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Human monocytic ehrlichiosis Classification and external resources ICD-9 082.41 DiseasesDB 31131 MedlinePlus 001381 eMedicine med/3391 MeSH D016873 Human monocytotropic ehrlichiosis[1] (HME) is a form of ehrlichiosis associated with Ehrlichia chaffeensis.[2] This bacteria is an obligate intracellular pathogen affecting monocytes and macrophages. Contents 1 Ecology & Epidemiology 2 Symptoms 3 Diagnosis 4 Treatment 5 References 6 See also // Ecology & Epidemiology HME occurs across the south-central, southeastern, and mid-Atlantic states, regions where both the white-tailed deer (Odocoileus virginianus) and lone star ticks (Amblyomma americanum) thrive. HME occurs in California in Ixodes pacificus ticks and in Dermacentor variabilis ticks.[3] Nearly 600 cases were reported to the CDC in 2006. In 2001-2002, the incidence was highest in Missouri, Tennessee, and Oklahoma, as well as in people older than 60.[4] Symptoms The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to Human Granulocytic Ehrlichiosis, rash is more common.[5] Laboratory abnormalities include thrombocytopenia, leukopenia, and elevated liver tests. The severity of the illness can range from minor or asymptomatic to life-threatening. CNS involvement may occur. A serious septic or toxic shock-like picture can also develop, especially in patients with impaired immunity.[6] Diagnosis Tick exposure is often overlooked. For patients living in high-prevalence areas who spend time outdoors, a high degree of clinical suspicion should be employed. Ehrlichia serologies can be negative in the acute period. PCR is therefore the laboratory diagnostic tool of choice.[7] Treatment If Ehrlichiosis is suspected, treatment should not be delayed while waiting for a definitive laboratory confirmation, as prompt doxycycline therapy has been associated with improved outcomes.[8] Doxycycline is the treatment of choice. Presentation during early pregnancy can complicate treatment.[9] Rifampin has been used in pregnancy and in patients allergic to doxycycline.[10] References ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1130. ISBN 1-4160-2999-0.  ^ Schutze GE, Buckingham SC, Marshall GS, et al. (June 2007). "Human monocytic ehrlichiosis in children". Pediatr. Infect. Dis. J. 26 (6): 475–9. doi:10.1097/INF.0b013e318042b66c. PMID 17529862. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00006454-200706000-00005.  ^ http://www.ncbi.nlm.nih.gov/pubmed/14680123 ^ CDC Ehrlichiosis statistics ^ Dumler JS, Choi KS, Garcia-Garcia JC, et al. (December 2005). "Human granulocytic anaplasmosis and Anaplasma phagocytophilum". Emerging infectious diseases 11 (12): 1828–34. PMID 16485466.  ^ Paddock CD, Folk SM, Shore GM, et al. (November 2001). "Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 33 (9): 1586–94. doi:10.1086/323981. PMID 11568857.  ^ Prince LK, Shah AA, Martinez LJ, Moran KA (August 2007). "Ehrlichiosis: making the diagnosis in the acute setting". Southern medical journal 100 (8): 825–8. PMID 17713310. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=100&issue=8&spage=825.  ^ Hamburg BJ, Storch GA, Micek ST, Kollef MH (March 2008). "The importance of early treatment with doxycycline in human ehrlichiosis". Medicine 87 (2): 53–60. doi:10.1097/MD.0b013e318168da1d. PMID 18344803.  ^ Muffly T, McCormick TC, Cook C, Wall J (2008). "Human granulocytic ehrlichiosis complicating early pregnancy". Infect Dis Obstet Gynecol 2008: 359172. doi:10.1155/2008/359172. PMID 18509484.  ^ Krause PJ, Corrow CL, Bakken JS (September 2003). "Successful treatment of human granulocytic ehrlichiosis in children using rifampin". Pediatrics 112 (3 Pt 1): e252–3. doi:10.1542/peds.112.3.e252. PMID 12949322. http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=12949322.  