ehrlichiosis
Introduction
Introduction to Ehrlich's disease Human ehrlichosis is caused by the transmission of Ehrlichia through the sputum. The pathogen invades monocytes or neutrophils and forms mulberry-like inclusions in the cytoplasm. Sudden onset of the patient, the symptoms are similar to the heat of the Rocky Mountain spot, rare rash. Leukopenia, thrombocytopenia, with hepatocyte damage and abnormal liver function can cause death if serious complications occur. Because of its epidemiology, clinical manifestations and similar to Rickettsia, some people have classified it as a spot fever disease. basic knowledge The proportion of illness: this disease is rare, the incidence rate is about 0.0001%-0.0004% Susceptible people: no specific people Mode of transmission: insect vector transmission Complications: gastrointestinal bleeding
Cause
Ehrlich's disease etiology
Bite (40%):
It is rumored that Eric body enters the human body through the bite of a sputum, enters the relevant organs through the microvascular or lymphatic vessels, and is analyzed by immunohistochemistry. It is found that the phenotype, liver, bone marrow and lymph nodes are mainly found in the phenotype. - The organs and tissues of the macrophage system, Chaffee eric body mainly invades mononuclear macrophages, occasionally lymphocytes, but does not invade multinucleated white blood cells, the pathogen grows and multiplies in mononuclear macrophages, directly causing Host cell damage, or induce the body's immune system response, so that immune cells release a variety of cytokines and other inflammatory mediators, leading to tissue damage, focal necrosis and granuloma formation, bone marrow granuloma formation, bone marrow hyperplasia And megakaryocyte proliferation; in the liver, the formation of ring granuloma and focal hepatic necrosis. In the lungs, extensive alveolar damage, interstitial pneumonia and pulmonary hemorrhage can be seen, lymphocytes infiltrating around the blood vessels of the kidney, spleen, heart, liver, brain, meninges, lungs, etc., but peripheral blood lymphocytes are reduced.
Phagocytes (40%):
Eric body group (including human granulocyte Ehrlichia) mainly invades bone marrow precursor cells, grows and matures in mature neutrophils, and reduces the adhesion, migration, phagocytosis and bactericidal ability of neutrophils. And affect lymphocytes, so that lymphocyte mitosis and proliferation are reduced, antibody production is reduced, resulting in prone to pathogenic bacteria, viral or fungal infections, due to the relative increase of mononuclear-macrophages, peripheral blood cells in the spleen, liver, lymph nodes The damage will also increase, resulting in a decrease in peripheral blood leukocytes and thrombocytopenia.
Infectious mononuclear cells, Ehrlichia, mainly invade mononuclear-macrophages, have major pathological features such as systemic lymphadenopathy and increased atypical and atypical lymphocytes, and the main pathological features of infectious mononucleosis. Swollen.
Prevention
Ehrlich body disease prevention
Prevention is based on prevention of cockroaches.
Complication
Ehrlich's disease complications Complications, gastrointestinal bleeding
Severe cases of pulmonary and gastrointestinal bleeding, acute renal failure and respiratory failure due to thrombocytopenia and DIC.
Symptom
Ehrlich's body symptoms common symptoms, rash, nausea, kidney failure, chills, high fever, bone marrow hematopoietic cell aplasia, maculopapular rash
The incubation period is about 12 to 14 days. The clinical manifestations of the patients are almost indistinguishable from the fever of the Rocky Mountain. They all have sudden onset, chills, high fever, often accompanied by slow pulse (<90 beats/min), headache, muscle pain, nausea, vomiting, fatigue. , discomfort, physical examination without obvious signs, about 20% of patients infected with Ehrlichia rash, but HGE-infected patients without rash, rash in various forms, with rash or papules, or maculopapular rash, bleeding rash , or erythema, common in the chest, legs and arms, rash appeared about 5 days after the onset, the natural course of disease averaged 7 days (3 to 19 days).
Older patients are prone to severe disease, severe patients may have renal failure, meningitis, coma, DIC, and even complete blood cell reduction and bone marrow hematopoietic cell aplasia, separation of blood components (ie, hemophagocytic syndrome), treatment can not cause death .
Examine
Ehrlich physical examination
Leukopenia (<4×109/L), absolute number of lymphocytes decreased (<1.5×109/L, median number was 0.41×109/L), thrombocytopenia, (49-75)×109/L, abnormal liver function On the first weekend of the disease, ALT and AST peaked at 90-583 U/L, and mulberry-like inclusions were observed in lymphocytes and monocytes or neutrophils.
Diagnosis
Diagnosis and diagnosis of Ehrlich's disease
According to the patient's past epidemic area, there is a history of bite or epidemiological data entering the area, and accompanied by the above clinical manifestations and laboratory abnormal data, leukocyte smear staining, such as mulberry-like inclusions, can be diagnosed. Immunofluorescence and PCR detection of Ehrlichia antibodies or DNA can be confirmed.
Clinically, it is easily confused with the heat of the Rocky Mountain spot. It should also be distinguished from Colorado Tick fever (CTF) and Lyme disease. CTF is transmitted by the coltivirus of the reovirus. Popular in the western United States, sudden onset, chills and fever, may have relatively slow pulse, nausea, but no vomiting, white blood cells decreased, about half of the patients after 2 to 3 days after the onset of body temperature decline, symptoms mostly disappear, 1 to 2 days later, It starts to have fever, the body temperature is higher, the symptoms are heavier, and the heat type is saddle-like. It is called saddle back heat. It is similar to dengue fever. Because of the typical heat type, it is not difficult to identify clinically. Lyme disease is also rumored. Borovia spirulina infection, clinically typical transitional erythema, white blood cells do not decrease, platelets are not reduced, can be identified.
