Ehrlichiosis and anaplasmosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Human ehrlichiosis and anaplasmosis, of all types, are nationally notifiable diseases.
Seasonality is due to higher likelihood of tick exposure/bite when people spend more time outdoors in warmer months.
Presumptive diagnosis is made in patients with potential tick exposure/demonstrated tick bite combined with fever and other characteristic constitutional symptoms plus leukopenia and/or thrombocytopenia and elevated LFTs. Serology or polymerase chain reaction confirms diagnosis.
Treatment with antibiotics should be started immediately if the diagnosis is suspected clinically. Doxycycline is the drug of choice.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Tick bite at later stage with central necrosis (dark area around tick bite) surrounded by a markedly erythematous area
Erythematous macular rash involving the lower extremity in a pediatric case of human monocytotropic/monocytic ehrlichiosis
Peripheral blood smear showing intracytoplasmic morulae (arrow) of Anaplasma phagocytophilum in a polymorphonuclear neutrophil (Giemsa stain, 1000x)

Citations

Key Articles

Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers. Sixth edition (2022). Aug 2022 [internet publication].[Full Text]
Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016 May 13;65(2):1-44.[Abstract][Full Text]

Referenced Articles

1. Dumler JS, Barbet AF, Bekker CP, et al. Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales: unification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designation of Ehrlichia equi and 'HGE agent' as subjective synonyms of Ehrlichia phagocytophila. Int J Syst Evol Microbiol. 2001 Nov;51(pt 6):2145-65.[Abstract][Full Text]
2. Anderson BE, Dawson JE, Jones DC, et al. Ehrlichia chaffeensis, a new species associated with human ehrlichiosis. J Clin Microbiol. 1991 Dec;29(12):2838-42.[Abstract]
3. Chen SM, Dumler JS, Bakken JS, et al. Identification of a granulocytotropic Ehrlichia species as the etiologic agent of human disease. J Clin Microbiol. 1994 Mar;32(3):589-95.[Abstract]
4. Buller RS, Arens M, Hmiel SP, et al. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med. 1999 Jul 15;341(3):148-55.[Abstract][Full Text]
5. Johnson DK, Schiffman EK, Davis JP, et al. Human infection with Ehrlichia muris-like pathogen, United States, 2007-2013. Emerg Infect Dis. 2015 Oct;21(10):1794-9. [Abstract]
6. Saito TB, Thirumalapura NR, Shelite TR, et al. An animal model of a newly emerging human ehrlichiosis. J Infect Dis. 2015 Feb 1;211(3):452-61.[Abstract]
7. von Loewenich FD, Geissdörfer W, Disqué C, et al. Detection of "Candidatus Neoehrlichia mikurensis" in two patients with severe febrile illnesses: evidence for a European sequence variant. J Clin Microbiol. 2010 Jul;48(7):2630-5.[Abstract][Full Text]
8. Welc-Falęciak R, Siński E, Kowalec M, et al. Asymptomatic "Candidatus Neoehrlichia mikurensis" infections in immunocompetent humans. J Clin Microbiol. 2014 Aug;52(8):3072-4.[Abstract][Full Text]
9. Raoult D. Uncultured candidatus neoehrlichia mikurensis. Clin Infect Dis. 2014 Oct;59(7):1042. [Abstract]
10. Grankvist A, Andersson PO, Mattsson M, et al. Infections with the tick-borne bacterium "Candidatus Neoehrlichia mikurensis" mimic noninfectious conditions in patients with B cell malignancies or autoimmune diseases. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2014 Jun;58(12):1716-22.[Abstract][Full Text]
11. Andréasson K, Jönsson G, Lindell P, et al. Recurrent fever caused by Candidatus Neoehrlichia mikurensis in a rheumatoid arthritis patient treated with rituximab. Rheumatology (Oxford). 2015 Feb;54(2):369-71.[Abstract]
