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CME / ABIM MOC

Ehrlichiosis and Anaplasmosis Among Transfusion and Transplant Recipients in the United States

  • Authors: Sanjida J. Mowla, MPH; Naomi A. Drexler, MPH, DrPH; Cara C. Cherry, DVM; Pallavi D. Annambholta, DrPH; Ian T. Kracalik, PhD; Sridhar V. Basavaraju, MD
  • CME / ABIM MOC Released: 10/13/2021
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/13/2022
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Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, hematologists, internists, intensivists, pulmonologists, transplant physicians, and other clinicians caring for transfusion and transplant recipients with ehrlichiosis and anaplasmosis.

The goal of this activity is to describe donor-derived ehrlichiosis and anaplasmosis cases in the United States among solid organ transplant and transfusion recipients and the risks for these infections among these patients, based on a case series and literature review.

Upon completion of this activity, participants will:

  • Assess donor-derived ehrlichiosis and anaplasmosis cases in the United States among solid organ transplant recipients, based on a case series, review of Centers for Disease Control and Prevention (CDC) investigations, and literature review
  • Evaluate donor-derived ehrlichiosis and anaplasmosis cases in the United States among transfusion recipients, based on a case series, review of CDC investigations, and literature review
  • Determine the clinical implications of donor-derived ehrlichiosis and anaplasmosis cases in the United States among solid organ transplant and transfusion recipients, based on a case series, review of CDC investigations, and literature review


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Faculty

  • Sanjida J. Mowla, MPH

    Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia; Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Sanjida J. Mowla, MPH, has disclosed no relevant financial relationships.

  • Naomi A. Drexler, MPH, DrPH

    Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Naomi A. Drexler, MPH, DrPH, has disclosed no relevant financial relationships.

  • Cara C. Cherry, DVM

    Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Cara C. Cherry, DVM, has disclosed no relevant financial relationships.

  • Pallavi D. Annambholta, DrPH

    Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Pallavi D. Annambholta, DrPH, has disclosed no relevant financial relationships.

  • Ian T. Kracalik, PhD

    Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Ian T. Kracalik, PhD, has disclosed no relevant financial relationships.

  • Sridhar V. Basavaraju, MD

    Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

    Disclosures

    Disclosure: Sridhar V. Basavaraju, MD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor

  • Tony Pearson-Clarke, MS

    Copyeditor
    Emerging Infectious Diseases

    Disclosures

    Disclosure: Tony Pearson-Clarke, MS, has disclosed no relevant financial relationships.

CME Reviewer

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.


Accreditation Statements



In support of improving patient care, this activity has been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this Journal-based CME for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


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CME / ABIM MOC

Ehrlichiosis and Anaplasmosis Among Transfusion and Transplant Recipients in the United States

Authors: Sanjida J. Mowla, MPH; Naomi A. Drexler, MPH, DrPH; Cara C. Cherry, DVM; Pallavi D. Annambholta, DrPH; Ian T. Kracalik, PhD; Sridhar V. Basavaraju, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / ABIM MOC Released: 10/13/2021

Valid for credit through: 10/13/2022

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Abstract and Introduction

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997–2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.

Introduction

Ehrlichiosis and anaplasmosis are emerging tickborne diseases caused by Ehrlichia and Anaplasma spp. obligate intracellular bacteria[1,2]. Tick bites are the primary route of infection, but transmission can also occur through blood transfusion or solid organ transplantation, because these pathogens infect leukocytes and circulate throughout the blood stream[2]. In the United States, human ehrlichiosis is caused primarily by Ehrlichia chaffeensis but can also result from E. ewingii or E. muris eauclairensis infections[1,3]. Anaplasmosis is caused by Anaplasma phagocytophilum[1]. Although distinct diseases, ehrlichiosis and anaplasmosis share clinical and laboratory features. Early symptoms often include fever, chills, headache, malaise, myalgia, or nausea, and many infections go unrecognized and undiagnosed[3–5]. Laboratory features often include leukopenia, thrombocytopenia, anemia, and elevated hepatic transaminases[3–5].

Both diseases have incubation periods of 5–14 days from the time of tick transmission, and during early illness infected asymptomatic persons or those with mild illness might be unknowingly accepted as blood donors[3,5]. In general, higher rates of ehrlichiosis and anaplasmosis are reported among adults >40 years of age, and most patients are men[5–7]. Illness onset is most commonly reported during June and July, corresponding to peak tick activity[3,5]. Approximately half of ehrlichiosis and anaplasmosis patients require hospitalization, and 7% require critical care[3,8]. Case-fatality rates are ≈1% for E. chaffeensis ehrlichiosis and 0.3% for anaplasmosis patients based on national surveillance reports[3,5]. In part because of immunosuppressive therapies to prevent organ rejection, transplant and transfusion recipients may be more susceptible to ehrlichiosis and anaplasmosis. Relative risk (RR) for severe outcomes among immunosuppressed compared with immunocompetent case-patients was higher for hospitalization (RR 1.4), life-threatening complications (RR 2.4), and death (RR 2.3), highlighting the potential severity of disease in immunocompromised populations[3,9–15].

In the United States, ehrlichiosis was first reported in 1987 and anaplasmosis in 1994, and both became nationally notifiable diseases in 1999[3,5,16,17]. Since 2000, reported cases of ehrlichiosis and anaplasmosis in the United States have increased substantially. Reported E. chaffeensis ehrlichiosis cases have increased >10-fold, from 200 in 2000 to 2,093 in 2019[18,19]. Reported anaplasmosis cases increased >16-fold, from 348 cases in 2000 to 5,655 in 2019[19,20].

Increasing rates of reported ehrlichiosis and anaplasmosis might be related to several factors, including improved diagnostics, changes in reporting practices, and expanded human contact with animal reservoirs and tick vectors[2,3,21,22]. E. chaffeensis and E. ewingii are primarily transmitted by the lone star tick (Amblyomma americanum); A. phagocytophilum is transmitted by either the blacklegged tick (Ixodes scapularis) or the western blacklegged tick (I. pacificus)[3,5]. E. muris eauclaurensis is transmitted by I. scapularis ticks. E. chaffeensis ehrlichiosis is most frequently reported in the southeastern and south-central regions of the United States, and anaplasmosis is most often reported in the upper midwestern and northeastern regions.

PCR and serologic testing using an indirect immunofluorescence antibody assay are the primary laboratory methods for diagnosing ehrlichiosis and anaplasmosis[3,5]. Because infection transmitted through blood or organs is rare, it might not be diagnosed in solid organ transplant and transfusion recipients. In addition, nonspecific signs and symptoms and a higher index of suspicion for other opportunistic infections might complicate diagnosis[14], which is unfortunate because early detection and treatment can prevent severe illness and death[23]. Here, we summarize and discuss the risks of ehrlichiosis and anaplasmosis cases in the United States among solid organ transplant and transfusion recipients, with a focus on donor-derived infections.