Cluster of Tick-Borne Infections at Fort Chaffee, Arkansas: Rickettsiae and Borrelia burgdorferi in Ixodid Ticks

Kardatzke, James T.; Neidhardt, K.; Dzuban, David P.; Sánchez, José L.; Azad, Abdu F.

doi:10.1093/jmedent/29.4.669

Cited by 30 publications

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“…It is known that the ticks harbor the spotted fever group of rickettsiae (4.8%) more often than Francisella tularensis (1.8%), E chaffeensis (0.3%), or Borrelia burgdorferi (0.1%). 5,6 The low numbers of reported infections in Arkansas may be attributable to the low number of infected ticks or the lack of adequate identification and reporting of this illness. Comparing RMSF, tularemia, and ehrlichiosis, we recognize the fact that reports from our institution comprise approximately 39% of the cases of RMSF, 38% of the cases of tularemia, but all of the ehrlichia cases in children Ͻ15 years of age (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Human Monocytic Ehrlichiosis in Children

Schutze

Jacobs

1997

Pediatrics

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ABSTRACT. 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. Pediatrics 1997;100(1). URL: http://www.pediatrics.org/ cgi/content/full/100/1/e10; erlichiosis, children, rickettsia, ticks.ABBREVIATIONS. HME, human monocytic ehrlichiosis; RMSF, Rocky Mountain spotted fever. I n the 10 years that human monocytic ehrlichiosis (HME) has been recognized in the United States, much of our knowledge concerning the clinical presentation and outcome of this illness has been obtained from experience with adult patients.1,2 This is because only approximately 10% of the patients described to date have been children. 3 As our knowledge of HME increases, it is imperative that we continue to gather data which will allow us to better understand the epidemiology and natural history, the clinical manifestations and the role of therapy, the prognostic indicators for outcome, and the longterm morbidity and mortality of this illness. The purpose of this study was to review our experience with HME to gain a better understanding of the features of ehrlichiosis in children. MATERIAL AND METHODSA retrospective review of all medical and laboratory records from Arkansas Children's Hospital from 1990 to 1996 were reviewed in an attempt to identify all patients infected with Ehrlichia chaffeensis. Patients were considered to have a diagnosis of HME if the patient had a clinically compatible history with a minimum titer to E chaffeensis of Ն1:64 or a fourfold or greater change in antibody titers fro...

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Section: Discussionmentioning

confidence: 99%

Human Monocytic Ehrlichiosis in Children

Schutze

Jacobs

1997

Pediatrics

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“…Tick-transmitted infection is an occupational health threat to military personnel (10,24,31). Effective arthropod repellents are available through the military supply system and are actively promulgated (Armed Forces Pest Management Board, technical guide 36 [http://www.afpmb.org/coweb/guidance targets/ppms/TG36/TG36.htm]); nevertheless, compliance is inadequate and many soldiers in the field experience tick bites (8).…”

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Evidence ofBorrelia lonestariDNA inAmblyomma americanum(Acari: Ixodidae) Removed from Humans

et al. 2003

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“…Ticks bit 75% of the personnel who participated in the training exercise, and one-half of these personnel were seropositive for Rickettsia rickettsii, which shares SFGR antigens with R. amblyommii. In examining more than 3,000 ticks at Fort Chaffee, Arkansas, during May, August, and November 1990, Kardatzke et al 86 found that 4.8% were positive for SFGR and 0.3% were positive for ehrlichiae. Stromdahl et al 82 80 Another SFGR, Rickettsia parkeri, was previously observed in the Gulf Coast tick, Amblyomma maculatum, and was considered to be nonpathogenic.…”

Section: Us Military Significancementioning

confidence: 99%

History of U.S. Military Contributions to the Study of Rickettsial Diseases

et al. 2005

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, MC USN (Ret.) § Rickettsial diseases have affected the military throughout history. Efforts such as those of the Joint U.S. Typhus Commission near the beginning of World War II and of military researchers since have reduced the impact of these diseases on U.S. and Allied forces. Despite the postwar development of effective antibiotic therapies, the newly emerging antibioticresistant scrub typhus rickettsial strains of the Asian Pacific region mandate continued research and surveillance. Similarly, tick-infested training areas in the United States and similar exposure abroad render the spotted fevers and the ehrlichioses problematic to deployed troops. The military continues to work on countermeasures to control the arthropod vectors, as well as actively participating in the development of rapid accurate diagnostic tests, vaccines, and improved surveillance methods. Several rickettsial diseases, including epidemic typhus, scrub typhus, the ehrlichioses, and the spotted fevers, are reviewed, with emphasis on the military historical significance and contributions. Introduction C ertain rickettsial diseases have had a significant impact on military operations throughout history. Before the middle of the 20th century, when effective antibiotics were introduced, military morbidity and mortality rates attributable to diseases such as epidemic typhus and scrub typhus were high. As far back as 429 B.C. and the plague of Athens, as described by Thucydides, typhus was thought to have killed the Athenian general Pericles and caused the downfall of Athens during the Peloponnesian War.1 There are reports in which the destruction of whole armies occurred. Arguably the most famous example is the destruction of the Grand Army of Napoleon following the 1812 withdrawal from Russia, which was attributed, in large part, to typhus and a "lousy" Russian winter. Because symptoms of these diseases often resemble those of other febrile illnesses, such as malaria and leptospirosis, rickettsioses are difficult to diagnose even today (Table I). Consequently, rickettsioses are often underreported or misdiagnosed and their true impact is underestimated. The purpose of this report is to describe the military significance of the rickettsioses and to outline the contributions made by military researchers to minimize the risk to military operations and personnel (Table II). These contributions have also greatly benefited the general public, both in the United States and globally. Epidemic TyphusEpidemic typhus (also known as louse-borne typhus, camp fever, ship fever, jail fever, and others) is an acute febrile illness of humans. The causative agent, Rickettsia prowazekii, contaminates the feces of its vector, the human body louse, Pediculus humanus. Aerosolized dried feces can be inhaled to induce infection, but the rickettsiae-laden feces are primarily self-inoculated through scratching of the site of the louse bite.3 Fever and headache occur 8 to 12 days following exposure, typically accompanied by generalized maculopapular rash, which spre...

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Cluster of Tick-Borne Infections at Fort Chaffee, Arkansas: Rickettsiae and Borrelia burgdorferi in Ixodid Ticks

Cited by 30 publications

References 0 publications

Human Monocytic Ehrlichiosis in Children

Human Monocytic Ehrlichiosis in Children

Evidence ofBorrelia lonestariDNA inAmblyomma americanum(Acari: Ixodidae) Removed from Humans

History of U.S. Military Contributions to the Study of Rickettsial Diseases

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