| Autor: |
Jevtic D; Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.; Department of Medicine, NYC Health + Hospitals/Elmhurst, New York, NY 11373, USA., da Silva MD; Municipal University of São Caetano do Sul-USCS Bela Vista, Sao Paulo 01327-000, Brazil., Haylock AB; Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.; Department of Medicine, NYC Health + Hospitals/Elmhurst, New York, NY 11373, USA., Nordstrom CW; Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA.; Mayo Clinic College of Medicine and Science, Rochester, MN 55902, USA., Oluic S; Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, USA., Pantic N; Clinic of Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia., Nikolajevic M; School of Medicine, University of Belgrade, 11000 Belgrade, Serbia., Nikolajevic N; School of Medicine, University of Belgrade, 11000 Belgrade, Serbia., Kotseva M; Internal Medicine Residency, Franciscan Health, Olympia Fields, Chicago, IL 60461, USA., Dumic I; Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA.; Mayo Clinic College of Medicine and Science, Rochester, MN 55902, USA. |
| Abstrakt: |
Hemophagocytic lymphohistiocytosis (HLH) secondary to tick-borne infections is a rare but potentially life-threatening syndrome. We performed a scoping review according to PRISMA guidelines to systematically analyze the existing literature on the topic. A total of 98 patients were included, with a mean age of 43.7 years, of which 64% were men. Most cases, 31%, were reported from the USA. Immunosuppression was present in 21.4%, with the most common cause being previous solid organ transplantation. Constitutional symptoms were the most common, observed in 83.7% of the patients, while fever was reported in 70.4% of cases. Sepsis was present in 27.6%. The most common laboratory abnormalities in this cohort were thrombocytopenia in 81.6% of patients, while anemia, leukopenia, and leukocytosis were observed in 75.5%, 55.1%, and 10.2%, respectively. Liver enzyme elevation was noted in 63.3% of cases. The H-score was analyzed in 64 patients, with the mean value being 209, and bone marrow analysis was performed in 61.2% of patients. Ehrlichia spp. was the main isolated agent associated with HLH in 45.9%, followed by Rickettsia spp. in 14.3% and Anaplasma phagocytophilum in 12.2%. Notably, no patient with Powassan virus infection or Lyme borreliosis developed HLH. The most common complications were acute kidney injury (AKI) in 35.7% of patients, shock with multiple organ dysfunction in 22.5%, encephalopathy/seizure in 20.4%, respiratory failure in 16.3%, and cardiac complications in 7.1% of patients. Treatment included antibiotic therapy alone in 43.9%, while 5.1% of patients were treated with immunosuppressants alone. Treatment with both antibiotics and immunosuppressants was used in 51% of patients. Appropriate empiric antibiotics were used in 62.2%. In 43.9% of cases of HLH due to tick-borne disease, patients received only antimicrobial therapy, and 88.4% of those recovered completely without the need for immunosuppressive therapy. The mortality rate in our review was 16.3%, and patients who received inappropriate or delayed empiric therapy had a worse outcome. Hence, we suggest empiric antibiotic treatment in patients who are suspected of having HLH due to tick-borne disease or in whom diagnostic uncertainty persists due to diagnostic delay in order to minimize mortality. |
