Pediatr Blood Cancer. 2010 Jan 5; [Epub ahead of print]

Severe ehrlichia infection in pediatric oncology and stem cell transplant patients.

Esbenshade A, Esbenshade J, Domm J, Williams J, Frangoul H.

Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt
University School of Medicine and the Monroe Carell Jr. Children's Hospital at
Vanderbilt, Nashville, Tennessee.

Ehrlichiosis, a tickborne illness transmitted by tick vectors Amblyomma
americanum and Ixodes scapularis, can be acquired in endemic areas. Clinical
manifestations range from asymptomatic to fulminant in nature. We report three
cases of ehrlichiosis in pediatric oncology patients, one of whom was a stem
cell transplant recipient. Early symptoms included fever, malaise, and vague
gastrointestinal symptoms. Laboratory abnormalities were initially attributed to
chemotherapy toxicity. Illness was severe in all three patients and one patient
died even after initiation of doxycycline. These cases emphasize the need for a
high index of suspicion for tickborne illness in oncology patients, and the
importance of a low threshold for starting empiric treatment before confirming
the diagnosis. Pediatr Blood Cancer. (c) 2010 Wiley-Liss, Inc.

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PMID: 20052776 [PubMed - as supplied by publisher]