Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in Persons Coinfected with Human Immunodeficiency Virus

Authors

ChristopheR D. Paddock, Centers for Disease Control and Prevention
Scott M. Folk, Adult Infectious Diseases,Tallahassee Community Hospit
G. Merrill Shore, St. Vincent's Medical Center, Jacksonvill
Linda J. Machado, University of Oklahoma Health Sciences Center
Mark M. Huycke, University of Oklahoma Health Sciences Center
Leonard N. Slater, University of Oklahoma Health Sciences Center
Allison M. Liddell, Washington University School of Medicine
Richard S. Buller, Washington University School of Medicine
Gregory A. Storch, Washington University School of Medicine
Thomas P. Monson, University of Arkansas for Medical Sciences
David Rimland, Department of Medicine Veterans Affairs Medical Center Atlanta
John W. Sumner, Centers for Disease Control and Prevention
Joseph Singleton, Centers for Disease Control and Prevention
Karen C. Bloch, Vanderbilt University Medical Center
Yi-Wei Tang, Vanderbilt University Medical Center
Steven M. Standaert, Vanderbilt University Medical Center
James E. Childs, Centers for Disease Control and PreventionFollow

Date of this Version

2001

Comments

Published in Clinical Infectious Diseases 2001;33:1586-94

Abstract

The clinical course and laboratory valuation of 21 patients coinfected with human immunodeficiency virus (HIV) and Ehrlichia chaffeensis or Ehrlichia ewingii are reviewed and summarized, including 13 cases of ehrlichiosis caused by E. chaffeensis, 4 caused by E. ewingii, and 4 caused by either E. chaffeensis or E. ewingii. Twenty patients were male, and the median CD4⁺ T lymphocyte count was 137 cells/μL. Exposures to infecting ticks were linked to recreational pursuits, occupations, and peridomestic activities. For 8 patients, a diagnosis of ehrlichiosis was not considered until ≥4 days after presentation. Severe manifestations occurred more frequently among patients infected with E. chaffeensis than they did among patients infected with E. ewingii, and all 6 deaths were caused by E. chaffeensis. Ehrlichiosis may be a life-threatening illness in HIV-infected persons, and the influence of multiple factors, including recent changes in the epidemiology and medical management of HIV infection, may increase the frequency with which ehrlichioses occur in this patient cohort.