Dr. Andrew Walter reported on Ehrlichiosis and Hemophagocytic Lymphohistiocytosis (HLH) in cases of children diagnosed in Delaware. Ehrlichiosis is an uncommon tick borne disease seen in the mid-Atlantic area and therefore clinicians need to maintain a heightened vigilance. Ticks in the MD/Delaware/PA area carry A. phagocytophilum which causes HGA. Amblyoma americanum ticks in the midwest carry E chaffeenis and cause Human Monocytic Ehrlichiosis (HME). The elderly have the highest rate of illness due to Ehrlichiosis although more than 20% of children in endemic regions have evidence for past infection with TBRD. Doxycycline is the drug of choice for treatment of Ehrlichiosis since patients sick with Ehrlichiosis may be co-infected with other TBRD which are effectively treated by doxycycline.
HLH is a rare complication of infectious diseases including Ehrlichiosis. Hemophagocytic lymphohistiocytosis (HLH) is a disease with major diagnostic and therapeutic difficulties. Primary HLH is an autosomal recessive illness that is fatal with a median survival among infants of less than 2 months. Secondary HLH may result from a strong immunological reaction from a severe infection; most patients are not immunosuppressed. The most typical findings of HLH are fever, hepatosplenomegaly, lymphadenopathy, skin rash, jaundice, cytopenias, as well as hypertriglyceridemia, coagulopathy with hypofibrinogenemia, liver dysfunction, and elevated levels of ferritin and serum transaminases. Neurological symptoms may be associated with a spinal fluid hyperproteinemia and a moderate pleocytosis. Patients who are very ill with Ehlichiosis or other infection should be immediately screened for HLH with LFT, CBC, ferritin with other specialized tests to follow as needed.
http://lymediseaseresource.com/2011NationalLymeConferencesummary%20(2).pdf
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Andrew Walter: Ehrlichiosis and HLH – Lyme Disease …
lymediseaseresource.com/2011NationalLymeConferencesummary%20(2).pdf
2011 Lyme and Tick Borne-Diseases National Conference. Scientific Chairs: … Finally, emerging knowledge on biofilm dispersants was reviewed. For more …
