What Are the Symptoms of Rocky Mountain Spotted Fever?

Human ehrlichiosis, also known as spotless rocky mountain spotted fever, is caused by tick-borne Ehrlichia. All had sudden onset, chills, high fever, often accompanied by slow pulse (<90 beats / min), headache, muscle pain, nausea, vomiting, fatigue, and discomfort. Examination showed leukopenia, thrombocytopenia, liver cell damage and abnormal liver function.

Elischiasis

Right!

Human ehrlichiosis, also known as spotless rocky mountain spotted fever, is caused by tick-borne Ehrlichia. All had sudden onset, chills, high fever, often accompanied by slow pulse (<90 beats / min), headache, muscle pain, nausea, vomiting, fatigue, and discomfort. Examination showed leukopenia, thrombocytopenia, liver cell damage and abnormal liver function.

nickname

Spotless rocky mountain spotted fever

TCM disease name

Human elischiasis

English name

human ehrlichiosis

Visiting department

Infectious Diseases

Common symptoms

Chills, high fever, often with slow pulses (<90 beats / min), headache, muscle pain, nausea, vomiting, fatigue, discomfort

Contagious

infection

way for spreading

tick

Human ehrlichiosis, also called spotless rocky mountain spotted fever, is caused by tick-borne Ehrlichia, and was found in Arkansas in the United States in 1986. Ehrlichiasennetsu pathogen was isolated from a patient with mononucleosis in 1954 in Japan, but it has not been confirmed outside the Far East. Pathogens invade monocytes or neutrophils, forming mulberry-like inclusions in the cytoplasm. Sudden onset of symptoms, the symptoms are exactly like Rocky Mountain spotted fever, rare rash. The incubation period is about 12 to 14 days, and the clinical manifestations of patients are almost indistinguishable from Rocky Mountain spot fever. All had sudden onset, chills, high fever, often accompanied by slow pulse (<90 beats / min), headache, muscle pain, nausea, vomiting, fatigue, and discomfort. Examination showed leukopenia, thrombocytopenia, liver cell damage and abnormal liver function. If severe complications can cause death. Because its epidemiology and clinical manifestations are similar to rickettsial disease, some people classify it as speckle fever. Most patients have a good prognosis, and a few have complications and have a poor prognosis. Prevention is mainly to prevent ticks.

Elischiasis

ehrlichiosis

Ehrlich disease; Ehrlich disease; Ehrlich disease

Infectious Diseases> Rickettsia Infection

A79.8

Human ehrlichiosis is also called spotless rocky mountain spotted fever. The pathogen is E. chaffeensis. It was discovered in Arkansas in 1986. In 1954, Ehrlichia sennetsu pathogen was isolated from a patient with mononucleosis-like disease in Japan, but it has not been confirmed outside the Far East. It is currently only found in the United States and has a cross-reactivity with the serology of animal E. canis strains.

There are currently more than 10 species of Ehrlichia. E. canis, E. phagocytophilia, E. Sennetsu and E. risticii. Especially E. Canis can cause severe pancytopenia in dogs. In 1986, a patient with Escherichiasis was found in the United States. Morus-like inclusion bodies were found in the monocyte cytoplasm. The patient's serum had an agglutination reaction with canine E. coli and the titer gradually increased. Smear staining of peripheral blood mononuclear cells can identify this pathogen. It is located in the cytoplasm but close to the cell membrane, with a diameter of about 0.2 to 1.5 m, and clusters into clusters, like mulberries. It has also been isolated in D. variabilis, a tick that is also a vehicle for transmitting Los Angeles spot fever.

In 1949, a kind of Ehrlich disease was also found in the United States. Its inclusion bodies were in granulocytes (while E. chaffeensis inclusion bodies were in monocytes), so it was named human granulocytic disease. ehrlichiosis, HGE). So there are at least two types of Ehrlich that cause disease.

Tick-borne ellipsoids enter the body through the bite of ticks and enter the relevant organs through microvessels or lymphatics. After immunohistochemical analysis, it was found that there are mainly organs and tissues of the mononuclear-macrophage system such as spleen, liver, bone marrow and lymph nodes in Chafia. E. chaffei mainly invades monocyte macrophages with occasional lymphocytes, but does not invade multinuclear leukocytes. The pathogen grows and reproduces in monocyte macrophages, directly causing host cell damage, or inducing the body's immune system to respond, causing immune cells to release various cytokines and other inflammatory mediators, leading to tissue damage, focal necrosis, and granuloma formation Wait. In the bone marrow, bone marrow granuloma formation, bone marrow hyperplasia, and megakaryocyte hyperplasia can be seen; in the liver, annular granulomas and focal liver necrosis are formed; in the lungs, extensive alveolar damage, interstitial pneumonia, and pulmonary hemorrhage are seen. Lymphocyte infiltration can be seen around the blood vessels of the kidneys, spleen, heart, liver, brain, meninges, lungs and other organs, but the peripheral blood lymphocytes are reduced.

