VA Report: What are the most common clinical characteristics of Human Monocytic Erlichiosis?

Human monocytic ehrlichiosis commonly presents as a self-limited sickness with symptoms that most often include fever, headache, myalgias, nausea, arthralgias, and malaise. In rare cases, it manifests as a life-threatening illness with features of toxic shock-like syndrome and end-organ damage; this mostly occurs in the immunocompromised, geriatric, or pediatric populations. The most important determinant in the diagnosis of human monocytic ehrlichiosis is clinical suspicion. In addition to symptoms, pancytopenia is an important hematologic abnormality that is frequently associated with human monocytic ehrlichiosis. Thrombocytopenia is detected in 70-90% of patients over the course of the illness, leukopenia is observed within the first week in 60-70%, and anemia is noted within the first 2 weeks of presentation in 50% of patients. Elevated hepatic transaminases are present in almost 90% of patients

Hilal, T., & Snapp, W. (n.d.). The perils of country life: Human monocytic ehrlichiosis. The American Journal of Medicine, 128(8), 831-833.

The current recommended regimen for the treatment of human monocytic ehrlichiosis is doxycycline, 100 mg, twice daily for 5-14 days. Patients with a delay in treatment have a significantly increased rate of transfer to the intensive care unit, increased risk for mechanical ventilation, longer hospital stay, and longer duration of illness. Encephalopathy, acute renal failure, pulmonary infiltrates, and death have been reported in patients with severe human monocytic ehrlichiosis.

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