Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a case of granulocytic ehrlichiosis in a 71-year-old man who presented with an acute febrile illness and subsequently developed multisystem organ dysfunction and sudden severe anemia with thrombocytopenia requiring intensive care, mechanical ventilation, hemodialysis, and transfusions. The diagnosis was suspected on the fifth hospital day after a peripheral blood smear was examined; intracytoplasmic inclusion bodies were present in granulocytes only. Results of serological tests of acute and convalescent sera confirmed the diagnosis of granulocytic ehrlichiosis. We discuss the features of this case that were similar to those of published case reports as well as the course and outcome of treatment. This, to our knowledge, represents to first documented case of human granulocytic ehrlichiosis to occur outside the Upper Midwest. Because of the possible epidemiological association of Ehrlichia species with the deer tick Ixodes scapularis (dammini), this case raises additional concern for clinicians and patients in regions where Lyme disease is endemic.
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PMID:Human granulocytic ehrlichiosis in Connecticut: report of a fatal case. 864 39

Human ehrlichiosis is a newly emergent, tick-borne, zoonotic infection caused by members of the genus Ehrlichia. These rickettsia-like, obligate intracellular, gram-negative bacteria produce two similar yet distinct diseases. Human monocytic ehrlichiosis is caused by Ehrlichia chaffeensis. Human granulocytic ehrlichiosis is caused by an organism closely related to Ehrlichia equi. The most common initial clinical findings include fever, malaise, myalgia, headaches and rigors, while the most common laboratory findings are thrombocytopenia, leukopenia, anemia and elevated liver enzyme levels. Both diseases can produce intracytoplasmic morulae, in either monocytes or neutrophils, which may be visible on Wright-stained peripheral smears. Treatment consists of tetracycline or doxycycline. Rifampin or chloramphenicol can be tried when tetracycline is absolutely contraindicated. Treatment should never be delayed pending serologic or polymerase chain reaction confirmation of the diagnosis because of the 5 to 10 percent mortality rate.
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PMID:Human ehrlichiosis. 890 Mar 57

C3H mice that were inoculated with ehrlichiae isolated from a patient with human granulocytic ehrlichiosis (HGE) developed anemia and leukopenia, but by day 24, they returned to normal values. Granulocytic morulae were present in peripheral blood and spleen smears on days 5 and 10, and there was a reduction in morulae on day 17. Ehrlichiae were present in HL-60 cell cultures of blood and spleen from all mice at all intervals. Pathogenicity, but not infectivity, waned with mouse passage but could be resurrected by SCID mouse passage. Various methods were tested for their relative sensitivity in detecting infection: blood smears, HL-60 cell cultures, polymerase chain reaction (PCR) amplification of a 16S recombinant DNA target, and a mouse infectivity assay. All assays detected the HGE agent in blood during early infection, but PCR and the mouse infectivity assay were most sensitive during late infection. Xenodiagnosis demonstrated that mice remain persistently infected through 55 days.
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PMID:Granulocytic ehrlichiosis in the laboratory mouse. 949 56

Following intravenous inoculation with horse blood-infected with the agent of human granulocytic ehrlichiosis (HGE) from a human fatality, two rhesus macaques (Macaca mulatta) exhibited pyrexia and lethargy on days 4-12 postinfection (PI). Hematology revealed neutropenia, thrombocytopenia, and anemia, with ehrlichial morulae in monocytes and neutrophils on days 4-12. Blood was polymerase chain reaction (PCR)-positive on days 4-12 and bone marrow was PCR-positive on day 11. There was a minor increase in gamma-glutamyl transpeptidase on day 12 and serum interferon-gamma levels increased by day 18. Seroconversion occurred on day 20 PI to a titer of 100 by day 22. Western blot bands characteristic of HGE included 25-, 44-, 80-, 94-, 105-, and 125-kD bands. There was generalized lymphohistiocytic infiltration in the liver, spleen, lymph nodes, and other tissues. The liver had focal hepatocyte apoptosis. There was HGE DNA (by PCR) only in the spleen. Comparable findings were not observed in a monkey that received uninfected horse blood as a control. This animal model of human disease is important for further studies of HGE diagnosis, management, and pathogenesis.
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PMID:A simian model of human granulocytic ehrlichiosis. 1040 32

