Monocyte erlichiosis in humans: diagnosis and treatment

Monocyte erlichiosis in humans is a rare infectious disease caused by bacteria from the Ehrlichia family. Pathology can be manifested by a sharp rise in body temperature, headache, muscle pain (myalgia), chills, unexplained fatigue, weakness. Symptomatic symptoms are observed a few weeks after the primary infection. In many cases, as a result of laboratory tests, a decrease in the number of platelets in the circulating blood (thrombocytopenia) is found, along with a decrease in the number of white blood cells (leukopenia) and an abnormal increase in the level of certain liver enzymes (hepatic transaminases). In some cases, the symptoms progress and are expressed in nausea, vomiting, diarrhea, weight loss, loss of orientation in space. If a patient has monocytic erlichiosis of a person, treatment should follow immediately after diagnosis, since in the absence of adequate therapy the disease leads to such dangerous complications as renal or respiratory failure. The carriers of infection are ticks.

Signs and Symptoms

Monocyte erlichiosis of a person whose symptoms are not difficult to be confused with signs of other infectious diseases was discovered and investigated relatively recently. As a rule, the pathology is manifested approximately three weeks after the bite of the tick - a carrier of bacteria of the family Ehrlichia. Initially, patients suffer from typical signs of infection, including a sharp increase in body temperature and general weakness. In some cases, a skin rash is added to this symptomatology. With severe infection, the patient loses appetite, quickly loses weight and is at risk of anorexia. Sometimes there are also more rare signs of erlichiosis - such as cough, diarrhea, sore throat (pharyngitis) and abdominal pain.

In most cases, when monocyte erlichiosis is suspected, diagnosis involves blood tests. The results of these examinations (combination of leuko- and thrombocytopenia simultaneously with an abnormal increase in the level of liver enzymes) allow the patient to be correctly diagnosed. In some cases, the patient also suffers from liver inflammation (hepatitis).

In the absence of adequate treatment, severe monocytic erlichiosis of a person develops. Symptoms of the disease in this stage differ from the standard manifestations of infection and can be expressed in the following phenomena and conditions:

• Shortness of breath (shortness of breath, dyspnoea);
• Bleeding disorder (coagulopathy), which can lead to bleeding in the gastrointestinal tract;
• Neurological disorders due to infection of the brain and spinal cord (central nervous system).

If the infection has swept the central nervous system, a patient with a diagnosis of "monocytic human erlichiosis" exhibits pathological changes in the tissues (tumors) in the brain. In addition, in a number of cases, meningitis develops, an inflammation of the protective membrane membranes of the brain and spinal cord. Cerebrospinal fluid can also be affected by infection.

Neurologic manifestations

Neurological symptoms of the disease include:

• Loss of orientation in space;
• Pathological sensitivity to light (photophobia);
• Stiff neck;
• Episodes of uncontrolled electrical activity in the brain (convulsions);
• coma.
• In rare cases, there are:
• Excessively intense reflex reactions (hyperreflexia);
• Violation of coordination of voluntary movements (ataxia);
• Partial loss of motor capacity of the facial muscles due to damage to one (or more) of the twelve pairs of nerves associated with the brain (paralysis of the cranial nerves).

Monocyte erlichiosis and granulocyte anaplasmosis in the absence of professional treatment become life-threatening diseases.

Causes

All types of pathology analyzed are caused by bacteria belonging to the Ehrlichia family. The causative agent of monocytic erlichiosis is considered to be gram negative.

It is believed that the main cause of infection is a tick bite. Some of these insects are carriers of pathogens.

Getting into the human body through the blood, erlichia spread through the blood and lymph vessels. Lymph is a bodily fluid that carries cells designed to fight infectious diseases. Bacteria settle in some cells (monocytes and macrophages), which play an invaluable role in maintaining the stable functioning of the immune system. These cells absorb and process microorganisms (a process called phagocytosis), including bacteria and other foreign elements. However, Erlichia penetrate deep into the natural defenders of immunity and begin to grow in vacuoles - cavities surrounded by a membrane. The disease affects not only monocytes and macrophages in the blood, but also certain types of bodily tissues (including bone marrow, lymph nodes, liver, spleen, kidneys, lungs and cerebrospinal fluid).

