Bakken J S, Krueth J, Wilson-Nordskog C, Tilden R L, Asanovich K, Dumler J S
Section of Infectious Diseases, Duluth Clinic Ltd, MN 55805, USA.
JAMA. 1996 Jan 17;275(3):199-205.
To characterize the clinical and laboratory features observed in patients with human granulocytic ehrlichiosis (HGE) and evaluate the utility of the diagnostic tools used to confirm the diagnosis.
Retrospective case study of 41 patients with laboratory-diagnosed HGE.
A total of 228 patients from Minnesota and Wisconsin were evaluated between June 1990 and May 1995.
Cases were presumptively identified by a history of an influenzalike illness acquired in an area known to be endemic for ticks. Diagnostic laboratory testing included microscopic examination of Wright-stained peripheral blood smears for presence of neutrophilic morulae, polymerase chain reaction (PCR) analysis of acute-phase blood samples for the Ehrlichia phagocytophila/Ehrlichia equi group DNA, and evaluation of serological responses by indirect immunofluorescent antibody assay (IFA), using E equi as antigen.
All patients presented with a temperature of at least 37.6 degrees C, and most had headache, myalgias, chills, and varying combinations of leukopenia, anemia, and thrombocytopenia. Eighty percent of the patients tested demonstrated morulae in the cytoplasm of peripheral blood neutrophils. Only 16 of 37 patients tested by PCR were positive for HGE, whereas serum IFA assays of acute or convalescent blood samples detected antibodies against E equi in 38 of 40 patients tested. Two patients died, and the calculated case fatality rate was 4.9%.
Human granulocytic ehrlichiosis is being increasingly recognized in Wisconsin and Minnesota. A more severe illness is associated with increased age, anemia, increased percentage of neutrophils and decreased percentage of lymphocytes in peripheral blood, and presence of morulae in neutrophils. The differential diagnosis for patients who develop an influenzalike illness following a tick bite should include HGE. Microscopic examination of the acute-phase blood smear to detect neutrophilic morulae is currently the quickest and most practical screening method for diagnosing HGE in the upper Midwest.
描述人粒细胞埃立克体病（HGE）患者的临床和实验室特征，并评估用于确诊的诊断工具的效用。
对41例经实验室确诊的HGE患者进行回顾性病例研究。
1990年6月至1995年5月期间，对明尼苏达州和威斯康星州的228例患者进行了评估。
根据在已知蜱虫流行地区感染类似流感疾病的病史初步确定病例。诊断性实验室检测包括对经瑞氏染色的外周血涂片进行显微镜检查，以检测嗜中性粒细胞桑葚体的存在；对急性期血样进行聚合酶链反应（PCR）分析，以检测嗜吞噬细胞埃立克体/马埃立克体组DNA；以及使用马埃立克体作为抗原，通过间接免疫荧光抗体测定（IFA）评估血清学反应。
所有患者体温至少为37.6摄氏度，大多数患者有头痛、肌痛、寒战，以及不同程度的白细胞减少、贫血和血小板减少。80%接受检测的患者外周血中性粒细胞胞质中可见桑葚体。在37例接受PCR检测的患者中，只有16例HGE呈阳性，而在40例接受检测的患者中，急性期或恢复期血样的血清IFA检测在38例患者中检测到抗马埃立克体抗体。2例患者死亡，计算得出的病死率为4.9%。
在威斯康星州和明尼苏达州，人粒细胞埃立克体病越来越受到认可。病情较重与年龄增加、贫血、外周血中性粒细胞百分比增加和淋巴细胞百分比降低以及中性粒细胞中存在桑葚体有关。蜱虫叮咬后出现类似流感疾病的患者的鉴别诊断应包括HGE。目前，对急性期血涂片进行显微镜检查以检测嗜中性粒细胞桑葚体是在中西部上游地区诊断HGE最快且最实用的筛查方法。
