Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 8, Number 3—March 2002

Severe Ehrlichia chaffeensis Infection in a Lung Transplant Recipient: A Review of Ehrlichiosis in the Immunocompromised Patient

Nasia Safdar, Robert B. Love, and Dennis G. Maki
Author affiliations: University of Wisconsin Medical School, Madison, Wisconsin, USA;

Main Article


Reports of immunocompromised patients with Ehrlichia infection

Immunocompromised state Age Form of ehrlichiosis Clinical features Outcome Reference
Rheumatoid arthritis, on methotrexate 49 Ehrlichia ewingii Fever, headache Survived 5
Emphysema, on prednisone 65 E. ewingii Fever, headache Survived 5
Renal transplant 11 E. ewingii Lyphadenopathy, fever Survived 5
Liver transplant 47 HMEa Multiorgan failure Survived 9
Leukemia 6 HME Hepatitis, pancytopenia, rash, renal failure Survived 10
Asplenia 71 HGE Fever, neurologic dysfunction Survived 11
Asplenia 30 HGE Rash, fever Survived 11
HIV infection (CD4 45/mm3) 33 HME Cardiomyopathy, heart failure Survived 12
Renal transplant 35 HME Rash, pancytopenia, renal failure Survived 13
HIV infection (CD4 NS) 38 HME Multiorgan failure Died 14
Sickle beta-thalassemia NS HME Respiratory failure Survived 15
Renal transplant NS HME NS Survived 15
HIV infection (CD4 164/mm3) 52 HME Hepatitis, thrombocytopenia Died 16
Renal transplant 67 HGE Pancytopenia, renal failure, hepatitis Survived 17
HIV infection CD4 (18/mm3) 36 HME Hepatitis, renal failure Died 18
Liver transplant 51 HME Pancytopenia, shock Survived 19
Asplenia, chronic lymphocytic leukemia, on steroids 80 HGE Multiorgan failure Died 7
HIV infection (CD4 199/mm3) 37 HME fever, pancytopenia, toxic-shock-like illness Survived 20
Splenectomy 46 HME Pancreatitis, shock, encephalitis Survived 20
HIV infection (CD4 64/mm3) 41 HME Pancytopenia, pulmonary hemorrhage Died 21
Asplenia 67 E. canis Renal failure respiratory failure, encephalitis Died 8
Crohn disease requiring prednisone 57 E. canis Pancytopenia, hepatitis Survived 22
Bilateral lung transplant 38 HME Pancytopenia, renal failure, TTP-like illness Survived Current case

aHME = human monocytic ehrlichiosis; HGE = human granulocytic ehrlichiosis; NS = not specified

