Severe ehrlichia infection in pediatric oncology and stem cell transplant patien

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Pediatr Blood Cancer. 2010 Jan 5; [Epub ahead of print]

 

Severe ehrlichia infection in pediatric oncology and stem cell transplant

patients.

 

Esbenshade A, Esbenshade J, Domm J, Williams J, Frangoul H.

 

Division of Pediatric Hematology/Oncology, Department of Pediatrics,

Vanderbilt

University School of Medicine and the Monroe Carell Jr. Children's

Hospital at

Vanderbilt, Nashville, Tennessee.

 

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. Pediatr Blood Cancer. © 2010 Wiley-Liss, Inc.

 

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PMID: 20052776 [PubMed - as supplied by publisher]