Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffee...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-01-01
|
| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2021/8285326 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832556711913717760 |
|---|---|
| author | Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu |
| author_facet | Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu |
| author_sort | Melissa Parkinson |
| collection | DOAJ |
| description | In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices. |
| format | Article |
| id | doaj-art-e094038afd454fb48a50081eb2072f93 |
| institution | Kabale University |
| issn | 2090-6951 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-e094038afd454fb48a50081eb2072f932025-02-03T05:44:38ZengWileyCase Reports in Transplantation2090-69512021-01-01202110.1155/2021/8285326Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant RecipientsMelissa Parkinson0Spandana Vuyyuru1Jay Patel2Chinelo Animalu3Internal Medicine and Pediatrics Residency ProgramCollege of MedicineCollege of MedicineDivision of Infectious DiseasesIn recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.http://dx.doi.org/10.1155/2021/8285326 |
| spellingShingle | Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients Case Reports in Transplantation |
| title | Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients |
| title_full | Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients |
| title_fullStr | Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients |
| title_full_unstemmed | Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients |
| title_short | Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients |
| title_sort | challenges of diagnosing severe ehrlichiosis in orthotopic liver transplant recipients |
| url | http://dx.doi.org/10.1155/2021/8285326 |
| work_keys_str_mv | AT melissaparkinson challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT spandanavuyyuru challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT jaypatel challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT chineloanimalu challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients |