0
July 1988, Vol 124, No. 7 >
Article | July 1988

From the MMWR: Title and subTitle BreakMorbidity and Mortality Report Centers for Disease Control, Atlanta

Arch Dermatol. 1988;124(7):993-994. doi:10.1001/archderm.1988.01670070007001
Text Size: A A A
Published online
Article
References
Comments

HUMAN INFECTION with Ehrlichia canis or another closely related rickettsia was described in the United States for the first time in 1986.1 In April of that year, a 51-year-old man developed fever, malaise, myalgia, and headache approximately 12 days after being bitten by ticks while he was planting trees in rural Arkansas. He was hospitalized 5 days after becoming ill.

Upon admission to the hospital, the patient had an oral temperature of 39.7°C (103.5°F), leukopenia, thrombocytopenia, renal failure, and elevated liver enzymes, but no rash. A presumptive diagnosis of "spotless" Rocky Mountain spotted fever (RMSF) was made, and the patient was treated with chloramphenicol and, later, with doxycycline. Cytoplasmic inclusions were observed in peripheral lymphocytes, neutrophils, and monocytes on the seventh day of illness. His illness was complicated by disseminated candidiasis, but he was discharged after 12 weeks of hospitalization without residual problems. Serum samples obtained during the late

REFERENCES

1 +
Maeda K, Markowitz N, Hawley RC, Ristic M, Cox D, McDade JE.  Human infection with Ehrlichia canis, a leukocytic rickettsia . N Engl J Med 1987;;316:853-6.
2 +
Fishbein DB, Sawyer LA, Holland CJ, et al.  Unexplained febrile illnesses after exposure to ticks: infection with an Ehrlichia? JAMA 1987;; 257:3100-4.
3 +
Fishbein DB, Taylor JP, Dawson J, et al.  Human ehrlichiosis in the United States  (Abstract no. 1277). In: Program and abstracts of the Twenty-Seventh Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1987;:319.
4 +
Rohrbach BW, Harkess JR, Ewing SA, Kudlac JF, McKee GL, Istre GR.  Human ehrlichiosis , Oklahoma (Abstract no. 1278). In: Program and abstracts of the Twenty-Seventh Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1987;:319.
5 +
Taylor JP, Betz TG, Fishbein DB, Roberts MA, Dawson J, Ristic M.  Serologic evidence of possible human infection with Ehrlichia in Texas . J Infect Dis (in press).
6 +
Helmick CG, Bernard KW, D'Angelo LJ.  Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases . J Infect Dis 1984;;150:480-8.
7 +
Ristic M.  Pertinent characteristics of leukocytic rickettsiae of humans and animals . In: Leive L, ed. Microbiology—1986 . Washington, DC: American Society for Microbiology, 1986;: 182-7.
8 +
Kuehn NF, Gaunt SD.  Clinical and hematologic findings in canine ehrlichiosis . J Am Vet Med Assoc 1985;;186:355-8.
9 +
Keefe TJ, Holland CJ, Salyer PE, Ristic M.  Distribution of Ehrlichia canis among military working dogs in the world and selected civilian dogs in the United States . J Am Vet Med Assoc 1982;;181:236-8.
10 +
Nelson VA.  Human parasitism by the brown dog tick . J Econ Entomol 1969;;62:710-2.
11 +
Tachibana N.  Sennetsu fever: the disease, diagnosis, and treatment . In: Leive L, ed. Microbiology—1986 . Washington, DC: American Society for Microbiology, 1986;:205-8.
12 +
Ristic M, Huxsoll DL, Weisiger RM, et al.  Serological diagnosis of tropical canine pancytopenia by indirect immunofluoresence . Infect Immun 1972;;6:226-31.
13 +
Amyx HL, Huxsoll DL, Zeiler DC, Hildebrandt PK.  Therapeutic and prophylactic value of tetracycline in dogs infected with the agent of tropical canine pancytopenia . J Am Vet Med Assoc 1971;;159:1428-32.
14 +
Alabama, Arkansas, Georgia, Missouri, New Jersey, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia. The state of residence was used for two persons with no history of tick exposure.
15 +
Kaufman L, Reiss E.  Serodiagnosis of fungal diseases . In: Lennette EH, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of clinical microbiology . 4th ed. Washington, DC: American Society for Microbiology, 1985;:924-44.
16 +
Wheat LJ, Kohler RB, Tewari RP.  Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens . N Engl J Med 1986;;314:83-8.
17 +
Larsh HW.  The epidemiology of histoplasmosis . In: Al-Doory Y, ed. The epidemiology of human mycotic diseases . Springfield, Illinois: 1975;:52-73.
18 +
Sacks JJ, Ajello L, Crockett LK.  An outbreak and review of cave-associated histoplasmosis capsulati . J Med Vet Mycol 1986;;24:313-25.
19 +
DiSalvo AF, Bigler WJ, Ajello L, Johnson JE, Palmer J.  Bat and soil studies for sources of histoplasmosis in Florida . Public Health Rep 1970;;85:1063-9.
20 +
Emmons CW, Klite PD, Baer GM, Hill WB Jr.  Isolation of Histoplasma capsulatum from bats in the United States . Am J Epidemiol 1986;;84:103-9.
21 +
Centers for Disease Control. Histoplasmosis control: decontamination of bird roosts, chicken houses, and other point sources . Atlanta: US Department of Health, Education, and Welfare, Public Health Service, 1979;; HEW publication no. (CDC)80-8380.
22 +
DiSalvo AF, Johnson WM.  Histoplasmosis in South Carolina: support for the microfocus concept . Am J Epidemiol 1979;;109:480-92.
23 +
A tour member who experienced any two of the following symptoms within 30 days after returning to the United States was considered to have histoplasmosis: fever, headache, cough, dyspnea, or chest pain.//9I

