| 词条 | Ehrlichiosis |
| 释义 |
| name = Ehrlichiosis | synonyms = | image = | caption = | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}Ehrlichiosis is a tickborne[1] bacterial infection,[2] caused by bacteria of the family Anaplasmataceae, genera Ehrlichia and Anaplasma. These obligate intracellular bacteria infect and kill white blood cells. The average reported annual incidence is on the order of 2.3 cases per million people.[3] SpeciesFive (see note below) species have been shown to cause human infection:[4]
The latter two infections are not well studied. In 2006, human infection by Boone County, Missouri. Symptoms: high fever, severe joint and muscle aches, vomiting. Onset of symptoms began exactly 14 days after bite occurred. Symptoms affected patient on a 12-hour cycle; beginning early evening, ending early morning. No symptoms occurred for next 12 hours. CBC presented low WBC. Note: In 2008, human infection by Panola Mountain (Georgia, USA) Ehrlichia species was reported.[5] On August 3, 2011, infection by a yet-unnamed bacterium in the genus Ehrlichia carried by deer ticks that has caused flu-like symptoms in at least 25 people in Minnesota and Wisconsin was reported; human ehrlichiosis was thought to be very rare or absent in Minnesota and Wisconsin.[6] The new species, which is very similar genetically to an Ehrlichia species found in Eastern Europe and Japan called E. muris, was identified at Mayo Clinic Health System's Eau Claire hospital.[6]Ehrlichia are transported between cells through the host cell filopodia during initial stages of infection, whereas, in the final stages of infection the pathogen ruptures the host cell membrane.[7]Signs and symptomsThe most common symptoms include headache, muscle aches, and fatigue. A rash may occur, but is uncommon. Ehrlichiosis can also blunt the immune system by suppressing production of TNF-alpha, which may lead to opportunistic infections such as candidiasis.{{citation needed|date=January 2015}} Most of the signs and symptoms of ehrlichiosis can likely be ascribed to the immune dysregulation that it causes.{{citation needed|date=July 2016}} A "toxic shock-like" syndrome is seen in some severe cases of ehrlichiosis. Some cases can present with purpura and in one such case the organisms were present in such overwhelming numbers that in 1991 Dr. Aileen Marty of the AFIP was able to demonstrate the bacteria in human tissues using standard stains, and later proved that the organisms were indeed Ehrlichia using immunoperoxidase stains.[8] Experiments in mouse models further supports this hypothesis, as mice lacking TNF-alpha I/II receptors are resistant to liver injury caused by ehrlichia infection.[9] 3% of human monocytic ehrlichiosis cases result in death; however, these deaths occur "most commonly in immunosuppressed individuals who develop respiratory distress syndrome, hepatitis, or opportunistic nosocomial infections."[10] Diagnosis{{Empty section|date=June 2018}}PreventionNo human vaccine is available for ehrlichiosis. Tick control is the main preventive measure against the disease. However, in late 2012 a breakthrough in the prevention of CME (canine monocytic ehrlichiosis) was announced when a vaccine was accidentally discovered by Prof. Shimon Harrus, Dean of the Hebrew University of Jerusalem's Koret School of Veterinary Medicine.[11] TreatmentDoxycycline and minocycline are the medications of choice. For people allergic to antibiotics of the tetracycline class, rifampin is an alternative.[3] Early clinical experience suggested that chloramphenicol may also be effective, however, in vitro susceptibility testing revealed resistance.{{citation needed|date=January 2015}} EpidemiologyEhrlichiosis is a nationally notifiable disease in the United States. There have been cases reported in every month of the year, but most cases are reported during April–September.[12][13][14] These months are also the peak months for tick activity in the United States. From 2008-2012, the average yearly incidence of ehrlichiosis was 3.2 cases per million persons. This is more than twice the estimated incidence for the years 2000-2007.[14] The incidence rate increases with age, with the ages of 60–69 years being the highest age-specific years. Children of less than 10 years and adults aged 70 years and older, have the highest case-fatality rates.[14] There is a documented higher risk of death among persons who are immunosuppressed.[12] See also