The phagocytosis Eric group (including human plasmoblasts) mainly invades bone marrow precursor cells, grows and reproduces in mature neutrophils, and makes neutrophil adhesion, migration, phagocytosis and The bactericidal ability is reduced, and it affects lymphocytes, which reduces mitosis and proliferation of lymphocytes, and reduces antibody production. It makes patients vulnerable to opportunistic bacterial, viral or fungal infections. Due to the relative increase of monocytes and macrophages, the destruction of peripheral blood cells in the spleen, liver, and lymph nodes will also increase, resulting in a decrease in peripheral blood leukocytes and platelets in patients.

Infectious mononuclear cells, Ericia mainly invades monocytes and macrophages. It has the main pathological characteristics of infectious mononucleosis such as enlarged lymph nodes and increased normal and atypical lymphocytes. Animal infections have obvious spleen Swelling.

The incubation period of Ehrlich's disease is about 12 to 14 days. The clinical manifestations of patients are almost indistinguishable from Rocky Mountain spot fever. All had sudden onset, chills, high fever, often accompanied by slow pulse (<90 beats / min), headache, muscle pain, nausea, vomiting, fatigue, and discomfort. There were no obvious signs on physical examination. Rash occurs in about 20% of patients infected with Escherichia chafe, but HGE-infected patients do not have a rash. The rash comes in many forms, with maculopapular or pimples, or maculopapular, hemorrhoidal, or erythema. Common on chest, legs and arms. The rash appears about 5 days after the onset. The average course of natural disease was 7 days (3-19 days).

Elderly patients are prone to severe illness. Severe patients may develop renal failure, meningitis, coma, DIC, and even whole blood cells decrease and bone marrow hematopoietic cell regeneration disorder, separation and destruction of blood components (ie hemophagocytic syndrome). Delays in treatment can cause death.

Severe cases due to thrombocytopenia and DIC lead to pulmonary and gastrointestinal bleeding, acute renal failure and respiratory failure.

Leukopenia decreased (<4 × 109 / L), and the absolute number of lymphocytes decreased (<1.5 × 109 / L, with a median of 0.41 × 109 / L). Thrombocytopenia, (49-75) × 109 / L. Hepatic dysfunction, ALT and AST rose to the peak at the first weekend of the disease, 90 583U / L. Morus-like inclusion bodies are seen in lymphocytes and monocytes or neutrophils.

According to the patient's past to the epidemic area of the disease, epidemiological data of tick bite history or entry to multi-tick areas, accompanied by the above clinical manifestations and laboratory examination abnormal data, the diagnosis of leukocyte smear staining can be diagnosed if mulberry-shaped inclusions are seen . Immunofluorescence and PCR tests for E. coli antibodies or DNA can confirm the diagnosis.

In addition to being easily confused with Rocky Mountain spotted fever clinically, it should be distinguished from Colorado tick fever (CTF) and Lyme disease. CTF is transmitted by the tick virus, Coltivirus, and is endemic in the western United States. Sudden onset of illness, chills and fever, relatively slow pulse, nausea, but no vomiting, white blood cells decreased. About half of the patients' body temperature dropped 2 to 3 days after the onset of symptoms, and most of the symptoms disappeared. After 1 to 2 days, fever begins again, the temperature is higher, and the symptoms are more severe. The hot type is saddle-shaped and is called "saddle fever", similar to dengue fever. Due to the typical thermal pattern, it is not difficult to identify clinically. Lyme disease is also tick-borne and is a Borrelia burgdorferi infection. Clinically, there are typical transitional erythema, white blood cells are not reduced, and platelets are not reduced, which can be identified.

Early application of tetracycline antibiotics can reduce fever after 1 to 2 days, and the prognosis is good. Doxycycline 100mg once every 12 hours, a total of two times, then 100mg, once per day, at least 3 consecutive days after heat regression. It can also be tetracycline 500mg, once / d; or chloramphenicol 500mg, once / d. Heparin is not required, as symptoms such as pancytopenia can quickly disappear after antibiotics control the symptoms.

Most patients with Escherichiasis have a good prognosis, and a few have complications and have a poor prognosis.

The prevention of Ehrlichosis is mainly to prevent ticks.

Tetracycline, doxycycline, chloramphenicol, heparin