12. Li H, Jiang JF, Liu W, et al. Human infection with Candidatus Neoehrlichia mikurensis, China. Emerg Infect Dis. 2012 Oct;18(10):1636-9.[Abstract][Full Text]
13. Otrock ZK, Gonzalez MD, Eby CS. Ehrlichia-induced hemophagocytic lymphohistiocytosis: a case series and review of literature. Blood Cells Mol Dis. 2015 Oct;55(3):191-3.[Abstract]
14. Patel TP, Beck P, Chairman D, et al. Ehrlichiosis presenting as hemophagocytic lymphohistiocytosis in an immunocompetent adult. IDCases. 2020;20:e00813.[Abstract][Full Text]
15. Nichols Heitman K, Dahlgren FS, Drexler NA, et al. Increasing incidence of Ehrlichiosis in the United States: a summary of national surveillance of Ehrlichia chaffeensis and Ehrlichia ewingii infections in the United States, 2008-2012. Am J Trop Med Hyg. 2016 Jan;94(1):52-60.[Abstract]
16. Olano JP, Masters E, Hogrefe W, et al. Human monocytotropic ehrlichiosis, Missouri. Emerg Infect Dis. 2003 Dec;9(12):1579-86.[Abstract]
17. Standaert SM, Yu T, Scott MA, et al. Primary isolation of Ehrlichia chaffeensis from patients with febrile illnesses: clinical and molecular characteristics. J Infect Dis. 2000 Mar;181(3):1082-8.[Abstract]
18. Marshall GS, Jacobs RF, Schutze GE, et al. Ehrlichia chaffeensis seroprevalence among children in the southeast and south-central regions of the United States. Arch Pediatr Adolesc Med. 2002 Feb;156(2):166-70.[Abstract][Full Text]
19. Standaert SM, Dawson JE, Schaffner W, et al. Ehrlichiosis in a golf-oriented retirement community. N Engl J Med. 1995 Aug 17;333(7):420-5.[Abstract][Full Text]
20. Centers for Disease Control and Prevention. Ehrlichiosis - epidemiology and statistics. Aug 2022 [internet publication].[Full Text]
21. Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers. Sixth edition (2022). Aug 2022 [internet publication].[Full Text]
22. Yu DH, Li YH, Yoon JS, et al. Ehrlichia chaffeensis infection in dogs in South Korea. Vector Borne Zoonotic Dis. 2008 Jun;8(3):355-8.[Abstract]
23. Dahlgren FS, Heitman KN, Drexler NA, et al. Human granulocytic anaplasmosis in the United States from 2008 to 2012: a summary of national surveillance data. Am J Trop Med Hyg. 2015 Jul;93(1):66-72. [Abstract]
24. Bakken JS, Goellner P, Van Etten M, et al. Seroprevalence of human granulocytic ehrlichiosis among permanent residents of northwestern Wisconsin. Clin Infect Dis. 1998 Dec;27(6):1491-6.[Abstract]
25. Centers for Disease Control and Prevention. Anaplasmosis - epidemiology and statistics. Aug 2022 [internet publication].[Full Text]
26. Heyman P, Cochez C, Hofhuis A, et al. A clear and present danger: tick-borne diseases in Europe. Exp Rev Anti Infect Ther. 2010 Jan;8(1):33-50.[Abstract]
27. Pritt BS. Haemaphysalis longicornis is in the United States and biting humans: where do we go from here? Clin Infect Dis. 2020 Jan 2;70(2):317-8.[Abstract]
28. Mowla SJ, Drexler NA, Cherry CC, et al. Ehrlichiosis and anaplasmosis among transfusion and transplant recipients in the United States. Emerg Infect Dis. 2021 Nov;27(11):2768-75.[Abstract][Full Text]
29. Sotomayor EA, Popov VL, Feng HM, et al. Animal model of fatal human monocytotropic ehrlichiosis. Am J Pathol. 2001;158:757-769.[Abstract]
30. Olano JP, Wen G, Feng HM, et al. Histologic, serologic, and molecular analysis of persistent ehrlichiosis in a murine model. Am J Pathol. 2004;165:997-1006.[Abstract]
31. Ismail N, Soong L, McBride JW, et al. Overproduction of TNF-alpha by CD8+ type 1 cells and down-regulation of IFN-gamma production by CD4+ Th1 cells contribute to toxic shock-like syndrome in an animal model of fatal monocytotropic ehrlichiosis. J Immunol. 2004 Feb 1;172(3):1786-800.[Abstract][Full Text]