Differential diagnosis: granulocyte anaplasmosis

Symptoms of this infectious disease can easily be confused with signs of other pathologies. Most often differential diagnosis is subject to monocytic erlichiosis and granulocyte anaplasmosis of a person.

Unlike MEC, granulocyte anaplasmosis is caused by a bacterium with the corresponding name of anaplasm. The microorganism carried by ticks affects certain granular white blood cells - neutrophilic granulocytes. These cells are involved in the process of phagocytosis and are usually responsible for the destruction of harmful microbes. When anaplasma is infected, typical symptoms usually appear one week after a tick bite - a carrier of bacteria. Almost always the patient suffers from fever, chills, muscle pain (myalgia), general weakness, fatigue, headache. Sometimes there is also coughing, vomiting and / or loss of orientation in space. In addition, granulocyte anaplasmosis is similar to an infection, such as human monocytic erlichiosis, also because the increase in some liver enzymes (hepatic transaminase) is equally detected in blood test results. Often diagnosed and anemia, caused by a pathological decrease in the level of red cells in the circulating blood. In the absence of proper treatment, there is a danger of developing renal failure. In the USA, cases of granulocyte anaplasmosis are most often recorded in the northeastern and western states.

Sennetz fever

Monocyte erlichiosis of man (MECh) must also be distinguished from Sennetz fever, an extremely poorly studied and very rare infectious disease belonging to the subtype of human erlichiosis and caused by bacteria with the corresponding name - erlikhia sennets. A few weeks after the initial infection, symptoms similar to the common signs of MEC develop: a sharp rise in body temperature, headache, muscle pain (myalgia). Some patients experience nausea, vomiting, or loss of appetite right up to anorexia. In addition, according to the results of blood tests, it is possible to judge the decrease in the level of white blood cells (leukopenia) and the pathological increase in the volume of liver enzymes. The carrier (or carrier) of the sennet fever has not yet been accurately established; Some scientists suggest that it can be ticks, while other researchers claim that the disease can be infected after eating raw fish. At the moment, infections were only observed in eastern Japan and in Malaysia.

Borreliosis Lyme

Lyme borreliosis is an infectious disease caused by spirochaete bacteria from the Borrelia family. Bearers of harmful microbes are black-footed mites. In most cases, this disease is primarily manifested by the appearance of a red tumor on the skin, which at first looks like an elevated circular spot of a small size (papule). Papula begins to grow rapidly and eventually reaches at least five centimeters in diameter. After this, there is a symptomatology, which also characterizes the monocytic erlichiosis of a person. The likelihood of infection with Lyme borreliosis is much lower than the risk of catching MEC, however, differential diagnosis remains a necessary stage in determining the infection. Patients with Lyme borreliosis often also complain of an increase in body temperature (not as sharp and dangerous as with MECh), chills, muscle and headaches, weakness, fatigue, and pain or stiffness in large joints (infectious arthritis), most often in Lap. Symptomatics can take the form of recurring cycles. In severe cases, in the absence of timely treatment, neurologic disorders and pathologies of the heart muscle are observed. According to statistics, most often Lyme borreliosis is found in the northeastern US states. However, there are cases of infection in other countries, including China, Japan, Australia and some European countries.

