We conducted a retrospective serosurvey of 1,000 persons in Israel who had fever of undetermined cause to look for Ehrlichia chaffeensis antibodies. Four of five cases with antibodies reactive to E. chaffeensis were diagnosed in the summer, when ticks are more active. All patients had influenzalike symptoms with high fever. None of the cases was fatal. Three serum samples were also seroreactive for antibodies to E. canis, and one was also reactive to the human granulocytic ehrlichiosis (HGE) agent. The titer to the HGE agent in this patient was higher than the serum titer to E. chaffeensis, and the Western blot analysis also indicated that the HGE agent was the primary cause of infection. We present the first serologic evidence that the agents of human monocytic ehrlichiosis (HME) and HGE are present in Israel. Therefore, human ehrlichiosis should be included in the differential diagnoses for persons in Israel who have been exposed to ticks and have influenzalike symptoms.
The changes in plasma fibronectin and IgG, and monocyte- and lymphocyte-associated fibronectin were studied in patients undergoing elective cardiopulmonary bypass surgery. A significant fall (P = less than 0.0005) in plasma fibronectin occurred during bypass, resulting largely from hemodilution as assessed by IgG concentrations, but also related to consumption of fibronectin. Plasma levels were still reduced 48 hours following the operative procedure, despite variable amounts of blood components infused in the immediate post-bypass period. Monocyte-associated fibronectin increased significantly (P = less than 0.05) during bypass, and lymphocyte-associated fibronectin levels decreased. Our studies confirm a reduction in circulating fibronectin in cardiac surgery, with accompanying fall in lymphocyte-associated levels presumed to reflect nonspecific adsorption. In contrast, the increased binding to monocytes may be an important functional aspect requiring further investigation, together with assessment of monocyte-macrophage function, before empiric use of cryoprecipitate therapy in these patients is recommended.
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