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Human monocytic ehrlichiosis (HME) is a form of ehrlichiosis associated with Ehrlichia chaffeensis.[1]
This bacteria is an obligate intracellular pathogen affecting monocytes and macrophages.
HME occurs across the south-central, southeastern, and mid-Atlantic states, regions where both the white-tailed deer (Odocoileus virginianus) and lone star ticks (Amblyomma americanum) thrive.
Nearly 600 cases were reported to the CDC in 2006. In 2001-2002, the incidence was highest in Missouri, Tenessee, and Oklahoma, as well as in people older than 60.[2]
The most common symptoms are fever, headache, malaise, and muscle aches (myalgia). Compared to Human Granulocytic Ehrlichiosis, rash is more common.[3] Laboratory abnormalities include thrombocytopenia, leukopenia, and elevated liver tests.
The severity of the illness can range from minor or asymptomatic to life-threatening. CNS involvement may occur. A serious septic or toxic shock-like picture can also develop, especially in patients with impaired immunity. [4]
Tick exposure is often overlooked. For patients living in high-prevalence areas who spend time outdoors, a high degree of clinical suspicion should be employed.
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