Background:
Human monocytic ehrlichiosis (HME) and Human granulocytic anaplasmosis (HGA) , zoonotic diseases transmitted by ticks, are caused by Anaplasma phagocytophilum and Ehrlichia chaffeensis, respectively .Most data on HME and HGA are on adult patients in northern America .Typical clinical presentation include: fever ,headache, myalgia and rash accompanied by leukopenia and thrombocytopenia .Data in pediatric patients are limited .
The aim of this study is to describe HME and HGA in children in Israel.
Study design:
We retrospectively reviewed clinical files of children, aged 0-18 years, admitted with HME and HGA between 2005 -2017. The data collected included: demographics, clinical presentation, laboratory findings, treatment protocols and outcome. HME and HGA were diagnosed serologically using the indirect fluorescent antibody (IFA) test.
Results:
18 patients had positive serology. Of whom 3 had other diagnoses. 15 patients
(9 females, 60%) were included in the final analysis. Mean age was 7.2 years (range 1.9 -15.9 years). Fever was present in all patients. The clinical presentation included anorexia (11 patients) Lymphadenopathy (n=9) vomiting (n=8) and abdominal pain (n=5).
Leukocytosis (n=7), anemia (n=10) , thrombocytosis(n=5) ,hyponatremia (n=9) and hypophosphatemia (n=8) were the most frequent laboratory abnormalities . Leukopenia was noted in only 20% of patients .Elevated liver enzymes were observed in only one patient.11 patients were treated with Doxycycline. There was no mortality.
Conclusion:
Pediatric HME and HGA infection in Israel may have atypical clinical and laboratory characteristics. HME and HGA, although uncommon, should be included in the differential diagnosis of febrile pediatric patients in Israel.
