Journal Article

Clinical and Laboratory Spectrum of Culture-Proven Human Granulocytic Ehrlichiosis: Comparison with Culture-Negative Cases

Harold W. Horowitz, Maria E. Aguero-Rosenfeld, Donna F. McKenna, Diane Holmgren, Tze-Chen Hsieh, Shobha A. Varde, Stephen J. Dumler, Joseph M. Wu, Ira Schwartz, Yasuko Rikihisa and Gary P. Wormser

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 5, pages 1314-1317
Published in print November 1998 | ISSN: 1058-4838
Published online November 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/515000
Clinical and Laboratory Spectrum of Culture-Proven Human Granulocytic Ehrlichiosis: Comparison with Culture-Negative Cases

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We describe the clinical and laboratory manifestations of human granulocytic ehrlichiosis (HGE) in eight patients for whom cultures were positive for the HGE agent and compare them with 15 patients for whom cultures were negative but who fulfilled a modified New York State surveillance definition for HGE. Polymerase chain reaction analysis was positive in 8 (100%) of 8 culture-positive cases vs. 3 (20%) of 15 culture-negative cases (P < .001), morulae were detected in 7 (100%) of 7 culture-positive cases in which tests were performed vs. 0 of 15 culture-negative cases (P < .001), and a fourfold change in antibody titer was demonstrated in 6 (75%) of 8 culture-positive cases vs. 9 (69%) of 13 culture-negative cases (P = not significant). Patients for whom cultures were positive had higher mean oral temperatures ±SD at presentation than did patients for whom cultures were negative (38.6°C ± 0.7°C vs. 37.2°C ± 0.8°C, respectively; P = .002). Other symptoms and signs were not significantly different between the two groups. Multivariate analysis revealed that the lymphocyte count at presentation was significantly lower in culture-positive cases than in culturenegative cases. Clinical response to treatment was similar in the two groups. Culture confirmation of HGE is the gold standard for defining the sensitivity and specificity of other diagnostic tests presently being developed.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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