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Human Monocytic Ehrlichiosis in Children

Schutze, Gordon E. MD*; Buckingham, Steven C. MD; Marshall, Gary S. MD; Woods, Charles R. MD§; Jackson, Mary Anne MD; Patterson, Lori E. MD; Jacobs, Richard F. MD*The Tick-borne Infections in Children Study (TICS) Group

The Pediatric Infectious Disease Journal: June 2007 - Volume 26 - Issue 6 - p 475-479
doi: 10.1097/INF.0b013e318042b66c
Original Studies

Background: Human monocytic ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis. Data about disease in children have been largely derived from case reports or small case series.

Methods: A retrospective review of all medical and laboratory records from 6 sites located in the “tick belt” of the Southeastern United States was carried out. Demographic, history and laboratory data were abstracted from the identified medical records of patients. Bivariate statistical comparisons were performed using Fisher exact test or Wilcoxon rank sum tests.

Results: Common clinical signs and symptoms of patients with HME (n = 32) included fever (100%), headache (69%), myalgia (69%), rash (66%), nausea/vomiting (56%), altered mental status (50%) and lymphadenopathy (47%). Only 48% had a complaint of fever, headache and rash. Common laboratory abnormalities included thrombocytopenia (94%), elevated aspartate aminotransferase (90%), elevated alanine aminotransferase (74%), hypoalbuminemia (65%), lymphopenia (57%), leukopenia (56%) and hyponatremia (55%). The median number of days of illness before the initiation of antirickettsial therapy was 6. Patients who received sulfonamides before starting doxycycline therapy developed a rash, were admitted to the hospital, and started doxycycline at a later date. Twenty-two percent of patients were admitted to the intensive care unit with 12.5% of patients requiring ventilatory and blood pressure support.

Conclusions: Although HME has been recognized among children for almost 20 years, there is only a limited knowledge about its clinical course. Even among physicians practicing in endemic regions, few cases are diagnosed each year. More work is needed to understand the true burden of disease and the natural history among asymptomatically and symptomatically infected children.

From the *University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital, Little Rock, AR; †University of Tennessee Health Science Center, Le Bonheur Children's Medical Center, Memphis, TN; ‡University of Louisville School of Medicine, Kosair Children's Hospital, Louisville, KY; §Wake Forrest University School of Medicine, Brenner Children's Hospital, Winston-Salem, NC; ∥University of Missouri, Children's Mercy Hospital, Kansas City, MO; and ¶East Tennessee Children's Hospital, Knoxville, TN.

Accepted for publication February 1, 2007.

Address for correspondence: Gordon E. Schutze, MD, Texas Children's Hospital, 6621 Fannin, CC1210, Houston, TX 77030. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.