Clinical and laboratory characteristics of human granulocytic ehrlichiosis

摘要: Objective. —To characterize the clinical and laboratory features observed in patients with human granulocytic ehrlichiosis (HGE) evaluate utility of diagnostic tools used to confirm diagnosis. Design. —Retrospective case study 41 laboratory-diagnosed HGE. Setting. —A total 228 from Minnesota Wisconsin were evaluated between June 1990 May 1995. Methods. —Cases presumptively identified by a history an influenzalike illness acquired area known be endemic for ticks. Diagnostic testing included microscopic examination Wright-stained peripheral blood smears presence neutrophilic morulae, polymerase chain reaction (PCR) analysis acute-phase samples theEhrlichia phagocytophila/Ehrlichia equigroup DNA, evaluation serological responses indirect immunofluorescent antibody assay (IFA), using E equi as antigen. Results. —All presented temperature at least 37.6°C, most had headache, myalgias, chills, varying combinations leukopenia, anemia, thrombocytopenia. Eighty percent tested demonstrated morulae cytoplasm neutrophils. Only 16 37 PCR positive HGE, whereas serum IFA assays acute or convalescent detected antibodies againstE equiin 38 40 tested. Two died, calculated fatality rate was 4.9%. Conclusions. —Human is being increasingly recognized Minnesota. A more severe associated increased age, percentage neutrophils decreased lymphocytes blood, The differential diagnosis who develop following tick bite should include Microscopic smear detect currently quickest practical screening method diagnosing HGE upper Midwest. (JAMA. 1996;275:199-205)