A Confirmed Ehrlichia ewingii Infection Likely Acquired Through Platelet Transfusion

Abstract

Ehrlichiosis is a tick-borne disease that ranges in severity from asymptomatic infection to fatal sepsis. Ehrlichiosis acquired from transfusion of blood products has not been documented in the literature to date. A case of Ehrlichia ewingii infection likely transmitted by transfusion of leukoreduced platelets is described, and public health implications are discussed.

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

“…Previous case reports suggested E. ewingii primarily affects those who are immunocompromised, which may be because immunocompromised persons are more likely to develop serious infections, be hospitalized, and have extensive laboratory diagnostic tests. 2,7,8,15,17,34 In addition, because E. ewingii is a milder illness, it is possible that immunocompetent patients may have less severe symptoms and not seek medical attention, which may have led to overrepresentation of immunocompromised cases in previous reports. In our report, the prevalence of reporting an immunosuppressive condition was 26% among E. ewingii cases; cases with E. ewingii infections reporting an immunocompromised condition were more likely to be hospitalized.…”

“…6,10 Patients with ehrlichiosis and who are immunocompromised, especially from human immunodeficiency virus (HIV), cancer treatments, or organ transplants, are at highest risk for severe outcome. 8,[15][16][17][18][19][20][21][22][23] As recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), doxycycline, a tetracycline-class antibiotic, is the treatment of choice for children and adults of all ages with rickettsial disease, including ehrlichiosis; treatment should never be withheld pending laboratory confirmation. 9,13,24 Treatment with doxycycline within the first 5 days of illness has been shown to decrease severity of disease in patients when compared with patients who were treated later in the course of illness.…”

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

“…Transmission of A. phagocytophilum despite leukoreduction of red blood cells and platelets has occurred (227,228,231,232). Transmission of E. ewingii infection via leukoreduced, irradiated platelet transfusion also has been reported (233). Although the risk for transmission of certain rickettsial pathogens might be reduced by leukoreduction of blood products (234), the risk for transfusion-acquired infection is not eliminated (227,228,231,233,235).…”

“…Transmission of E. ewingii infection via leukoreduced, irradiated platelet transfusion also has been reported (233). Although the risk for transmission of certain rickettsial pathogens might be reduced by leukoreduction of blood products (234), the risk for transfusion-acquired infection is not eliminated (227,228,231,233,235). In vitro studies demonstrate that A. phagocytophilum and E. chaffeensis survive in refrigerated packed erythrocytes for up to 18 and 11 days, respectively (236,237).…”

Relative Risk for Ehrlichiosis and Lyme Disease in an Area Where Vectors for Both Are Sympatric, New Jersey, USA

“…Because ehrlichiosis cases have steadily increased since becoming reportable (13,15), the spread of A. americanum ticks and the emergence of ehrlichiosis as a human pathogen in the United States may parallel increases in I. scapularis tick populations and the emergence of Lyme disease that occurred 30 years prior (14). Even if most unrecognized infections are mild or asymptomatic, these could still have consequences for public health; for example, blood donors who are unknowingly infected could pass the infection to immunocompromised patients (45), or prescription of sulfa drugs for unrelated ailments could result in worsened disease presentation (46).…”