References1. ^{{cite web |title=Ehrlichiosis |date=15 November 2013 |publisher=Division of Vector-Borne Diseases (DVBD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention |url=https://www.cdc.gov/ehrlichiosis/}} 2. ^{{cite book |last=Dawson |first=Jacqueline E. |last2=Marty |first2=Aileen M. |chapter=Ehrlichiosis |editor-last=Horsburgh |editor-first=C.R. |editor2-last=Nelson |editor2-first=A.M. |title=Pathology of emerging Infections |publisher=American Society for Microbiology Press |year=1997 |volume=1 |isbn=1555811205}} 3. ^1 2 {{cite journal |author=Goddard J |title=What Is New With Ehrlichiosis?|journal=Infections in Medicine|date=September 1, 2008 |url=http://www.consultantlive.com/headache/article/1145625/1405478}} 4. ^{{cite journal |vauthors=Dumler JS, Madigan JE, Pusterla N, Bakken JS |title=Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment |journal=Clin. Infect. Dis. |volume=45 |issue=Suppl 1 |pages=S45–51 |date=July 2007 |pmid=17582569 |doi=10.1086/518146 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17582569}} 5. ^{{cite journal |vauthors=Reeves WK, Loftis AD, Nicholson WL, Czarkowski AG |title=The first report of human illness associated with the Panola Mountain Ehrlichia species: a case report |journal=Journal of Medical Case Reports |volume=2 |pages=139 |year=2008 |pmid=18447934 |pmc=2396651 |doi=10.1186/1752-1947-2-139 |url=http://www.jmedicalcasereports.com/content/2//139}} 6. ^1 {{cite news|first=J. |last=Steenhuysen |title=New tick-borne bacterium found in upper Midwest |agency=Reuters |date=3 August 2011 |url=http://www.trust.org/alertnet/news/new-tick-borne-bacterium-found-in-upper-midwest/ |deadurl=yes |archiveurl=https://web.archive.org/web/20120609141251/http://www.trust.org/alertnet/news/new-tick-borne-bacterium-found-in-upper-midwest/ |archivedate=2012-06-09 |df= }} 7. ^{{cite journal |vauthors=Thomas S, Popov VL, Walker DH |title=Exit Mechanisms of the Intracellular Bacterium Ehrlichia |journal=PLoS ONE |volume=5 |issue=12 |pages=e15775 |year=2010 |url=http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0015775 |doi=10.1371/journal.pone.0015775 |pmid=21187937 |pmc=3004962 |editor1-last=Kaushal |editor1-first=Deepak}} 8. ^{{cite journal |vauthors=Marty AM, Dumler JS, Imes G, Brusman HP, Smrkovski LL, Frisman DM |title=Ehrlichiosis mimicking thrombotic thrombocytopenic purpura. Case report and pathological correlation |journal=Hum. Pathol. |volume=26 |issue=8 |pages=920–5 |date=August 1995 |pmid=7635455 |url=http://www.humanpathol.com/article/0046-8177(95)90017-9/abstract |doi=10.1016/0046-8177(95)90017-9}} 9. ^{{cite journal |vauthors=McBride JW, Walker DH |title=Molecular and cellular pathobiology of Ehrlichia infection: targets for new therapeutics and immunomodulation strategies |journal=Expert Rev Mol Med |volume=13 |pages=e3 |year=2011 |pmid=21276277 |pmc=3767467 |doi=10.1017/S1462399410001730 |url=http://journals.cambridge.org/abstract_S1462399410001730}} 10. ^{{cite journal|last=Thomas|first=Rachael J|author2=Dumler, J Stephen |author3=Carlyon, Jason A |title=Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and ehrlichiosis|journal=Expert Review of Anti-infective Therapy|date=1 August 2009|volume=7|issue=6|pages=709–722|doi=10.1586/eri.09.44|pmid=19681699|pmc=2739015}} 11. ^{{cite journal |vauthors=Rudoler N, Baneth G, Eyal O, van Straten M, Harrus S |title=Evaluation of an attenuated strain of Ehrlichia canis as a vaccine for canine monocytic ehrlichiosis |journal=Vaccine |volume=31 |issue=1 |pages=226–33 |date=December 2012 |pmid=23072894 |doi=10.1016/j.vaccine.2012.10.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0264-410X(12)01448-X}} 12. ^1 Dahlgren FS, Heitman KN, Drexler NA, Massung RF, Behravesh CB. Human granulocytic anaplasmosis in the United States from 2008 to 2012: a summary of national surveillance data. Am J Trop Med Hyg 2015;93:66–72. 13. ^Drexler NA, Dahlgren FS, Heitman KN, Massung RF, Paddock CD, Behravesh CB. National surveillance of spotted fever group rickettsioses in the United States, 2008–2012. Am J Trop Med Hyg 2016;23–34. 14. ^1 2 Nichols KH, Dahlgren FS, Drexler NA, Massung RF, Behravesh CB. Increasing incidence of ehrlichiosis in the United States: a summary of national surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii infections in the United States, 2008–2012. Am J Trop Med Hyg 2016;94:52–60. External links{{Medical resources| DiseasesDB = | ICD10 = | ICD9 = {{ICD9|082.4}} | ICDO = | OMIM = | MedlinePlus = 001381 | eMedicineSubj = article | eMedicineTopic = 235839 | MeshID = D016873 }}{{Tick-borne diseases}}{{Gram-negative bacterial diseases}} 2 : Bacterium-related cutaneous conditions|Tick-borne diseases |
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