Volume 21, Number 10—October 2015
Human Infection with Ehrlichia muris–like Pathogen, United States, 2007–20131
|Patient age at illness onset, y|
|Period from symptom onset to testing, d|
|Immunocompromised state†||13/49 (27%)|
|Solid organ allograft recipient||7|
|Receipt of chemotherapy for malignancy||2|
|Receipt of systemic steroids for autoimmune disease‡
|Elevated AST or ALT||18/23 (78%)|
|Ehrlichia chaffeensis positive serology, acute||1/6 (17%)|
|Anaplasma phagocytophilum positive serology, acute||1/6 (17%)|
|Borrelia burgdorferi positive serology or PCR
|Doxycycline treatment†¶||66/68 (96%)|
|Length of treatment, d|
|Length of stay, d|
|Immunocompromised patients†||10/15 (67%)|
*ALT, alanine aminotransferase; AST, aspartate aminotransferase; EML, Ehrlichia muris–like.
†Expressed as number of patients with a specific risk factor, symptom, laboratory finding, or outcome, divided by the number of patients with available data. Corresponding percentage is also provided.
‡Of the 4 patients receiving systemic steroids for an autoimmune condition, 3 had rheumatoid arthritis, and 1 had mixed connective tissue disease.
§Anemia, hemoglobin <13.5g/dL for male or <12.0g/dL for female patients; leukopenia, <3.5 cells x 10−9/liter; thrombocytopenia, <150 cells × 10−9/liter; elevated AST, >48 U/liter; elevated ALT, >55 U/liter; positive Ehrlichia chaffeensis or Anaplasma phagocytophilum serology, reciprocal IgG titer >64.
¶Two patients recovered without treatment. Treatment information was unavailable for 1 patient.
#Length of stay was unknown for 2 of the 16 hospitalized patients.
1Preliminary data from this study were presented at the American Society for Clinical Laboratory Science–Minnesota meeting, March 8, 2012, St. Cloud, Minnesota, USA; the Interscience Conference of Antimicrobial Pathogens and Chemotherapy, September 9–12, 2012, San Francisco, California, USA; the Emerging Infections in Clinical Practice and Public Health Continuing Medical Education Conference, November 16, 2012, Minneapolis, Minnesota, USA; the Interscience Conference of Antimicrobial Pathogens and Chemotherapy, September 10–13, 2013, Washington, DC, USA; the Entomological Society of America annual meeting, November 10–13, 2013, Austin, Texas, USA; the American Society of Tropical Medicine and Hygiene annual meeting, November 13–17, 2013, Washington, DC, USA; the European Congress of Clinical Microbiology and Infectious Diseases, May 10–13, 2014, Barcelona, Spain; and the International Conference on Diseases in Nature Communicable to Man, August 10–12, 2014, Vancouver, British Columbia, Canada.
2These authors contributed equally to this article.