Perinatal Transmission of the Agent of Human Granulocytic Ehrlichiosis

Horowitz, Harold W.; Kilchevsky, Eitan; Haber, Stephen; Agüero-Rosenfeld, Maria E.; Kranwinkel, R.; James, Edward K.; Wong, Susan J.; Chu, Frederick K.; Liveris, Dionysios; Schwartz, Ira

doi:10.1056/nejm199808063390604

Cited by 103 publications

(76 citation statements)

References 23 publications

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“…Horowitz described HGA in a woman during pregnancy. 28 The infant developed HGA eight days after being borne, and the authors argued that transplacental transmission A. phagocytophilum occurred. Several butchers from northwestern Wisconsin acquired HGA after butchering large quantities of white tail deer carcasses during hunting season [36].…”

Section: Patient Historymentioning

confidence: 99%

Human Granulocytic Anaplasmosis

Bakken

Dumler

2008

Infectious Disease Clinics of North America

164

193

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SynopsisHuman granulocytic anaplasmosis (HGA), a deer tick transmitted rickettsial infection caused by Anaplasma phagocytophilum, is a common cause of undifferentiated fever in the Northeast and Upper Midwest U.S. Patients are often initially diagnosed with a mild viral infection, and illness readily resolves in most cases. However, as many as 3% may develop life threatening complications and nearly 1% die from the infection. A history of tick bite and a high degree of clinical suspicion thus warrant consideration for doxycycline treatment in both adults and children, even in the absence of known tick bite, a negative blood film examination, or pending results of specific A. phagocytophilum diagnostic tests such as paired serology or PCR on acute phase blood. Antibody tests and titers should not be used to monitor active infection as detectable antibodies can remain present for years. Moreover, persistent infection has never been reported. While coinfections with Borrelia burgdorferi and Babesia microti occur, there is little evidence to suggest synergism of disease or a role for A. phagocytophilum in chronic illness. Preventive measures include avoiding tick-infested areas, use of tick repellents, and careful searches of skin to remove attached ticks; no vaccine is available.

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Section: Patient Historymentioning

confidence: 99%

Human Granulocytic Anaplasmosis

Bakken

Dumler

2008

Infectious Disease Clinics of North America

164

193

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“…2 While its epidemiologic and public health significance remain to be fully defined, HGE has been responsible for hundreds of cases and several fatalities. [3][4][5][6][7][8][9][10] Clinical information on HGE in children is limited to individual case reports. 4,8 Treatment in children is complicated because doxycycline, the antibiotic of choice, may cause permanent staining of the teeth in children younger than 8 years of age.…”

mentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10] Clinical information on HGE in children is limited to individual case reports. 4,8 Treatment in children is complicated because doxycycline, the antibiotic of choice, may cause permanent staining of the teeth in children younger than 8 years of age. 11,12 We report 2 children who experienced A phagocytophilum infection and were successfully treated with rifampin.…”

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confidence: 99%

Successful Treatment of Human Granulocytic Ehrlichiosis in Children Using Rifampin

2003

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ABSTRACT. Human granulocytic ehrlichiosis (HGE) is an emerging tick-borne infectious disease caused by Anaplasma phagocytophilum. Clinical features include a flu-like illness that usually resolves within 1 week. More serious infection may occur that requires hospital admission or culminates in death. Doxycycline is the treatment of choice for HGE but may cause permanent staining of teeth in children younger than 8 years of age. We report successful treatment of HGE with rifampin in 2 children, 4 and 6 years old. A course of rifampin for 5 to 7 days should be considered in children younger than 8 years of age who experience non-life-threatening A phagocytophilum infection. Pediatrics 2003;112:e252-e253. URL: http://www.pediatrics.org/cgi/content/full/112/3/e252; human granulocytic ehrlichiosis, HGE, A phagocytophilum, rifampin.ABBREVIATIONS. HGE, human granulocytic ehrlichiosis; WBC, white blood cell count.H uman granulocytic ehrlichiosis (HGE), a tickborne zoonoses that was first reported in 1994, is an emerging public health problem in the northeastern and northern Midwestern United States. 1 The name of the causative pathogen was recently changed from "the agent of human granulocytic ehrlichiosis" to Anaplasma phagocytophilum. 2 While its epidemiologic and public health significance remain to be fully defined, HGE has been responsible for hundreds of cases and several fatalities. [3][4][5][6][7][8][9][10] Clinical information on HGE in children is limited to individual case reports. 4,8 Treatment in children is complicated because doxycycline, the antibiotic of choice, may cause permanent staining of the teeth in children younger than 8 years of age. 11,12 We report 2 children who experienced A phagocytophilum infection and were successfully treated with rifampin. CASE REPORTS Case 1A 6-year-old female kindergarten student from northwestern Wisconsin presented on June 17, 1998, with a 1-day history of fever, mild sore throat, intermittent headache, generalized myalgia, malaise, and shaking chills. She had noticed neck pain after the removal of a small brown tick attached behind her left ear 7 days earlier. The physical examination was unremarkable other than a temperature of 39.8°C. The hemogram showed a white blood cell count (WBC) of 10.9 ϫ 10 9 /L with 61% segmented neutrophils, 24% band neutrophils, 10% lymphocytes, and 5% monocytes, and a platelet count of 238 ϫ 10 9 /L. Microscopic examination of 800 leukocytes on a Wright-stained peripheral blood smear failed to reveal diagnostic inclusions (morulae) in neutrophils. The patient was thought to have a viral syndrome, and she was asked to return for follow-up examination in 48 hours. Her fever exceeded 39°C and her other symptoms persisted.At a follow-up visit 2 days later on June 19, 1998, the total WBC was 2.5 ϫ 10 9 /L and the platelet count was 153 ϫ 10 9 /L. Hepatic transaminase concentrations in serum were normal and repeated blood smear evaluation failed to detect morulae. HGE was suspected, and she was given oral rifampin (10 mg/kg orally twice dai...

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“…The clinical presentation and course of HGA is generally mild, although hospitalization occurs in 36% of patients. Of those hospitalized, 7% are admitted to the ICU due to severe complications such as shock-like syndrome, respiratory and neurological involvement [5][6][7][8][9]. These severe courses are most commonly seen in immunocompromised persons.…”

Section: Discussionmentioning

confidence: 99%

“…2015;6(6):282-284 been increasing, reports of HGA during immunosuppression or pregnancy remain limited. Among the 11 cases of HGA during pregnancy previously reported, all patients had relatively mild disease without severe complications [2,[9][10][11][12][13]. Muffly reported a case of a first trimester spontaneous abortion after a complicated presumed ehrlichia/anaplasma infection; however, the diagnosis was made on clinical suspicion alone without laboratory confirmation [13].…”

Section: Discussionmentioning

confidence: 99%