Human monocytic ehrlichiosis: An emerging pathogen in transplantation

Background. The spectrum of disease caused by Ehrlichia spp. ranges from as ymptomatic to fatal. Awareness and early diagnosis of the infection is para mount because appropriate therapy leads to rapid defervescence and cure. If left untreated, particularly in immunosuppressed patients, ehrlichioses ma y result in multi-system organ failure and death. Methods. We report the second case of human monocytic ehrlichiosis (HME) in a liver transplant recipient, and review the literature. Results. The patient presented with fever and headache, had negative cultur es, and despite broad-spectrum antimicrobial coverage appeared progressivel y septic. After eliciting a history of tick exposure we treated the patient empirically with doxycycline, The diagnosis of HME was confirmed by 1) pol ymerase chain reaction (PCR) for Ehrlichia chaffeensis 2) acute and convale scent serum titers, and 3) in vitro cultivation of E chaffeensis from perip heral blood. Conclusion, Although human ehrlichioses are relatively uncommon, they are e merging as clinically significant arthropod-borne infections. Although epid emiological exposure is responsible for infection, immunosuppression makes patients more likely to succumb to disease. A high index of suspicion and e arly treatment results in a favorable outcome.