PURPOSE: Human monocytic ehrlichiosis is a disease caused by an obligate intracellular bacteria occurring in both immunocompromised and immuncompetent patients. The spectrum of disease can range from asymptomatic infection to fatal, fulminant sepsis.
METHODS: A retrospective review was performed on solid-organ transplant recipients with a known diagnosis of ehrlichiosis. Clinical data including baseline demographics, hospital length of stay, ICU length of stay, respiratory failure and other clinical outcomes was collected. This data was then compared to evaluate differences in clinical manifestations between the different solid-organ transplant groups.
RESULTS: Between 2000 and 2007, 17 solid-organ transplant recipients were identified as having ehrlichiosis by whole blood polymerase chain reaction. These transplant recipients included 5 lung recipients, 9 kidney recipients, 2 heart recipients and 1 liver recipient. There were no significant differences in patient demographic information between the groups of solid organ transplant. Eighty percent of lung transplant recipients and only eight percent of other solid-organ recipients were admitted to the intensive care unit (p=0.28). Lung transplant recipients had more episodes of acute lung injury and acute respiratory distress syndrome than other solid-organ transplant recipients (3 versus 0, p=0.015). The incidence of acute renal failure was the same between lung transplant recipients and other solid-organ recipients, however there was a greater number of lung-transplant recipients requiring renal-replacement therapy (p=0.024). Lung transplant recipients also had longer hospital length of stay compared to other solid-organ recipients (p=0.038). No patient died in any group.
CONCLUSION: Human monocytic ehrlichiosis results in significant morbidity. Lung transplant recipients are more likely to develop acute lung injury, renal failure requiring renal replacement therapy and have overall hospital length of stay compared to other solid-organ transplant recipients.
CLINICAL IMPLICATIONS: A high index of suspicion for human monocytic ehrlichiosis is indicated for patients who reside or travel in endemic areas. Initial appropriate antibiotic therapy and other aggressive measures should be initiated early in the course of the infection, as this may improve the outcomes in solid-organ transplant recipients.
DISCLOSURE: Matthew Morrell, None.