Human Ehrlichiosis

by CDC

Toward the end of the 19th century, scientists began to understand the important potential for ticks to act as transmitters of disease. In the last decades of the 20th century, several tick-borne diseases have been recognized in the United States, including babesiosis, Lyme disease, and ehrlichiosis.

Ehrlichiosis is caused by several bacterial species in the genus Ehrlichia (pronounced err-lick-ee-uh) which have been recognized since 1935. Over several decades, veterinary pathogens that caused disease in dogs, cattle, sheep, goats, and horses were identified. Currently, three species of Ehrlichia in the United States and one in Japan are known to cause disease in humans; others could be recognized in the future as methods of detection improve.

In 1953, the first ehrlichial pathogen of humans was identified in Japan. Sennetsu fever, caused by Ehrlichia sennetsu, is characterized by fever and swollen lymph nodes. The disease is very rare outside the Far East and Southeast Asia, and most cases have been reported from western Japan.

In the United States, human diseases caused by Ehrlichia species have been recognized since the mid-1980s. The ehrlichioses represent a group of clinically similar, yet epidemiologically and etiologically distinct, diseases caused by Ehrlichia chaffeensis, E. ewingii, and a bacterium extremely similar or identical to E. phagocytophila. The remainder of the information on this web page will focus on the types of ehrlichiosis that occur in the United States.

Human ehrlichiosis due to Ehrlichia chaffeensis was first described in 1987. The disease occurs primarily in the southeastern and south central regions of the country and is primarily transmitted by the lone star tick, Amblyomma americanum.

Human granulocytic ehrlichiosis (HGE) represents the second recognized ehrlichial infection of humans in the United States, and was first described in 1994. The name for the species that causes HGE has not been formally proposed, but this species is closely related or identical to the veterinary pathogens Ehrlichia equi and Ehrlichia phagocytophila. HGE is transmitted by the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus) in the United States.

Ehrlichia ewingii is the most recently recognized human pathogen. Disease caused by E. ewingii has been limited to a few patients in Missouri, Oklahoma, and Tennessee, most of whom have had underlying immunosuppression. The full extent of the geographic range of this species, its vectors, and its role in human disease is currently under investigation.

Signs and Symptoms

Symptoms

The early clinical presentations of ehrlichiosis may resemble nonspecific signs and symptoms of various other infectious and non-infectious diseases. It is unclear if all persons infected with ehrlichiae become ill. It is possible that many infected persons develop an illness so mild they do not seek medical attention or perhaps have no symptoms at all.

Patients with ehrlichiosis generally visit a physician in their first week of illness, following an incubation period of about 5-10 days after the tick bite. Initial symptoms generally include fever, headache, malaise, and muscle aches. Other signs and symptoms may include nausea, vomiting, diarrhea, cough, joint pains, confusion, and occasionally rash. In contrast to Rocky Mountain spotted fever, rash is relatively uncommon in adult patients with HME, and is rarely reported with HGE. However, rash has been described in approximately 60% of pediatric patients infected with E. chaffeensis.

Laboratory findings indicative of ehrlichiosis include leukopenia, thrombocytopenia, and elevated liver enzymes.

Ehrlichiosis can be a severe illness, especially if untreated, and as many as half of all patients require hospitalization. Severe manifestations of the disease may include prolonged fever, renal failure, disseminated intravascular coagulopathy, meningoencephalitis, adult respiratory distress syndrome, seizures, or coma. It is estimated that 2%-3% of patients may die from the infection. Preliminary evidence suggests that E. chaffeensis infection may become more severe than other ehrlichial infections.

The severity of ehrlichiosis may be related in part to the immune status of the patient. Persons with compromised immunity caused by immunosuppresive therapies (e.g., cortiocosteroids or cancer chemotherapy), HIV infection, or splenectomy appear to develop more severe disease, and case-fatality ratios for these individuals are characteristically higher than case-fatality ratios reported for the general population.

About the Author

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