Main Article

  1. Maeda  K, Markowitz  N, Hawley  RC, Ristic  M, Cox  D, McDade  JE. Human infection with Ehrlichia canis, a leukocytic rickettsia. N Engl J Med. 1987;316:8536.PubMedGoogle Scholar
  2. Dumler  JS, Bakken  JS. Ehrlichial diseases of humans: emerging tick-borne infections. Clin Infect Dis. 1995;20:110210.PubMedGoogle Scholar
  3. McQuiston  JH, Paddock  CD, Holman  RC, Childs  JE. The human ehrlichioses in the United States. Emerg Infect Dis. 1999;5:63542.PubMedGoogle Scholar
  4. Rikihisa  Y. The tribe Ehrlichiae and ehrlichial diseases. Clin Microbiol Rev. 1991;4:286308.PubMedGoogle Scholar
  5. Buller  RS, Arens  M, Hmiel  SP, Paddock  CD, Sumner  JW, Rikhisa  Y, Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med. 1999;341:14855. DOIPubMedGoogle Scholar
  6. Fishbein  DB, Dawson  JE, Robinson  LE. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med. 1994;120:73643.PubMedGoogle Scholar
  7. Bakken  JS, Dumler  JS, Chen  S-M, Eckman  MR, Van Etta  LL, Walker  DH. Human granulocytic ehrlichiosis in upper Midwest United States. JAMA. 1994;272:2128. DOIPubMedGoogle Scholar
  8. Eng  TR, Harkness  JR, Fishbein  DB, Dawson  JE, Greene  CN, Redus  MA, Epidemiologic, clinical, and laboratory findings of human ehrlichiosis in the United States, 1988. JAMA. 1990;264:22518. DOIPubMedGoogle Scholar
  9. Tan  HP, Dumler  S, Maley  WR, Klein  AS, Burdick  JF, Fred Poordad  F, Human monocytic ehrlichiosis: an emerging pathogen in transplantation. Transplantation. 2001;71:167880. DOIPubMedGoogle Scholar
  10. Arav-Boger  R, Knepp  JH, Walls  JJ, Dumler  JS. Human monocytic ehrlichiosis in a child with leukemia. Pediatr Infect Dis J. 2000;19:1735. DOIPubMedGoogle Scholar
  11. Rabinstein  A, Tikhomirov  V, Kaluta  A, Gelfmann  N, Iannini  P, Edwards  L. Recurrent and prolonged fever in asplenic patients with human granulocytic ehrlichiosis. QJM. 2000;93:198201. DOIPubMedGoogle Scholar
  12. Whitt  SP, Everett  ED, Roland  W, Dolan  S. Ehrlichia chaffeenis—associated cardiomyopathy in patients with AIDS. Clin Infect Dis. 1999;28:140. DOIPubMedGoogle Scholar
  13. Sadikot  R, Shaver  MJ, Reeves  WB. Ehrlichia chaffeensis in a renal transplant recipient. Am J Nephrol. 1999;19:6746. DOIPubMedGoogle Scholar
  14. Martin  GS, Christman  BW, Standaert  SM. Rapidly fatal infection with Ehrlichia chaffeensis. N Engl J Med. 1999;341:7634. DOIPubMedGoogle Scholar
  15. Schutze  GE, Jacobs  RF. Human monocytic ehrlichiosis in children. Pediatrics. 1997;100:E10. DOIPubMedGoogle Scholar
  16. Paddock  CD, Sumner  JW, Shore  MG, Bartley  DC, Elie  RC, McQuade  JG, Isolation and characterization of Ehrlichia chaffeensis strains from patients with fatal ehrlichiosis. J Clin Microbiol. 1997;35:2496502.PubMedGoogle Scholar
  17. Adachi  JA, Grimm  EM, Johnson  P, Uthman  M, Kaplan  B, Rakita  RM. Human granulocytic ehrlichiosis in a renal transplant patient. Transplantation. 1997;64:113942. DOIPubMedGoogle Scholar
  18. Barenfanger  J, Patel  PG, Dumler  SJ, Walker  DH. Identifying human ehrlichiosis. Lab Med. 1996;27:3724.
  19. Antony  SJ, Dummer  S, Hunter  E. Human ehrlichiosis in a liver transplant recipient. Transplantation. 1995;60:87981. DOIPubMedGoogle Scholar
  20. Fichtenbaum  CJ, Peterson  LR, Weil  GJ. Ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome. Am J Med. 1993;95:3517. DOIPubMedGoogle Scholar
  21. Paddock  CD, Suchard  DP, Grumbach  KL, Hadley  WK, Kerschmann  RL, Abbey  NW, Brief report: fatal seronegative ehrlichiosis in a patient with HIV infection. N Engl J Med. 1993;329:11647. DOIPubMedGoogle Scholar
  22. Manian  FA, Weidner  J. Costello, Fishbein DB, Dawson JE. Human ehrlichiosis. Mo Med. 1989;86:6915.PubMedGoogle Scholar
  23. Fresno  M, Kopf  M, Rivas  L. Cytokines and infectious diseases. Immunol Today. 1997;18:568. DOIPubMedGoogle Scholar
  24. Dumler  JS, Trigiani  ER, Bakken  JS, Aguero-Rosenfeld  ME, Wormser  GP. Serum cytokine responses during acute human granulocytic ehrlichiosis. Clin Diagn Lab Immunol. 2000;7:68.PubMedGoogle Scholar
  25. Winslow  GM, Yage  E. Shilo, Collins DN, Chu FK. Infection of the laboratory mouse with the intracellular pathogen Ehrlichia chaffeensis. Infect Immun. 1998;66:38929.PubMedGoogle Scholar
  26. UNOS transplant patient data base. Available at URL:
  27. Paddock  CD, Folk  SM, Shore  GM, Machado  LJ, Huyuke  MM, Slater  LN, Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus. Clin Infect Dis. 2001;33:158694. DOIPubMedGoogle Scholar
  28. Modi  KS, Dahl  DC, Berkseth  RO, Schut  R, Greeno  E. Human granulocytic ehrlichiosis presenting with acute renal failure and mimicking thrombotic thrombocytopenic purpura. Am J Nephrol. 1999;19:67781. DOIPubMedGoogle Scholar
  29. Marty  AM, Dumler  JS, Imes  G, Brusman  HP, Smrkovski  LL, Frisman  DM. Ehrlichiosis mimicking thrombotic thrombocytopenic purpura. A case report and pathological correlation. Hum Pathol. 1995;26:9205. DOIPubMedGoogle Scholar
  30. Remuzzi  G, Bertani  T. Renal vascular and thrombotic effects of cyclosporine. Am J Kidney Dis. 1989;13:26172.PubMedGoogle Scholar
  31. Ratnasamy  N, Everett  ED, Roland  WE, McDonald  G, Caldwell  CW. Central nervous system manifestations of human ehrlichiosis. Clin Infect Dis. 1996;23:3149.PubMedGoogle Scholar
  32. Anderson  BE, Summer  JW, Dawson  JE, Tzianabos  T, Greene  CR, Olson  JG, Detection of the etiologic agent of human ehrlichiosis by polymerase chain reaction. J Clin Microbiol. 1992;30:77580.PubMedGoogle Scholar

Main Article

Page created: July 15, 2010
Page updated: July 15, 2010
Page reviewed: July 15, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.