Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 1-2, Pages: 79-82
https://doi.org/10.2298/SARH1402079A
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A case of human monocytic ehrlichiosis in Serbia
Arsić Bogdan (Department of Infectious Diseases, General Hospital, Subotica)
Gligić Ana (Institute of Immunology and Virology “Torlak”, Belgrade)
Ristanović Elizabeta (Institute of Microbiology, Military Medical Academy, Belgrade)
Lako Branislav (Department of Veterinary Medicine, Faculty of Agriculture, Novi Sad)
Potkonjak Aleksandar (Department of Veterinary Medicine, Faculty of Agriculture, Novi Sad)
Peruničić Milan (Institute of Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade)
Pavlović Momčilo (Pediatric Department, General Hospital, Subotica)
Introduction. Ehrlichiosis is a bacterial zoonosis transmitted by
hematophagous arthropods - ticks. In humans, it occurs as monocytic,
granulocytic, and ewingii ehrlichiosis. Pathological process is based on
parasitic presence of Ehrlichia organisms within peripheral blood cells -
monocytes and granulocytes. Case Outline. Fifty-two year old patient was
admitted to hospital due to high fever of over 40°C that lasted two days,
accompanied with chills, muscle aches, malaise, loss of appetite, headache,
confusion, breathing difficulties, and mild dry cough. The history suggested
tick bite that occurred seven days before the onset of disease. Doxycycline
was introduced and administered for 14 days, causing the disease to subside.
Indirect immunofluorescence assay was used to analyze three serum samples
obtained from this patient for Ehrlichia chaffeensis antibodies, and
peripheral blood smear was evaluated for the presence of Ehrlichia and
Ehrlichia aggregation into morulae. Conclusion. Ehrlichiosis should be
considered in each case where there is a history of tick bite together with
the clinical picture (high fever, chills, muscle aches, headache, generalized
weakness and malaise, and possible maculopapular rash). The presence of
Ehrlichia chaffeensis antibodies was confirmed in a patient with the history
of tick bite, appropriate clinical picture and indirect immunofluorescence
assay. This confirmed the presence of human monocytotropic ehrlichiosis, a
disease that is uncommonly identified in our country.
Keywords: Ehrlichia chaffeensis, human ehrlichiosis, fluorescent antibody technique, indirect, doxycycline