Enzyme-linked immunosorbent assays (ELISA) with a purified recombinant 44-kDa protein and indirect fluorescent antibody (IFA) staining methods incorporating whole-cell antigens of the human granulocytic ehrlichiosis (HGE) agent were used to detect antibodies to Ehrlichia phagocytophila genogroup organisms in cattle sera. The cattle lived in tick-infested areas of Connecticut, USA and were healthy at the times blood samples were collected in 1990, 1999 and 2000. Of the 339 serum samples analysed, 40 (12%) and 15 (4%) were positive by ELISA and IFA, respectively. Western immunoblots of a subset of sera verified antibody reactivity of six serum samples, positive by ELISA with titres of 640-2,560, to a protein with a molecular mass of c. 44 kDa. Although seroprevalence rates were low, cattle were exposed to the HGE agent at different sites and should be monitored for anaemia, leukopenia or thrombocytopenia, especially if there is evidence of unexplained decreased milk production. Different serological testing methods should be used to detect immunoglobulins.
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PMID:Antibodies to granulocytic ehrlichiae in cattle from Connecticut. 1192 38

Ehrlichiosis comprises a group of emerging tick-borne infectious diseases caused by obligate intracellular Gram-negative bacteria that infect leukocytes. Infections caused by members of the genus Ehrlichia have been described in animals and humans, but to date there are no convincing reports of the presence of other types of human ehrlichiosis different from human granulocytic ehrlichiosis (HGE) in Europe. The European vector is the same as that of Lyme borreliosis, the hard tick Ixodes ricinus, and HGE has a similar epidemiology to that of Borrelia burgdorferi infection. Across Europe, I. ricinus is infected to a variable extent (0.4-66.7%) with the causative agent Ehrlichia (Anaplasma) phagocytophila genogroup, and since its first description in Slovenia in 1997, details of 15 patients have been published. Diagnosis requires careful consideration of all circumstances and symptoms (history of tick bite and the presence of a flu-like syndrome with variable degrees of anemia, thrombocytopenia, and leukopenia, and elevated liver enzymes). Some differences can be seen between US and European HGE patients. European HGE cases have a less severe course, and the presence of morulae is uncommon. In Europe, verification of HGE has been based on PCR and immunofluorescence antibody tests, because no isolation from humans has been reported.
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PMID:Human granulocytic ehrlichiosis in Europe. 1251 49

Lyme disease, human granulocytic ehrlichiosis (HGE) and babesiosis are emerging infections in the northeastern and midwestern United States, where Ixodes scapularis ticks are prevalent. Lyme disease and babesiosis have also been reported on the West Coast, but less frequently. Lyme disease presents frequently with a skin lesion known as erythema migrans (EM), and diagnostic tests are not necessary if the lesion is classical. Those patients presenting without EM or with atypical skin lesions may need laboratory confirmation. The most frequently used laboratory modality consists of the 2-step serological assays, employing a sensitive ELISA as a first step, followed by IgG and/or IgM immunoblots. Current guidelines for interpretation are those recommended by the CDC. HGE and babesiosis are febrile illnesses with non-specific signs and symptoms. Both infections may present with routine laboratory abnormalities, including leukopenia and/or thrombocytopenia in HGE and anemia in babesiosis. Moderate elevations of liver enzymes may occur in all three tick-borne infections. Specific diagnostic modalities for acute-phase HGE include buffy coat smear examination, culture and PCR. Culture appears to have the greatest sensitivity of the three tests. Babesiosis can be diagnosed by peripheral blood examination for the intraerythrocytic parasites, PCR or serology. Co-infections with these agents exist, but they should be documented by detection of the organisms rather than by serology, since seroprevalence rates are high in endemic areas.
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PMID:Laboratory aspects of tick-borne diseases: lyme, human granulocytic ehrlichiosis and babesiosis. 1276 39

Ehrlichia spp. are obligate intracellular bacteria with tropism for hematopoietic cells. Monocytic ehrlichioses in dogs and humans are transmitted by ticks and primarily caused by E. canis and E. chaffeensis, respectively. E. canis causes canine monocytic ehrlichioses (CME), a potentially fatal disease in dogs that requires rapid and accurate diagnosis in order to initiate appropriate therapy leading to a favorable prognosis. CME is characterized by three stages; 1) acute, 2) subclinical and 3) chronic. Dogs infected with E. canis remain infected for their entire lives, even after receiving antibiotic treatment with doxycycline. The prevalence of E. canis is dependent on the distribution of the vector, Rhipicephalus sanguineus tick, which occurs mainly in tropical and subtropical regions. The agent causing canine granulocytic ehrlichiosis (CGE) in Europe has been determined by nucleotide sequencing of the 16S rRNA gene to be similar to both Ehrlichia equi and E. phagocytophila (Anaplasma phagocytophila), and is identical to the agent of human granulocytic ehrlichiosis (HGE). The vector of this pathogen in Europe is the common European tick, Ixodes ricinus and its reservoir - wild and domestic animals. Two distinct clinical disease syndromes, including chronic, moderate to sever anemia and polyarthritis, are associated with CGE. In areas infested with vectors of tick-borne agents known to be endemic for Lyme disease, veterinarians may suspect ehrlichiosis in dogs.
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PMID:Canine ehrlichiosis. 1467 3