Ehrlichiosis

Definition

Ehrlichiosis is an infectious disease transmitted by the bite of a tick.

Alternative Names

Causes

Ehrlichiosis is caused by bacteria that belong to the family called Rickettsiae. Rickettsial bacteria cause a number of serious diseases worldwide, including Rocky Mountain spotted fever and typhus. All of these diseases are spread to humans by a tick, flea, or mite bite. Scientists first described ehrlichiosis in 1990, and have identified two types in the United States.

• Human monocytic ehrlichiosis (HME) is caused by the rickettsial bacteria called Ehrlichia chaffeensis.
• Human granulocytic ehrlichiosis (HGE) is also called human granulocytic anaplasmosis (HGA). It is caused by the rickettsial bacteria called Anaplasma phagocytophilum (once called Ehrlichia equi or Ehrlichia phagocytophila).

Ehrlichia bacteria can be carried by the Lone Star tick, the American dog tick, and the deer tick, which can also cause Lyme disease

In the United States, HME is found mainly in the southern central states and the Southeast. HGE is found mainly in the Northeast and upper Midwest.

Risk factors for ehrlichiosis include living near an area with a lot of ticks, walking or playing in high grasses, and owning a pet that may bring a tick home.

Symptoms

The time between the tick bite and when symptoms occur is about 7 - 9 days. This is called the incubation period.

Symptoms may seem like the flu (influenza), and may include:

• Fever
• Chills
• Headache
• Nausea
• Muscle aches

Other possible symptoms:

• Diarrhea
• Malaise
• Rash, maculopapular
• Rash, petechial (fine pinhead-sized hemorrhages in the skin)

A rash appears in less than half of the cases. Sometimes, the disease may be mistaken for Rocky Mountain spotted fever. The symptoms are often quite general, but the patient is sometimes sick enough to see a doctor.

Exams and Tests

The doctor will perform a physical exam and check your vital signs, including blood pressure, heart rate, and temperature.

A complete blood count (CBC) shows decreased white blood cells, a condition called leukopenia. The platelet count will be low. This is called thrombocytopenia.

A granulocyte stain shows clumps of the ehrlichia bacteria inside white blood cells. Tests of liver function may show high levels of a substance called transaminase.

A fluorescent antibody test may be used to detect the specific type of bacteria that is causing the condition.

Treatment

Tetracycline or doxycycline antibiotics are used to treat the disease. Young children should not take tetracycline by mouth until after all the permanent teeth have grown in, because it can permanently discolor growing teeth.

Outlook (Prognosis)

Ehrlichiosis is rarely deadly. With antibiotics, improvements are usually seen in 24 to 48 hours. Recovery takes 3 weeks.

Possible Complications

• Lung damage
• Kidney damage
• Other organ damage
• Death (rare)

When to Contact a Medical Professional

Call your health care provider if you become sick after a recent tick bite or being around areas where ticks are common. Be sure to tell your doctor about the tick exposure.

Prevention

Ehrlichiosis is spread by tick bites. Preventing tick bites will prevent this condition, as well as other tick-borne diseases. Common measures include:

• Using insect repellent
• Wearing clothing to cover skin
• Avoiding dense brush and long grasses when hiking
• Not standing under trees or bushes
• Checking yourself for ticks and removing any that may be found after being outside

Studies suggest that a tick must be attached to your body for at least 24 hours in order to cause disease, so early removal will prevent infection. If you are bit by a tick, write down the date and time the bite happened, and bring this information to your doctor if you become sick.

Bratton RL. Tick-borne disease. Am Fam Physician. 2005; 71(12): 2323-30.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 5th ed. London: Churchill Livingstone; 2000:2310-2315.