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Loop-mediated Isothermal Amplification (LAMP) Assays for the Species-specific Detection of Eimeria that Infect Chickens

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Human monocytic ehrlichiosis.

John H Stone¹, Kerry Dierberg, Ghazaleh Aram

¹Johns Hopkins Vasculitis Center, Division of Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, Md 21224, USA. jstone@jhmi.edu

|November 13, 2004

Summary

A patient with Wegener granulomatosis was initially suspected, but human monocytic ehrlichiosis (HME) was diagnosed. Prompt doxycycline treatment led to rapid improvement and full recovery of cardiac function.

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Area of Science:

Infectious Diseases
Cardiology
Rheumatology

Background:

Wegener granulomatosis (WG) can present with diverse systemic symptoms, making differential diagnosis challenging.
Flares of WG often mimic new infectious processes, complicating patient management.

Observation:

A 56-year-old male with WG history presented with symptoms mimicking a WG exacerbation, including fever, rash, and malaise.
The patient rapidly developed multi-organ involvement, including acute renal failure, thrombocytopenia, transaminitis, and severe myocarditis.
Clinical evolution and further history prompted empirical treatment for human monocytic ehrlichiosis (HME).

Findings:

Diagnosis of HME was confirmed by polymerase chain reaction for Ehrlichia chaffeensis and morulae in peripheral blood mononuclear cells.
The patient demonstrated a prompt and significant clinical improvement following initiation of doxycycline therapy.
Cardiac function normalized within four months of treatment, indicating resolution of HME-induced myocarditis.

Implications:

This case highlights the importance of considering HME in the differential diagnosis of patients presenting with systemic symptoms and multi-organ failure, even those with underlying autoimmune diseases.
Early recognition and treatment of HME with doxycycline are crucial for preventing severe complications and ensuring favorable outcomes, including cardiac recovery.
The successful management underscores the need for a broad diagnostic approach when faced with complex clinical presentations in patients with chronic conditions.