Human monocytic ehrlichiosis in children.

BACKGROUND Much of what is known about human monocytic ehrlichiosis (HME) is based upon studies with adult patients. PURPOSE To review our experience with HME to better understand the epidemiology, clinical manifestations, and outcome of this disease in children. METHODS Demographic, clinical, and laboratory data were gathered after review of the medical records of patients identified with HME. RESULTS Twelve patients with an median age of 7.4 years (range, 7 months to 13.7 years) were identified with HME; 10 were white, 7 were male, and 10 were from hometowns of <800 people. Eight patients presented from May through July, and 8 had a history of tick bites. Symptoms demonstrated by the patients during their illness included fever (100%), rash (67%), myalgias (58%), and vomiting, diarrhea, and headache (25%). On presentation, patients demonstrated thrombocytopenia (92%), elevated liver function tests (91%), lymphopenia (75%), hyponatremia (67%), leukopenia (58%), and anemia (42%) on the initial laboratory examination. Four patients presented in shock and 3 required blood pressure support and mechanical ventilation for a median of 10 days (8 to 37 days). These complicated patients required longer hospitalization (19.5 days vs 5. 5 days) and attained higher blood urea nitrogen levels (42.5 mg/dL vs 10 mg/dL) than the patients not presenting with shock. Morbidity associated with HME patients included a decrease in cognitive and neurologic performance. CONCLUSIONS More information and long-term follow-up is required to understand the full spectrum of disease and morbidity associated with HME in children.