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Ehrlichioses - Causes, Symptoms and Treatment

What is Ehrlichioses?

The human ehrlichioses are considered emerging zoonotic diseases (diseases that can be passed from animals to man). There are two distinct forms of illness: human monocytic ehrlichiosis (HME) and human granulocytic ehrlichiosis (HGE). Since these diseases are newly recognized and there is no national surveillance program yet, national incidence rates are not available. However, hundreds of cases have been reported in 30 states, predominantly in the south-central, southeastern and mid-Atlantic regions. One-third of persons who seroconvert actually become ill. A majority of documented cases require hospitalization and a small percentage die.

What are the Causes of Ehrlichioses?

Human monocytic ehrliehiosis is caused by Ehrlichia chaileensis and an agent similar to the veterinary microbe E. equi, while E. phagocytophilia causes human granulocytic ehrlichiosis. The bacteria are transmitted to humans through tick bites. The lone star tick carries E. chaffeensis and is common in the southeastern United States . The black-legged tick transmits E. phagocytophilia in the northeastern United States and the western black-legged tick in the western coastal United States.

What are the Signs and Symptoms of Ehrlichioses?

The most common symptoms of both HME and HGE are nonspecitlc and include fever, headache, myalgia, thrombocytopenia, leukopenia, and elevated liver enzyme levels. A rash develops in approximately one-third of patients with HME but is rare in patients with HGE. Complications such as adult respiratory distress syndrome, renal failure, neurologic disorders, and disseminated intravascular coagulation can occur.

Diagnosis for Ehrlichioses

To diagnose ehrlichiosis, the doctor must have a high index of suspicion when presented with the above symptoms and a history of recent exposure to ticks in an endemic area during the previous 3 weeks. Laboratory results showing leukopenia and thrombocytopenia are used to support ,clinical findings. Indirect immunofluorescence assay and polymerase chain reaction are used to confirm the diagnosis.

Differential diagnoses include rickettsial diseases such as Rocky Mountain spotted fever, eastern tick-borne rickettsioses, rickettsialpox, and Q fever. Other infectious diseases to consider are meningococcemia and rubeola. Until a rash appears, it may be difficult to differentiate; however, treatment of suspected ehrlichiosis should not be delayed.

Treatment for Ehrlichioses

Tetracycline or doxycycline can be given orally or I.V. Chloramphenicol can also be used but may not be as effective.

Special Considerations and Prevention Tips for Ehrlichioses

  • Stress the importance of completing the full course of antibiotic therapy even if symptoms resolve.
  • Provide appropriate comfort measures.
  • Observe for Signs and symptoms of any developing complications and respond appropriately.
  • Advise patients that the best way to prevent Ehrlichiosis is to avoid being bitten by ticks. Instruct patients on proper precautions in endemic areas, such as wearing protective clothing, using tick repellent, and careful, prompt removal of ticks found on the body.

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