Human pyroplasmosis

Human monocyte erlichiosis, the probability of infection is relatively higher than the risk of infection with other bacteria, is not the only potentially infectious disease carried by ticks. Human pyroplasmosis (in another terminology - babesiosis) is an infection caused by unicellular microorganisms from the family of Babesia. Most often this disease affects animals, but from time to time there are cases of infection of people. In particular, it is believed that ixodid mites are the carriers of babesias, capable of parasitizing on the human body. Pyroplasmosis is similar to monocyte erlichiosis in humans primarily symptomatic: patients complain of fever, chills, headaches and muscle pains, nausea, vomiting. In addition, such pathological phenomena as premature destruction of red bodies in circulating blood (hemolytic anemia), an abnormal decrease in their number (thrombocytopenia), a decrease in the total volume of white blood cells (leukopenia) and an increase in the spleen (splenomegaly) are observed. In people with a general satisfactory state of health, the symptoms of the disease may be mild or nonexistent. Severe cases of human pyroplasmosis are observed in patients who have undergone surgery to remove the spleen (splenectomy) or have a weak immune system. Most often, a man's babesiosis is diagnosed in the north of the USA, but cases of its detection are also known in European countries.

American tick rickettsiosis

Monocyte erlichiosis of a human being must be distinguished from American tick-borne rickettsiosis , a rare infectious disease caused by bacteria from the Rickettsia family. The carriers of the infection are the same insects that can infect a person with monocytic erlichiosis. With rickettsiosis, there are severe head and muscle pains, fever, chills, loss of orientation in space. In most cases, after two to six days after the tick bite, a skin rash appears, primarily covering the palms, wrists, soles of the feet, ankles and forearms. Later, the rash spreads to the face, trunk and lower legs. Sometimes there is nausea, vomiting and abdominal pain. In some cases, when the disease is not diagnosed on time or in the absence of adequate treatment, symptoms of American tick-borne rickettsiosis may be life threatening. Epidemic outbreaks of this disease are recorded in various regions of the United States.

Diagnostics

To diagnose the monocytic erlichiosis of a person, whose infection can lead to potentially dangerous symptoms, is necessary with the help of a thorough medical examination, an analysis of the signs of the disease and the conduct of specialized laboratory studies. Blood tests often indicate typical manifestations of monocytic human erhychosis: a decrease in the volume of red blood cells (thrombocytopenia), a decrease in the number of certain white bodies (leukopenia), and a simultaneous increase in the level of certain liver enzymes (eg, serum aspartate aminotransferase and alanine aminotransferase). In some cases, as a result of laboratory examinations, the pathologies of the cerebrospinal fluid are found. In addition, chest radiography can detect abnormal changes in the lung (eg, pulmonary infiltrates or excess fluid accumulation).

The study of a blood smear under an electron-beam microscope makes it possible to detect clusters of bacteria in the vacuoles of some cells (in particular, monocytes), but at an early stage of an infectious disease such clusters are not always visible. In some cases, additional specialized laboratory tests are required to determine the specific type of infection or confirm the diagnosis.

Such specialized tests include, for example, an indirect immunofluorescence method for detecting pathologies, which consists in examining serum produced from the patient's blood. Antibodies - proteins produced by certain white blood cells - help the body fight toxins and harmful microorganisms. Using an indirect immunofluorescent method, human antibodies are labeled with special fluorescent dyes, the serum is placed under ultraviolet light and examined under a microscope to reveal the antibody response to specific microorganisms.

Treatment

If the diagnosis of "monocytic erlichiosis of a person" is confirmed, what is the treatment for this disease? Most often, doctors prescribe a standard dosage of tetracycline antibiotics. Alternatively, doxycycline-based therapy is sometimes used. In severe cases, the patient may need professional supervision in a hospital. In addition to antibiotics, it is possible to take any medicines permitted by a doctor to alleviate the typical symptoms of infection.

Prevention

If you live in a geographic region inhabited by mites of potentially dangerous species, including bacteria carriers of the Ehrlichia family, it is advisable to take appropriate precautions. If you go to nature, remember that you thereby increase the risk of contracting such a serious disease as monocytic erlichiosis of a person. Photo ticks, which are confirmed by the carrier of bacteria, will help maintain vigilance, but to know the potential enemy in the face is not enough. Wear long pants, shirts and long-sleeved T-shirts. It is important to wear hats, best of all - wide-brimmed hats, as many mites live on trees. Choose clothes of light shades, as on it is easier to see an insect. Use special repellent remedies and be sure to inspect skin and clothing as often as possible. Most tick bites fall on the scalp and neck.