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Maeda K, Markowitz N, Hawley RC, Ristic M, Cox D, McDade JE.  Human infection with Ehrlichia canis, a leukocytic rickettsia . N Engl J Med 1987;;316:853-6.
2 +
Fishbein DB, Sawyer LA, Holland CJ, et al.  Unexplained febrile illnesses after exposure to ticks: infection with an Ehrlichia? JAMA 1987;; 257:3100-4.
3 +
Fishbein DB, Taylor JP, Dawson J, et al.  Human ehrlichiosis in the United States  (Abstract no. 1277). In: Program and abstracts of the Twenty-Seventh Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1987;:319.
4 +
Rohrbach BW, Harkess JR, Ewing SA, Kudlac JF, McKee GL, Istre GR.  Human ehrlichiosis , Oklahoma (Abstract no. 1278). In: Program and abstracts of the Twenty-Seventh Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC: American Society for Microbiology, 1987;:319.
5 +
Taylor JP, Betz TG, Fishbein DB, Roberts MA, Dawson J, Ristic M.  Serologic evidence of possible human infection with Ehrlichia in Texas . J Infect Dis (in press).
6 +
Helmick CG, Bernard KW, D'Angelo LJ.  Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases . J Infect Dis 1984;;150:480-8.
7 +
Ristic M.  Pertinent characteristics of leukocytic rickettsiae of humans and animals . In: Leive L, ed. Microbiology—1986 . Washington, DC: American Society for Microbiology, 1986;: 182-7.
8 +
Kuehn NF, Gaunt SD.  Clinical and hematologic findings in canine ehrlichiosis . J Am Vet Med Assoc 1985;;186:355-8.
9 +
Keefe TJ, Holland CJ, Salyer PE, Ristic M.  Distribution of Ehrlichia canis among military working dogs in the world and selected civilian dogs in the United States . J Am Vet Med Assoc 1982;;181:236-8.
10 +
Nelson VA.  Human parasitism by the brown dog tick . J Econ Entomol 1969;;62:710-2.
11 +
Tachibana N.  Sennetsu fever: the disease, diagnosis, and treatment . In: Leive L, ed. Microbiology—1986 . Washington, DC: American Society for Microbiology, 1986;:205-8.
12 +
Ristic M, Huxsoll DL, Weisiger RM, et al.  Serological diagnosis of tropical canine pancytopenia by indirect immunofluoresence . Infect Immun 1972;;6:226-31.
13 +
Amyx HL, Huxsoll DL, Zeiler DC, Hildebrandt PK.  Therapeutic and prophylactic value of tetracycline in dogs infected with the agent of tropical canine pancytopenia . J Am Vet Med Assoc 1971;;159:1428-32.
14 +
Alabama, Arkansas, Georgia, Missouri, New Jersey, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia. The state of residence was used for two persons with no history of tick exposure.
15 +
Kaufman L, Reiss E.  Serodiagnosis of fungal diseases . In: Lennette EH, Balows A, Hausler WJ Jr, Shadomy HJ, eds. Manual of clinical microbiology . 4th ed. Washington, DC: American Society for Microbiology, 1985;:924-44.
16 +
Wheat LJ, Kohler RB, Tewari RP.  Diagnosis of disseminated histoplasmosis by detection of Histoplasma capsulatum antigen in serum and urine specimens . N Engl J Med 1986;;314:83-8.
17 +
Larsh HW.  The epidemiology of histoplasmosis . In: Al-Doory Y, ed. The epidemiology of human mycotic diseases . Springfield, Illinois: 1975;:52-73.
18 +
Sacks JJ, Ajello L, Crockett LK.  An outbreak and review of cave-associated histoplasmosis capsulati . J Med Vet Mycol 1986;;24:313-25.
19 +
DiSalvo AF, Bigler WJ, Ajello L, Johnson JE, Palmer J.  Bat and soil studies for sources of histoplasmosis in Florida . Public Health Rep 1970;;85:1063-9.
20 +
Emmons CW, Klite PD, Baer GM, Hill WB Jr.  Isolation of Histoplasma capsulatum from bats in the United States . Am J Epidemiol 1986;;84:103-9.
21 +
Centers for Disease Control. Histoplasmosis control: decontamination of bird roosts, chicken houses, and other point sources . Atlanta: US Department of Health, Education, and Welfare, Public Health Service, 1979;; HEW publication no. (CDC)80-8380.
22 +
DiSalvo AF, Johnson WM.  Histoplasmosis in South Carolina: support for the microfocus concept . Am J Epidemiol 1979;;109:480-92.
23 +
A tour member who experienced any two of the following symptoms within 30 days after returning to the United States was considered to have histoplasmosis: fever, headache, cough, dyspnea, or chest pain.//9I

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems