typically last 1 to 2 weeks, and recovery
generally occurs without sequelae; however, reports suggest
the occurrence
. . . [Go to Full Text]
Related text in Red Book:
- Prevention of Tickborne Infections
Red Book
2006: 195-197.
[Extract]
[Full Version]
- Rocky Mountain Spotted Fever
Red Book
2006: 570-572.
[Extract]
[Full Version]
- Introduction
Red Book
2006: 735.
[Extract]
[Full Version]
This topic has been referenced by these articles:
- Krause, P. J., Corrow, C. L., Bakken, J. S.
(2003). Successful Treatment of Human Granulocytic Ehrlichiosis in Children Using Rifampin. Pediatrics
112: e252-253
[Abstract]
[Full Version]
- Gershel, J. C.
(2000). Human Granulocytic Ehrlichiosis Presenting as Abdominal Pain. Pediatrics
106: 602-604
[Abstract]
[Full Version]
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