Tan H P, Dumler J S, Maley W R, Klein A S, Burdick J F, Fred Poordad F, Thuluvath P J, Markowitz J S
Department of Surgery, Johns Hopkins Hospital, Harvey 611, 600 N Wolfe Street, Baltimore, MD 21287-8611, USA.
Transplantation. 2001 Jun 15;71(11):1678-80. doi: 10.1097/00007890-200106150-00030.
The spectrum of disease caused by Ehrlichia spp. ranges from asymptomatic to fatal. Awareness and early diagnosis of the infection is paramount because appropriate therapy leads to rapid defervescence and cure. If left untreated, particularly in immunosuppressed patients, ehrlichioses may result in multi-system organ failure and death.
We report the second case of human monocytic ehrlichiosis (HME) in a liver transplant recipient, and review the literature.
The patient presented with fever and headache, had negative cultures, and despite broad-spectrum antimicrobial coverage appeared progressively septic. After eliciting a history of tick exposure we treated the patient empirically with doxycycline. The diagnosis of HME was confirmed by 1) polymerase chain reaction (PCR) for Ehrlichia chaffeensis, 2) acute and convalescent serum titers, and 3) in vitro cultivation of E chaffeensis from peripheral blood.
Although human ehrlichioses are relatively uncommon, they are emerging as clinically significant arthropod-borne infections. Although epidemiological exposure is responsible for infection, immunosuppression makes patients more likely to succumb to disease. A high index of suspicion and early treatment results in a favorable outcome.
埃立克体属细菌引起的疾病谱范围从无症状感染到致命感染。对该感染的认知和早期诊断至关重要，因为恰当的治疗可使发热迅速消退并治愈疾病。若不进行治疗，尤其是在免疫抑制患者中，埃立克体病可能导致多系统器官衰竭和死亡。
我们报告了肝移植受者中第二例人单核细胞埃立克体病（HME）病例，并对相关文献进行了回顾。
该患者出现发热和头痛症状，培养结果为阴性，尽管给予了广谱抗菌药物治疗，病情仍逐渐加重出现败血症表现。在了解到其有蜱虫叮咬史后，我们给予患者多西环素经验性治疗。HME的诊断通过以下方法得以证实：1）针对查菲埃立克体的聚合酶链反应（PCR）；2）急性期和恢复期血清滴度检测；3）从外周血中体外培养出查菲埃立克体。
尽管人埃立克体病相对不常见，但它们正逐渐成为具有临床意义的节肢动物传播感染。虽然感染是由流行病学暴露引起的，但免疫抑制使患者更易患病。高度的怀疑指数和早期治疗可带来良好的预后。
