Complications

Complication
Timeframe
Likelihood
short term
low

More common in human monocytotropic/monocytic ehrlichiosis (HME) patients.

Occurs when perivascular inflammatory infiltrates are located in the meninges and brain parenchyma.[69][133]

Stupor and coma and/or meningeal signs can occur.

A lumbar puncture should be performed to rule out other bacterial/viral pathogens.

No specific treatment is required besides antibiotic therapy for ehrlichioses. Cerebral oedema should be treated if clinically indicated.

short term
low

More common in human monocytotropic/monocytic ehrlichiosis (HME) patients. The pathogenesis seems to be related to severe interstitial pneumonitis and the presence of hypovolaemic shock.

Management is the same as in other diseases leading to acute respiratory distress syndrome.[134][135][136]

short term
low

Due to acute tubular necrosis. Occurs in patients with hypotension/shock.[137]

Management is the same as in other conditions leading to acute tubular necrosis.

short term
low

Has been reported in patients with human granulocytotropic/granulocytic anaplasmosis (HGA).[138]

Pathogenesis of this complication is unknown.

short term
low

This complication has been reported more frequently in patients with human granulocytotropic/granulocytic anaplasmosis (HGA).[77]​​[139]​​

Oral candidiasis, pulmonary aspergillosis, herpes simplex oesophagitis, and cryptococcosis have been described during convalescence.[69][77]​​[84]​​[133]

Pathogenesis of opportunistic infections during the convalescence period is poorly understood.

short term
low

Occurs in both human monocytotropic/monocytic ehrlichiosis (HME) and human granulocytotropic/granulocytic anaplasmosis (HGA) patients.[140]

Pathogenesis is poorly understood.

There have also been case reports of sudden sensorineural hearing loss.[141]

short term
low

More commonly observed in patients with human monocytotropic/monocytic ehrlichiosis (HME).[61][77][101][139]

In animal models, this complication is related to the presence of high levels of tumour necrosis factor (TNF)-alpha in serum.

Management is the same as in other conditions.

short term
low

More commonly observed in patients with human monocytotropic/monocytic ehrlichiosis (HME).[139]

Includes disseminated intravascular coagulation.

Pathogenesis is poorly understood and management is the same as in other conditions.

short term
low

More commonly observed in patients with human monocytotropic/monocytic ehrlichiosis (HME).[142][143][144]

Pathogenesis is poorly understood.

short term
low

Reported only in patients with human granulocytotropic/granulocytic anaplasmosis (HGA).[145]

Pathogenesis is poorly understood.

short term
low

Reported only in patients with human granulocytotropic/granulocytic anaplasmosis (HGA).[146]

Pathogenesis is poorly understood.

short term
low

An allergy to mammalian red meat that can occur after a tick bite due to the transmission of galactose-alpha-1,3-galactose (alpha-gal), a sugar molecule that is also found in red meat. Some people have a strong IgE antibody response to alpha-gal resulting in a delayed-onset allergic reaction or anaphylaxis. It is associated with bites from the Lone Star tick in the US, but has been reported in other countries such as Australia, Europe, and Asia due to bites from other types of ticks. The only treatment is to avoid consuming red meat.[147][148] At one US clinic, red meat allergies caused by tick bites were the most common cause of anaphylaxis, accounting for 33% of cases.[149]

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