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- Jack G Schneider, BS MT (ASCP)⇑
- Address for correspondence: Jack G Schneider BS MT (ASCP), Clarian Pathology Laboratory, Clinical Laboratory Sciences Program, 350 W 11th Street, Indianapolis IN 46202. (812) 707-1773, (317) 491-6163 (fax). jgschneid{at}gmail.com.
Extract
Ehrlichiosis is an infection of white blood cells that affects various mammals, including mice, cattle, dogs, and humans.1 It was first reported in dogs in 1935, and the first human case was documented in the United States in 1986. Ehrlichia are obligate, intracellular bacteria that are transmitted by ticks to humans. They grow as a cluster (morula) in neutrophils (Anaplasma phagocytophilum and E. ewingii) and in monocytes (E. chaffeensis).2,3 The infection may cause prolonged fever and general aches, and is characterized by leukopenia, cytopenia, and elevated liver transaminases.4 In the first week of infection, ehrlichiae can be detected by finding intracellular aggregates on the blood/body fluid smears and various other laboratory findings. Immunofluorescent antibodies (IFA) titers and PCR are generally needed for confirmation and a definitive diagnosis. Early diagnosis is necessary as antibiotic treatment with doxycycline is very effective.3,5
CASE PRESENTATION A 52-year-old avid outdoorsman has had multiple tick bites throughout his adult life. He experienced nonspecific malaise and fatigue for about one month. There were no fevers, chills, sweats, or weight loss. He was witnessed to have a generalized seizure and a marked decrease in mental status and was admitted into the hospital for thorough evaluation.
Due to sepsis-like presentation and clinical picture, he was treated empirically with broad-spectrum antibiotics, including vancomycin and doxycycline. Serum creatinine, blood urea nitrogen (BUN) levels, and hepatic enzymes were extremely high as a result of the patient's acute renal and liver failure respectively. As his illness progressed, pulmonary function diminished and mechanical ventilation…
ABBREVIATIONS: ALP = alkaline phosphatase; ALT, SGPT = alanine aminotransferase; AST, SGOT = aspartate aminotransferase; BUN = blood urea nitrogen; PTT = partial thromboplastin time; WBC = white blood cell count.
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