Human Ehrlichiosis in a Liver Transplant Recipient

Sj, Antony; Js, Dummer; Hunter, Elizabeth

doi:10.1097/00007890-199510000-00021

Cited by 11 publications

(2 citation statements)

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“…Emerging pathogens such as Ehrlichia spp. have also been associated with similar disease characteristics [48][49][50][51]. Although the pathologic mechanisms are not understood to date, disease symptoms and inflammation often persist even though microbial copies are hardly recovered from the respective tissues, suggesting a potential autoimmune component elicited by the bacteria -a phenomenon that has also been observed with other infections, such as Chagas or Lyme disease [40,[52][53][54].…”

Section: Autoimmune Phenotypes Associated With Infections With (Alphamentioning

confidence: 91%

Autoimmune disease triggered by infection with alphaproteobacteria

Mohammed

Mattner²

2009

Expert Review of Clinical Immunology

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Despite having long been postulated, compelling evidence for the theory that microbial triggers drive autoimmunity has only recently been reported. A specific association between Novosphingobium aromaticivorans, an ubiquitous alphaproteobacterium, and primary biliary cirrhosis (PBC) has been uncovered in patients with PBC. Notably, the association between Novosphingobium infection and PBC has been confirmed in a mouse model in which infection leads to the development of liver lesions resembling PBC concomitant with the production of anti-PDC-E2 antibodies that cross-react with conserved PDC-E2 epitopes shared by Novosphingobium. The discovery of infectious triggers of autoimmunity is likely to change our current concepts about the etiology of various autoimmune syndromes and may suggest new and simpler ways to diagnose and treat these debilitating diseases. Keywords alphaproteobacteria; antibiotics; autoimmunity; E2 subunit of the pyruvate dehydrogenase complex; mitochondrial enzymes; molecular mimicry; Novosphingobium spp.; primary biliary cirrhosis Induction of autoimmunity by microbesThe underlying etiologies of autoimmune diseases have been difficult to elucidate, as they are driven by complex interactions between environmental factors and genetic traits [1][2][3]. Although autoimmunity often clusters together in individuals and families, indicating the potential for a broad-spectrum genetic defect in immunological tolerance mechanisms, the genetic factors leading to the development of immune responses against specific antigens in a tissue and/or organ-specific manner remain largely unknown. This compartmentalization of autoimmune responses is particularly surprising, as many autoantigens are ubiquitously expressed.

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Section: Autoimmune Phenotypes Associated With Infections With (Alphamentioning

confidence: 91%

Autoimmune disease triggered by infection with alphaproteobacteria

Mohammed

Mattner²

2009

Expert Review of Clinical Immunology

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“…Systemic and other infections. There have been numerous reports of ehrlichiosis reported in transplant recipients, including human monocytic ehrlichiosis due to Ehrlichia chaffeensis infection in liver [26][27][28], kidney [29,30], and lung [31] transplant recipients and several cases of human granulocytic ehrlichiosis due to Anaplasma phagocytophilum infection in kidney [6,7] and pancreas [8] transplant recipients. Rickettsia rickettsii infection (Rocky Mountain spotted fever) has been described after heart transplantation [55], and Rickettsia conorii infection has been reported after liver transplantation [56].…”

Section: Bacterial Infectionmentioning

confidence: 99%

Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients

Kotton

2007

Clinical Infectious Diseases

138

105

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Numerous reports exist of the transmission of zoonoses to humans during and after solid-organ and hematopoietic stem cell transplantation. Donor-derived infections of numerous etiologies, including West Nile virus infection, Chagas disease, toxoplasmosis, rabies, lymphocytic choriomeningitis virus infection, and infection due to Brucella species have been reported. Most zoonoses occur as a primary infection after transplantation, and immunocompromised patients are more likely to experience significant morbidity and mortality from these infections. Risks of zoonotic infection in the posttransplantation period could be reduced by patient education. Increased recognition of the risks of zoonoses, as well as the advent of molecular biology-based testing, will potentially augment diagnostic aptitude. Documented zoonotic infection as it affects transplantation will be the primary focus of this review.

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Assessment of Risk Factors and Outcomes of Severe Ehrlichiosis Infection

et al. 2020

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IMPORTANCEEhrlichiosis cases in the US have increased more than 8-fold since 2000. Up to 57% of patients with ehrlichiosis require hospitalization and 11% develop a life-threatening complication; however, risk factors for serious disease are not well documented. OBJECTIVE To examine risk factors associated with severe ehrlichiosis. DESIGN, SETTING, AND PARTICIPANTS An analytic cross-sectional study of patients diagnosed with ehrlichiosis by polymerase chain reaction (PCR) between January 1, 2007, and December 31, 2017, was conducted in a single tertiary-care center in a region endemic for ehrlichiosis. Analysis was performed from February 27, 2018, to September 9, 2020. A total of 407 positive Ehrlichia PCR results were identified from 383 unique patients, with 155 unique patients meeting study criteria. Patients hospitalized at other institutions who had a positive Ehrlichia PCR performed as a reference test (n = 222) were excluded as no clinical data were available. Electronic medical record review was performed to collect demographic, clinical, laboratory, treatment, and outcomes data. Cases were excluded when there were insufficient clinical data to assess the severity of illness (n = 3) and when the clinical illness did not meet the case definition for ehrlichiosis (n = 3). EXPOSURES Date of presentation, onset of symptoms, date of PCR testing, date of treatment initiation, site of care, age, birth sex, race/ethnicity, Charlson Comorbidity Index, trimethoprim with sulfamethoxazole use within the prior 2 weeks, and immunosuppression. MAIN OUTCOMES AND MEASURES Requirement for intensive care unit (ICU) admission. RESULTSOf the 155 patients who met inclusion criteria, 99 patients (63.9%) were men, and 145 patients (93.5%) identified as non-Hispanic White; median age was 50 years (interquartile range, 23-64 years). Intensive care unit admission was indicated in 43 patients (27.7%), 94 patients (60.6%) were hospitalized on general medical floors, and 18 patients (11.6%) received care as outpatients. In adjusted analysis, time to treatment initiation was independently associated with an increased risk for ICU admission (adjusted prevalence ratio [aPR], 1.09; 95% CI, 1.04-1.14; P < .001). Documentation of tick exposure was independently associated with a decreased risk for ICU admission (aPR, 0.54; 95% CI, 0.34-0.86; P = .01). There appeared to be a nonsignificant change toward a decreased need for ICU care among immunosuppressed persons (aPR, 0.51; 95% CI, 0.26-1.00; P = .05). CONCLUSIONS AND RELEVANCEThis study suggests that delay in initiation of doxycycline therapy is a significant factor associated with severe ehrlichiosis. Increased recognition of infection by frontline clinicians to promote early treatment may improve outcomes associated with this increasingly common and life-threatening infection.

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Human Ehrlichiosis in a Liver Transplant Recipient

Cited by 11 publications

References 0 publications

Autoimmune disease triggered by infection with alphaproteobacteria

Autoimmune disease triggered by infection with alphaproteobacteria

Zoonoses in Solid-Organ and Hematopoietic Stem Cell Transplant Recipients

Assessment of Risk Factors and Outcomes of Severe Ehrlichiosis Infection

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