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Published on: September 6, 2017
Human ehrlichiosis in transplant recipients
L D Thomas1, I Hongo, K C Bloch
1Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Summary
Immunosuppression impacts Ehrlichia infections in transplant recipients, leading to different symptoms like less rash but more leukopenia. Prompt doxycycline treatment ensures favorable outcomes, similar to immunocompetent patients.
Area of Science:
- Infectious Diseases
- Immunology
- Transplantation
Background:
- Human ehrlichiosis is a tick-borne bacterial infection.
- Immunosuppression in transplant recipients may alter disease presentation and outcomes.
Purpose of the Study:
- To characterize the impact of immunosuppression on human ehrlichiosis.
- To compare clinical features and outcomes of ehrlichiosis in transplant recipients versus immunocompetent individuals.
Main Methods:
- Retrospective review of 15 transplant recipients and 43 immunocompetent patients diagnosed with ehrlichiosis between 1998 and 2006.
- Diagnosis by whole blood polymerase chain reaction (PCR) or serology.
- Species identification (E. ewingii or E. chaffeensis) for PCR-diagnosed cases.
Main Results:
- Transplant recipients showed a trend towards more E. ewingii infections (23% vs. 5%).
- Fewer transplant recipients experienced rash (0% vs. 36%) but presented with lower hepatic enzymes, more leukopenia, and renal dysfunction.
- Doxycycline treatment initiation was similar in both groups (73% vs. 78%).
Conclusions:
- Ehrlichia infections occur in transplant recipients in endemic areas.
- Prompt doxycycline treatment leads to favorable outcomes in infected transplant recipients, comparable to immunocompetent patients.
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