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

• Published in: Clinical infectious diseases Vol. 33; no. 9; pp. 1586 - 1594
• Main Authors: Paddock, Christopher D., Folk, Scott M., Shore, G. Merrill, Machado, Linda J., Huycke, Mark M., Slater, Leonard N., Liddell, Allison M., Buller, Richard S., Storch, Gregory A., Monson, Thomas P., Rimland, David, Sumner, John W., Singleton, Joseph, Bloch, Karen C., Tang, Yi-Wei, Standaert, Steven M., Childs, James E.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University Chicago Press 01.11.2001; University of Chicago Press
• Subjects: Adult; AIDS; Biological and medical sciences; Blood; Diseases; Ehrlichia; Ehrlichia - immunology; Ehrlichia - isolation & purification; Ehrlichia chaffeensis; Ehrlichia chaffeensis - immunology; Ehrlichia chaffeensis - isolation & purification; Ehrlichiosis; Ehrlichiosis - complications; Ehrlichiosis - epidemiology; Ehrlichiosis - immunology; Ehrlichiosis - physiopathology; Epidemiology; Female; HIV; HIV Infections - complications; HIV Infections - epidemiology; HIV Infections - immunology; HIV Infections - physiopathology; HIV-1 - immunology; HIV-1 - physiology; HIV/AIDS; Human viral diseases; Humans; Infections; Infectious diseases; Male; Medical sciences; Middle Aged; United States - epidemiology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; North America; Oklahoma; Tennessee; America; Ehrlichiaceae; Human; Immunopathology; Mixed infection; Rickettsialosis; Ehrlichia chaffeensis; Retroviridae; AIDS; Ehrlichieae; Immune deficiency; Lentivirus; Epidemiology; Infection; Rickettsiales; Virus; Symptomatology; Viral disease; Bacteriosis; Bacteria; Human immunodeficiency virus; Ehrlichia infection
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/323981

The clinical course and laboratory evaluation 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.