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

Esbenshade A, Esbenshade J, Domm J, Williams J, Frangoul H
Pediatr Blood Cancer. 2010 54 (5): 776-8

PMID: 20052776 · DOI:10.1002/pbc.22392

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.

MeSH Terms (15)

Adolescent Child Delayed Diagnosis Ehrlichiosis Endemic Diseases Fatal Outcome Female Hodgkin Disease Humans Immunocompromised Host Leukemia, Myelogenous, Chronic, BCR-ABL Positive Male Neoplasms Precursor Cell Lymphoblastic Leukemia-Lymphoma Stem Cell Transplantation

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