Human Case of  Ehrlichia chaffeensis  Infection, Taiwan

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Abstract

In 2018, an immunosuppressed woman in southern Taiwan had onset of fever, chills, myalgia, malaise, thrombocytopenia, lymphocytopenia, and elevated hepatic transaminases. Investigation revealed infection with Ehrlichia chaffeensis. This autochthonous case of human monocytotropic ehrlichiosis was confirmed by PCR, DNA sequencing, and seroconversion.

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Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States.

Holly Biggs, Casey Barton Behravesh, Kristy K Bradley … (2016)

Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.

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Increasing Incidence of Ehrlichiosis in the United States: A Summary of National Surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii Infections in the United States, 2008–2012

F. Scott Dahlgren, Kristen Nichols Heitman, Casey Barton Behravesh … (2016)

Human ehrlichiosis is a potentially fatal disease caused by Ehrlichia chaffeensis and Ehrlichia ewingii . Cases of ehrlichiosis are reported to Centers for Disease Control and Prevention through two national surveillance systems: Nationally Notifiable Diseases Surveillance System (NNDSS) and Case Report Forms. During 2008–2012, 4,613 cases of E. chaffeensis infections were reported through NNDSS. The incidence rate (IR) was 3.2 cases per million person-years (PYs). The hospitalization rate (HR) was 57% and the case fatality rate (CFR) was 1%. Children aged < 5 years had the highest CFR of 4%. During 2008–2012, 55 cases of E. ewingii infection were reported through NNDSS. The national IR was 0.04 cases per million PY. The HR was 77%; no deaths were reported. Immunosuppressive conditions were reported by 26% of cases. The overall rate for ehrlichiosis has increased 4-fold since 2000. Although previous literature suggests E. ewingii primarily affects those who are immunocompromised, this report shows most cases occurred among immunocompetent patients. This is the first report to show children aged < 5 years with ehrlichiosis have an increased CFR, relative to older patients. Ongoing surveillance and reporting of tick-borne diseases are critical to inform public health practice and guide disease treatment and prevention efforts.

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Isolation and characterization of an Ehrlichia sp. from a patient diagnosed with human ehrlichiosis.

J Dawson, B Anderson, D B Fishbein … (1991)

A new disease was recognized in the United States in 1986. The etiologic agent, although not previously isolated from a human, appeared to be serologically related to Ehrlichia canis, a canine leukotropic rickettsia. We obtained blood specimens from 27 febrile patients with a history of tick exposure. Leukocytes from 24 patients not treated with tetracycline were placed onto a monolayer of DH82 cells. We performed indirect immunofluorescence on sera from all 27 febrile patients as well as sera from 12 patients with previously diagnosed ehrlichiosis. Intractoplasmic inclusions were first observed in culture 35 days after the addition of infected blood from one patient. Partial sequencing of the rRNAs from the human isolate and E. canis indicated that they are 98.7% related. Positive indirect immunofluorescence reactions to the human isolate were obtained for all 12 previously diagnosed patients and for 33% of the 27 febrile patients. Two patients were seropositive for the human isolate but not for E. canis. No sera were positive for E. canis and negative for the human isolate. We report the isolation of a previously unrecognized Ehrlichia sp. that appears to be the etiologic agent of human ehrlichiosis. Serologic data (range of antibody titers, 256 to 32,768) in combination with rRNA sequencing indicated that the newly isolated Ehrlichia sp. is similar, but not identical, to E. canis.

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Author and article information

Journal

Journal ID (nlm-ta): Emerg Infect Dis

Journal ID (iso-abbrev): Emerging Infect. Dis

Journal ID (publisher-id): EID

Title: Emerging Infectious Diseases

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 1080-6040

ISSN (Electronic): 1080-6059

Publication date (Print): November 2019

Volume: 25

Issue: 11

Pages: 2141-2143

Affiliations

[1]Centers for Disease Control, Taipei, Taiwan (S.-H. Peng, S.-L. Yang, H.-F. Chen, P.-Y. Shu);

[2]Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan (Y.-N. Ho)

Author notes

Address for correspondence: Pei-Yun Shu, Vector-Borne Viral and Rickettsial Diseases Laboratory, Center for Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, No. 161, Kunyang St, Taipei 11561, Taiwan; email: pyshu@ 123456cdc.gov.tw

Article

Publisher ID: 19-0665

DOI: 10.3201/eid2511.190665

PMC ID: 6810210

PubMed ID: 31625863

SO-VID: 278561b2-2359-40e0-aa9d-3f628b9fb9b0

Human Case of Ehrlichia chaffeensis Infection, Taiwan

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Most cited references 9

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States.

Increasing Incidence of Ehrlichiosis in the United States: A Summary of National Surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii Infections in the United States, 2008–2012

Isolation and characterization of an Ehrlichia sp. from a patient diagnosed with human ehrlichiosis.

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