EHRLICHIOSIS: HME and HGE

History of Ehrlichiosis
(Source: University Of North Carolina At Chapel Hill)
Ehrlichiosis was first described in Algerian dogs in 1935, and Japanese scientists found that a bacterium caused a human form of the illness in 1956. Thirty years later, U.S. investigators discovered the first case of a different variety, human monocytic ehrlichiosis, at Fort Chafee, Ark. That infection chiefly occurs in the central and southeastern United States, while still another form, human granulocytic ehrlichiosis, chiefly is found in north central states.

Dog, deer and Lone Star ticks can carry ehrlichiosis bacteria, which infect and kill white blood cells...Keeping leaves raked and bushes trimmed around homes can minimize shelter for mice and other small mammals to help keep down the tick population.

What is ehrlichiosis? Ehrlichiosis is a newly recognized and potentially life-threatening disease that is spread by ticks. Since 1986, two types of human ehrlichiosis have been identified in the United States: human monocytic ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE). The illnesses differ in the types of white blood cells they attack-either monocytes or granulocytes.

What is the infectious agent that causes ehrlichiosis?
Ehrlichiosis is caused by specialized bacteria called rickettsiae. HME is caused by Ehrlichia chaffeensis. HGE is caused by a newly identified but as yet unnamed Ehrlichia.

Where is ehrlichiosis found?
In the United States, HME has so far been concentrated in the southeast and south-central regions. HGE has been found mainly in the upper midwestern and northeastern states, but also in northern California.

Symptoms of Ehrlichiosis (Source: Gastrointestinal and hepatic manifestations of human ehrlichiosis: 8 cases and a review of the literature. Dig Dis 1999;17(1):37-43 , Nutt AK, Raufman J)
Ehrlichiosis has emerged as an increasingly recognized tick-borne rickettsial disease. It can affect multiple organs including the gastrointestinal tract and liver. Signs and symptoms include abdominal pain, nausea, vomiting, diarrhea, jaundice, and hepatosplenomegaly. Patients commonly have elevated liver transaminases early in the course of illness as well as leukopenia and thrombocytopenia. If not diagnosed and treated in a timely fashion, ehrlichiosis can progress to multiorgan failure.
.....All 8 patients were treated with and responded to doxycycline. One developed multiorgan failure but eventually recovered with intensive medical care and doxycycline.

CONCLUSION: To avoid treatment delay and serious complications, in the appropriate clinical setting ehrlichiosis should be considered as a cause of elevated liver transaminases.

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