Difference between revisions of "Ehrlichiosis"

(Management)
(Disposition)
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==Disposition==
 
==Disposition==
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*most cases of Ehrlichiosis are treated as an outpatient
  
 
==See also==
 
==See also==

Revision as of 02:09, 24 October 2015

Background

  • Bacterial infection of the family Anaplasmataceae common in mammals such as cattle, dogs, sheep, goats, and horses[1]
  • Spread by the Lonestar tick (Amblyomma americanum)
    • Eastern seaboard from Florida to Maine and as far west as Iowa and Texas
    • People often unaware they are bitten with case fatality rate of approximately 1.8%[2]
    • More severe disease in immunocompromised patients (HIV, Elderly, Asplenic)
Lone Star Tick (preserved

Clinical Features

  • Fever, chills, headache, malaise, myalgias, nausea, vomiting, diarrhea, conjunctival injection
    • Up to 60% of children may have a rash (30% of adults)

Differential Diagnosis

Tick Borne Illnesses

Diagnosis

  • Peripheral blood smear[3]
  • Obligate intracellular organism
    • Smear shows intracellular parasites only 20% of time
  • PCR
    • Most sensitive in first week of illness
  • Indirect Immunoflorescence Assay'
    • Gold Standard
    • Negative 85% of time in first 7 days of illness
    • Compare 2 samples drawn at different times
    • 4 fold increase in titers of second draw is positive
  • Enzyme Immunoassay
    • Qualitative tests, not quantitative
  • Leukopenia, elevated transaminases, thrombocytopenia often present

Management

Doxycycline

  • Adults: 100mg PO/IV BID x 14 days
  • Children: (under 45 kg): 2.2 mg/kg body weight twice a day

Disposition

  • most cases of Ehrlichiosis are treated as an outpatient

See also

References