Fishbein D B, Dawson J E, Robinson L E
National Center for Infectious Diseases, Atlanta, Georgia.
Ann Intern Med. 1994 May 1;120(9):736-43. doi: 10.7326/0003-4819-120-9-199405010-00003.
To describe the epidemiology, clinical features, laboratory manifestations, response to therapy, and factors related to morbidity and mortality in a large group of patients with ehrlichiosis.
Case-series.
Laboratory-based surveillance in the United States.
237 patients whose serum had a fourfold increase or decrease in antibodies to Ehrlichia canis or E. chaffeensis.
Epidemiologic, clinical, laboratory data, hospitalization, duration of illness, complications, and treatment response.
From 1985 through 1990, 237 case-patients were identified in 21 states; rates exceeded 1 per 100,000 per year in only 5 counties. Incidence rates increased with age and were higher among men. Most case-patients had nonspecific illness and were not suspected of having a rickettsial infection. Many patients (60.8%) were hospitalized. Leukocyte and platelet counts typically decreased and liver function tests typically increased through day 7. Three (6.1%) of 49 outpatients treated only with tetracycline were hospitalized compared with 35 (92%) of 38 outpatients treated only with antibiotics other than tetracycline or chloramphenicol (P < 0.001). Among hospitalized patients, recovery was faster for those initially treated with tetracycline (median, 16 days) or chloramphenicol (median, 12 days) than for those initially treated with other antibiotics (median, 27 days; P = 0.03 for both comparisons). In a logistic regression analysis, severe illness or death was more probable among case-patients 60 years or older (odds ratio [OR], 4.60; 95% CI, 1.87 to 11.2) and among those who did not receive tetracycline or chloramphenicol until 8 or more days after symptom onset (OR, 4.38; CI, 1.36 to 14.0).
The findings of this study are primarily representative of more seriously ill patients with human ehrlichiosis. Although rates are low, ehrlichiosis is found in many areas of the United States. Patients with a history of tick exposure, acute febrile illness, decreasing leukocyte counts, and decreasing platelet counts may have ehrlichiosis. Prompt treatment with tetracycline or chloramphenicol markedly decreases the morbidity.
描述一大群埃立克体病患者的流行病学、临床特征、实验室表现、治疗反应以及与发病率和死亡率相关的因素。
病例系列研究。
美国基于实验室的监测。
237例血清中犬埃立克体或查菲埃立克体抗体呈四倍升高或降低的患者。
流行病学、临床、实验室数据、住院情况、病程、并发症及治疗反应。
1985年至1990年期间，在21个州共识别出237例病例；每年发病率超过十万分之一的仅5个县。发病率随年龄增长而升高，男性发病率更高。大多数病例患者患有非特异性疾病，未被怀疑患有立克次体感染。许多患者（60.8%）住院治疗。白细胞和血小板计数通常在第7天前下降，肝功能检查通常升高。49例仅接受四环素治疗的门诊患者中有3例（6.1%）住院，而38例仅接受四环素或氯霉素以外抗生素治疗的门诊患者中有35例（92%）住院（P<0.001）。在住院患者中，最初接受四环素（中位数16天）或氯霉素（中位数12天）治疗的患者比最初接受其他抗生素治疗的患者恢复得更快（中位数27天；两组比较P均=0.03）。在逻辑回归分析中，60岁及以上的病例患者（比值比[OR]，4.60；95%可信区间[CI]，1.87至11.2）以及症状出现后8天或更长时间才接受四环素或氯霉素治疗的患者（OR，4.38；CI，1.36至14.0）发生重症或死亡的可能性更大。
本研究结果主要代表病情较重的人类埃立克体病患者。尽管发病率较低，但在美国许多地区都发现了埃立克体病。有蜱虫暴露史、急性发热性疾病、白细胞计数下降和血小板计数下降的患者可能患有埃立克体病。及时用四环素或氯霉素治疗可显著降低发病率。
