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Severe ehrlichia infection in pediatric oncology and stem cell transplant patients.

Abstract
Ehrlichiosis, a tickborne illness transmitted by tick vectors Amblyomma americanum and Ixodes scapularis, can be acquired in endemic areas. Clinical manifestations range from asymptomatic to fulminant in nature. We report three cases of ehrlichiosis in pediatric oncology patients, one of whom was a stem cell transplant recipient. Early symptoms included fever, malaise, and vague gastrointestinal symptoms. Laboratory abnormalities were initially attributed to chemotherapy toxicity. Illness was severe in all three patients and one patient died even after initiation of doxycycline. These cases emphasize the need for a high index of suspicion for tickborne illness in oncology patients, and the importance of a low threshold for starting empiric treatment before confirming the diagnosis.
AuthorsAdam Esbenshade, Jennifer Esbenshade, Jennifer Domm, John Williams, Haydar Frangoul
JournalPediatric blood & cancer (Pediatr Blood Cancer) Vol. 54 Issue 5 Pg. 776-8 (May 2010) ISSN: 1545-5017 [Electronic] United States
PMID20052776 (Publication Type: Case Reports, Journal Article)
Topics
  • Adolescent
  • Child
  • Delayed Diagnosis
  • Ehrlichiosis (diagnosis, drug therapy, epidemiology)
  • Endemic Diseases
  • Fatal Outcome
  • Female
  • Hodgkin Disease (complications, therapy)
  • Humans
  • Immunocompromised Host
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive (complications, therapy)
  • Male
  • Neoplasms (complications, therapy)
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma (complications, therapy)
  • Stem Cell Transplantation (adverse effects)

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