See also monocyte Human granulocytic ehrlichiosis Human granulocytic anaplasmosis Human ewingii ehrlichiosis v • d • e Infectious diseases · Bacterial diseases: Proteobacterial G- (primarily A00–A79, 001–041, 080–109) α Rickettsiales Rickettsiaceae/ (Rickettsioses) Typhus Rickettsia typhi (Murine typhus) · Rickettsia prowazekii (Epidemic typhus, Brill–Zinsser disease, Flying squirrel typhus) Spotted fever Tick-borne Rickettsia rickettsii (Rocky Mountain spotted fever) · Rickettsia conorii (Boutonneuse fever) · Rickettsia japonica (Japanese spotted fever) · Rickettsia sibirica (North Asian tick typhus) · Rickettsia australis (Queensland tick typhus) · Rickettsia honei (Flinders Island spotted fever) · Rickettsia africae (African tick bite fever) · Rickettsia parkeri (American tick bite fever) · Rickettsia aeschlimannii (Rickettsia aeschlimannii infection) Mite-borne Rickettsia akari (Rickettsialpox) · Orientia tsutsugamushi (Scrub typhus) Flea-borne Rickettsia felis (Flea-borne spotted fever) Anaplasmataceae Ehrlichiosis: Anaplasma phagocytophilum (Human granulocytic anaplasmosis, Anaplasmosis) · Ehrlichia chaffeensis (Human monocytic ehrlichiosis) · Ehrlichia ewingii (Ehrlichiosis ewingii infection) Rhizobiales Brucellaceae Brucella abortus (Brucellosis) Bartonellaceae Bartonellosis: Bartonella henselae (Cat scratch disease) · Bartonella quintana (Trench fever) · either henselae or quintana (Bacillary angiomatosis) · Bartonella bacilliformis (Carrion's disease, Verruga peruana) β Neisseriales M+ Neisseria meningitidis/meningococcus (Meningococcal disease, Waterhouse-Friderichsen syndrome, Meningococcal septicaemia) M- Neisseria gonorrhoeae/gonococcus (Gonorrhea) ungrouped: Eikenella corrodens/Kingella kingae (HACEK) · Chromobacterium violaceum (Chromobacteriosis infection) Burkholderiales Burkholderia pseudomallei (Melioidosis) · Burkholderia mallei (Glanders) · Burkholderia cepacia complex · Bordetella pertussis/Bordetella parapertussis (Pertussis) γ Enterobacteriales (OX-) Lac+ Klebsiella pneumoniae (Rhinoscleroma, Klebsiella pneumonia) · Klebsiella granulomatis (Granuloma inguinale) · Klebsiella oxytoca Escherichia coli: Enterotoxigenic · Enteroinvasive · O157:H7/Enterohemorrhagic (Hemolytic-uremic syndrome) Enterobacter aerogenes/Enterobacter cloacae Slow/weak Serratia marcescens (Serratia infection) · Citrobacter koseri/Citrobacter freundii Lac- H2S+ Salmonella enterica (Typhoid fever, Paratyphoid fever, Salmonellosis) H2S- Shigella dysenteriae/sonnei/flexneri/boydii (Shigellosis, Bacillary dysentery) · Proteus mirabilis/Proteus vulgaris · Yersinia pestis (Plague/Bubonic plague) · Yersinia enterocolitica · Yersinia pseudotuberculosis Pasteurellales Haemophilus: H. influenzae (Haemophilus meningitis, Brazilian purpuric fever) · H. ducreyi (Chancroid) H. parainfluenzae (HACEK) Pasteurella multocida (Pasteurellosis) · Actinobacillus (Actinobacillosis) Aggregatibacter actinomycetemcomitans (HACEK) Legionellales Legionella pneumophila/Legionella longbeachae (Legionellosis) · Coxiella burnetii (Q fever) Thiotrichales Francisella tularensis (Tularemia) Vibrionales Vibrio cholerae (Cholera) · Vibrio vulnificus · Vibrio parahaemolyticus · Vibrio alginolyticus · Plesiomonas shigelloides Pseudomonadales Pseudomonas aeruginosa (Pseudomonas infection) · Moraxella catarrhalis · Acinetobacter baumannii Xanthomonadales Stenotrophomonas maltophilia Cardiobacteriales Cardiobacterium hominis (HACEK) Aeromonadales Aeromonas hydrophila/Aeromonas veronii (Aeromonas infection) ε Campylobacterales Campylobacter jejuni (Campylobacteriosis, Guillain-Barré syndrome) · Helicobacter pylori (Peptic ulcer, MALT lymphoma) · Helicobacter cinaedi (Helicobacter cellulitis) M: BAC bact (clas) gr+f/gr+a(t)/gr-p(c)/gr-o drug(J1p, w, n, m, vacc) v • d • e Zoonosis: Tick-borne diseases and mite-borne diseases Bacterial infection (all G-) Rickettsiales Rocky Mountain spotted fever · Ehrlichiosis (Human granulocytic, Human monocytic) · Boutonneuse fever Spirochaete Lyme disease · Relapsing fever Thiotrichales Tularemia Viral infection Colorado tick fever · Tick-borne encephalitis · Crimean-Congo hemorrhagic fever · Omsk hemorrhagic fever · Kyasanur forest disease · Powassan encephalitis Protozoan infection Babesiosis Neurotoxin Tick paralysis General Tick infestation Vectors Ticks Ixodes: Ixodes scapularis · Ixodes holocyclus · Ixodes pacificus · Ixodes ricinus Dermacentor: Dermacentor variabilis · Dermacentor andersoni Amblyomma: Amblyomma americanum · Amblyomma cajennense Ornithodoros: Ornithodoros moubata · Ornithodoros hermsi other: Rhipicephalus sanguineus Mites Leptotrombidium deliense · Liponyssoides sanguineus M: IFT helm,arth (acar) helm, arth (lice), zoon helm, arth