Bakken J S, Dumler J S, Chen S M, Eckman M R, Van Etta L L, Walker D H
Section of Infectious Disease, Duluth Clinic Ltd, MN 55805.
JAMA. 1994 Jul 20;272(3):212-8.
To characterize the clinical presentation and course, laboratory findings, and treatment outcome of 12 patients with human granulocytic ehrlichiosis.
The 12 patients were male, ranged in age from 29 to 91 years, and contracted their illness in Wisconsin or Minnesota.
Cases were recognized by the presence of intracytoplasmic inclusions (morulae) in peripheral neutrophils of patients presenting with temperature of 38.5 degrees C or higher, chills, severe headache, and myalgias. All patients had a complete blood cell count and blood chemistry profile. Blood smears were examined by light microscopy. All available paired serum samples were analyzed for presence of indirect fluorescent antibodies against Ehrlichia chaffeensis, Ehrlichia phagocytophila, and Ehrlichia equi. Blood samples from 12 patients were subjected to polymerase chain reaction analysis using primers specific for the E phagocytophila/E equi group, primers that include the agent identified in our patients, as well as E chaffeensis.
Varying combinations of leukopenia, anemia, and thrombocytopenia were found in all but one patient. All 12 patients demonstrated morulae in the cytoplasm of neutrophils, but not in mononuclear white blood cells. Serum assays failed to detect antibodies against E chaffeensis, but eight of 10 patients and seven of 10 patients tested had antibody titers of 1:80 or more for E phagocytophila and E equi, respectively. Polymerase chain reaction products obtained with primers for E phagocytophila, E equi, and the granulocytotropic Ehrlichia revealed that seven patients were infected with the same agent. The results of serological assays or polymerase chain reaction strongly suggest that all 12 patients were infected by E phagocytophila, E equi, or a closely related Ehrlichia species. Two of the 12 patients died. The other 10 patients improved rapidly with oral doxycycline treatment.
We believe that all 12 patients have been infected with a granulocytic Ehrlichia species, reflecting a recently described new disease entity. The infective organism appears to be closely related to E phagocytophila and E equi. The geographic domain of human granulocytic ehrlichiosis is currently unknown. This novel granulocytic Ehrlichia species is capable of causing fatal infections in humans. Early detection and treatment with tetracycline drugs appear to offer the best chance for complete recovery.
描述12例人粒细胞埃立克体病患者的临床表现、病程、实验室检查结果及治疗转归。
12例患者均为男性，年龄在29至91岁之间，均在威斯康星州或明尼苏达州患病。
对于体温达38.5摄氏度或更高、伴有寒战、严重头痛及肌痛的患者，若其外周血中性粒细胞内存在胞浆内包涵体（桑葚体）则可诊断病例。所有患者均进行了全血细胞计数及血液生化检查。通过光学显微镜检查血涂片。对所有可获得的配对血清样本分析针对查菲埃立克体、嗜吞噬细胞埃立克体及马埃立克体的间接荧光抗体。使用针对嗜吞噬细胞埃立克体/马埃立克体组的引物、包括在我们患者中鉴定出的病原体的引物以及查菲埃立克体的引物，对12例患者的血样进行聚合酶链反应分析。
除1例患者外，所有患者均发现有不同程度的白细胞减少、贫血及血小板减少。12例患者的中性粒细胞胞浆内均可见桑葚体，但单核白细胞内未见。血清检测未检测到针对查菲埃立克体的抗体，但10例接受检测的患者中有8例及7例针对嗜吞噬细胞埃立克体及马埃立克体的抗体效价分别达到或超过1:80。用针对嗜吞噬细胞埃立克体、马埃立克体及粒细胞埃立克体的引物获得的聚合酶链反应产物显示，7例患者感染的是同一种病原体。血清学检测或聚合酶链反应结果强烈提示，所有12例患者均感染了嗜吞噬细胞埃立克体、马埃立克体或与之密切相关的埃立克体种。12例患者中有2例死亡。其他10例患者口服强力霉素治疗后迅速好转。
我们认为所有12例患者均感染了粒细胞埃立克体种，这反映了一种最近描述的新疾病实体。感染病原体似乎与嗜吞噬细胞埃立克体及马埃立克体密切相关。人粒细胞埃立克体病的地理分布目前尚不清楚。这种新型粒细胞埃立克体种能够在人类中引起致命感染。早期检测并用四环素类药物治疗似乎为完全康复提供了最佳机会。
