2. Introduction
Small gram negative, obligate, intracellular parasites
These are tiny organisms measuring 0.2-2.4micromtrs.
Which have affinity towards WBC particularly mononucslear
phagocytes
3.
Clusters of Ehrlichia multiply in host cell vacuoles to form
large mulbery shaped aggregates called MORULAE
Ehrlichia inclusions like morulae are visible in cytoplasm of
infected cell after 5-7 days
5. EHRLICHIA SENNETSU
Endemic in JAPAN and SOUTH EAST ASIA
It causes GLANDULAR FEVER
It shows lymphoid hyperplasia and atypical
lymphocytosis
No arthropod vector identified
Human infection is suspected to be caused by ingestion
of fish carrying infected flukes
6. EHRLICHIA PHAGOCYTOPHILA
Causes human GRANULOCYTIC EHRLICHIOSIS
Transmitted by IXODES ticks
Deer, cattle and sheep are suspecte reservoirs
Leucopenia and thrombocytopenia observed in patients
7. EHRLICHIA CAFFEENSIS
Cause human MONOCYTIC EHRLICHIOSIS
Transmitted by Amblyomma ticks
Deers and rodents reservoirs
Leucopenia and
thrombocytopenia
increased liver
enzymes
Most dangerous can cause multisystem failure and fatality
8. EHRLICHIOSIS
Ehrlichiosis is infection of WBC that is characterised by mulbery
shaped aggregates called morulae in infected cells
These morulae are visiible after 5-7days of infection
9. Pathophysiology
It is not completely known
Like RICKETTSIA sps EHRLICHIA gain access to blood via bite
from infected tick
13. Mortality and morbidity
Great majority of EHRLICHIOSIS are asymptomatic
Most cases present as mild to moderate acute febrile illness
In immunocompromised persons ehrliosis
may be severe manifesting as ROCKY MOUNTAIN SPOTTED
FEVER may be fatal
15.
Patients with Ehrlichiosis usually present with
head ache,
myalgia,
fever,
shaking chills.
Nausea and vomiting are common
Abdominal pain is uncommon and is typically mild
Skin rash due to ehrlichiosis is rare. When present as
macculopapular rash rather than peticheal
16. Cont…
Some patients develop heptomegaly
Lymphadenopathy is observed in <25%
Splenomegaly is uncommon
Patients with severe ehrlichiosis develop
thrombocytopenia and disseminated intravascular
coaggulation(DIC) which can result in hemorrhage into
skin
17. Distribution
Ehrlichiosis occurs worldwide and frequensy parallels
distribution of appropriate tick vector for transmission
of ehrlichia and mammalian host
In USA it occurs in states of CALIFORNIA, TEXAS and
SOUTH EAST NORTHERN REGIONS OF CAENTRY
World wide it occurs in JAPAN, SOUTH EAST ASIA
18. Lab diagnosis
Diagnosis rests on
1)single elevated IgG IFA antibody titre
2)demonstration of incr. in acute and convalescent
IFA ehrlichia titre
Difficult to culture
Detection with PCR
19.
Blood smear for cytoplasmic
inclusions
CBP for thrombocytopenia and
neutropenia
Atypical lymphocytes in blood
Serum transaminases are
mild high
DIC may be diagnosed with
cutaneous bleeding
Lumbar puncture to rule out
meningitis