Weinstein R S
Georgetown University School of Medicine, Washington, D.C., USA.
Am Fam Physician. 1996 Nov 1;54(6):1971-6.
Human ehrlichiosis is a newly emergent, tick-borne, zoonotic infection caused by members of the genus Ehrlichia. These rickettsia-like, obligate intracellular, gram-negative bacteria produce two similar yet distinct diseases. Human monocytic ehrlichiosis is caused by Ehrlichia chaffeensis. Human granulocytic ehrlichiosis is caused by an organism closely related to Ehrlichia equi. The most common initial clinical findings include fever, malaise, myalgia, headaches and rigors, while the most common laboratory findings are thrombocytopenia, leukopenia, anemia and elevated liver enzyme levels. Both diseases can produce intracytoplasmic morulae, in either monocytes or neutrophils, which may be visible on Wright-stained peripheral smears. Treatment consists of tetracycline or doxycycline. Rifampin or chloramphenicol can be tried when tetracycline is absolutely contraindicated. Treatment should never be delayed pending serologic or polymerase chain reaction confirmation of the diagnosis because of the 5 to 10 percent mortality rate.
人埃立克体病是一种新出现的、由蜱传播的人兽共患病感染，由埃立克体属的成员引起。这些类似立克次体、专性细胞内寄生的革兰氏阴性细菌会引发两种相似但又不同的疾病。人单核细胞埃立克体病由查菲埃立克体引起。人粒细胞埃立克体病由一种与马埃立克体密切相关的病原体引起。最常见的初始临床症状包括发热、不适、肌痛、头痛和寒战，而最常见的实验室检查结果是血小板减少、白细胞减少、贫血和肝酶水平升高。两种疾病均可在单核细胞或中性粒细胞内产生胞浆内桑葚体，在瑞氏染色的外周血涂片上可能可见。治疗包括使用四环素或多西环素。当四环素绝对禁忌时，可尝试使用利福平或氯霉素。由于死亡率为5%至10%，因此绝不应因等待血清学或聚合酶链反应确诊而延迟治疗。
