Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients

In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffee...

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Autores principales:	Melissa Parkinson, Spandana Vuyyuru, Jay Patel, Chinelo Animalu
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Surgery RD1-811
Acceso en línea:	https://doaj.org/article/e094038afd454fb48a50081eb2072f93
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spelling	oai:doaj.org-article:e094038afd454fb48a50081eb2072f932021-11-29T00:57:04ZChallenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients2090-695110.1155/2021/8285326https://doaj.org/article/e094038afd454fb48a50081eb2072f932021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/8285326https://doaj.org/toc/2090-6951In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.Melissa ParkinsonSpandana VuyyuruJay PatelChinelo AnimaluHindawi LimitedarticleSurgeryRD1-811ENCase Reports in Transplantation, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Surgery RD1-811
spellingShingle	Surgery RD1-811 Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
description	In recent solid organ transplant recipients, acute febrile illness is usually a source of grave concern and a diagnostic dilemma, especially if no response is noted after initiation of broad antimicrobial therapy. Human Monocytic Ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis and is not considered an opportunistic infection in immunocompromised patients such as solid organ transplant patients. Ehrlichiosis in immunocompromised patients can be life-threatening, and a strong index of suspicion is needed, especially in patients who live in endemic areas, for proper treatment initiation with doxycycline. We report a case of a 40-year-old male who received an orthotopic liver transplant six months earlier secondary to primary sclerosing cholangitis, on chronic immunosuppressive medication, who presented with complaints of sudden onset fever associated with nausea, vomiting, and diarrhea. Initial extensive infectious workup was negative and no response to empiric antimicrobials. There was suspicion for ehrlichiosis prompting empiric doxycycline use. Subsequently, E. chaffeensis polymerase chain reaction (PCR) was positive, and the antibiotic regimen was de-escalated to only doxycycline with complete resolution of his symptoms and progressive improvement in previously abnormal biochemical indices.
format	article
author	Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu
author_facet	Melissa Parkinson Spandana Vuyyuru Jay Patel Chinelo Animalu
author_sort	Melissa Parkinson
title	Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
title_short	Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
title_full	Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
title_fullStr	Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
title_full_unstemmed	Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients
title_sort	challenges of diagnosing severe ehrlichiosis in orthotopic liver transplant recipients
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/e094038afd454fb48a50081eb2072f93
work_keys_str_mv	AT melissaparkinson challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT spandanavuyyuru challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT jaypatel challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients AT chineloanimalu challengesofdiagnosingsevereehrlichiosisinorthotopiclivertransplantrecipients
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Challenges of Diagnosing Severe Ehrlichiosis in Orthotopic Liver Transplant Recipients

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