Ehrlichiosis

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Background

  • Bacterial infection of the family Anaplasmataceae common in mammals such as cattle, dogs, sheep, goats, and horses[1]
  • Spread by the Lonestar tick (Amblyomma americanum)
    • Eastern seaboard from Florida to Maine and as far west as Iowa and Texas
    • States with the highest incidence:[2]
      • Rhode Island (36.5 cases per million)
      • Minnesota (3.9 to 12.3 cases per million)
      • Connecticut (8.1 to 15.9 cases per million)
    • People often unaware they are bitten with case fatality rate of approximately 1.8%[3]
    • More severe disease in immunocompromised patients (HIV, Elderly, Asplenic)
Lone Star Tick (preserved

Clinical Features

Differential Diagnosis

Tick Borne Illnesses

Evaluation

  • Peripheral blood smear[4]
  • Obligate intracellular organism
    • Smear shows intracellular parasites only 20% of time
  • PCR
    • Most sensitive in first week of illness
  • Indirect Immunoflorescence Assay'
    • Gold Standard
    • Negative 85% of time in first 7 days of illness
    • Compare 2 samples drawn at different times
    • 4 fold increase in titers of second draw is positive
  • Enzyme Immunoassay
    • Qualitative tests, not quantitative
  • Leukopenia, elevated transaminases, thrombocytopenia often present

Management

Doxycycline

  • Adults: 100mg PO/IV BID x 14 days
  • Children: (under 45 kg): 2.2mg/kg body weight twice a day

Disposition

  • most cases of Ehrlichiosis are treated as an outpatient

See also

References

  1. CDC. Ehrlichiosis. http://www.cdc.gov/ehrlichiosis.
  2. Sexton DJ and McClain MT. Human ehrlichiosis and anaplasmosis. UpToDate.
  3. CDC http://www.cdc.gov/ehrlichiosis/stats/
  4. http://www.cdc.gov/ehrlichiosis/symptoms/index.html#diagnosis