32. Bunnell JE, Trigiani ER, Srinivas SR, et al. Development and distribution of pathologic lesions are related to immune status and tissue deposition of human granulocytic ehrlichiosis agent-infected cells in a murine model system. J Infect Dis. 1999 Aug;180(2):546-50.[Abstract][Full Text]
33. Martin ME, Caspersen K, Dumler JS. Immunopathology and ehrlichial propagation are regulated by interferon-gamma and interleukin-10 in a murine model of human granulocytic ehrlichiosis. Am J Pathol. 2001;158:1881-1888.[Abstract]
34. Foley JE, Lerche NW, Dumler JS, et al. A simian model of human granulocytic ehrlichiosis. Am J Trop Med Hyg. 1999 Jun;60(6):987-93.[Abstract]
35. Zhu B, Nethery KA, Kuriakose JA, et al. Nuclear translocated Ehrlichia chaffeensis ankyrin protein interacts with a specific adenine-rich motif of host promoter and intronic Alu elements. Infection and Immunity. 2009:77:4243-4255[Abstract][Full Text]
36. Garcia-Garcia JC, Barat NC, Trembely SJ, et al. Epigenetic silencing of host cell defense genes enhances intracellular survival of the rickettsial pathogen Anaplasma phagocytophilum. PLoS Pathog. 2009:5:e1000488.[Abstract][Full Text]
37. Zhang JZ, McBride JW, Yu XJ. L-selectin and E-selectin expressed on monocytes mediating Ehrlichia chaffeensis attachment onto host cells. FEMS Microbiol Lett. 2003;227:303-309.[Abstract]
38. Kumagai Y, Cheng Z, Lin M, et al. Biochemical activities of three pairs of Ehrlichia chaffeensis two-component regulatory system proteins involved in inhibition of lysosomal fusion. Infect Immun. 2006 Sep;74(9):5014-22.[Abstract][Full Text]
39. Lin M, Rikihisa Y. Degradation of p22phox and inhibition of superoxide generation by Ehrlichia chaffeensis in human monocytes. Cell Microbiol. 2007;9:861-874.[Abstract]
40. Banerjee R, Anguita J, Roos D, et al. Cutting edge: infection by the agent of human granulocytic ehrlichiosis prevents the respiratory burst by down-regulating gp91phox. J Immunol. 2000;164:3946-3949.[Abstract][Full Text]
41. Barnewall RE, Rikihisa Y, Lee EH. Ehrlichia chaffeensis inclusions are early endosomes which selectively accumulate transferrin receptor. Infect Immun. 1997 Apr;65(4):1455-61.[Abstract][Full Text]
42. Barnewall RE, Rikihisa Y. Abrogation of gamma interferon-induced inhibition of Ehrlichia chaffeensis infection in human monocytes with iron-transferrin. Infect Immun. 1994 Nov;62(11):4804-10.[Abstract][Full Text]
43. Rikihisa Y. Anaplasma phagocytophilum and Ehrlichia chaffeensis: subversive manipulators of host cells. Nat Rev Microbiol. 2010;8:328-339.[Abstract]
44. Byerly CD, Patterson LL, McBride JW. Ehrlichia TRP effectors: moonlighting, mimicry and infection. Pathog Dis. 2021 May 11;79(5):.[Abstract][Full Text]
45. Patterson LL, Byerly CD, McBride JW. Anaplasmataceae: dichotomous autophagic interplay for infection. Front Immunol. 2021;12:642771.[Abstract][Full Text]
46. Dumler JS, Dawson JE, Walker DH. Human ehrlichiosis: hematopathology and immunohistologic detection of Ehrlichia chaffeensis. Hum Pathol. 1993 Apr;24(4):391-6.[Abstract]
47. Sehdev AE, Dumler JS. Hepatic pathology in human monocytic ehrlichiosis: Ehrlichia chaffeensis infection. Am J Clin Pathol. 2003;119:859-865.[Abstract]
48. Walker DH, Dumler JS. Human monocytic and granulocytic ehrlichioses: discovery and diagnosis of emerging tick-borne infections and the critical role of the pathologist. Arch Pathol Lab Med. 1997 Aug;121(8):785-91.[Abstract]
49. Dierberg KL, Dumler JS. Lymph node hemophagocytosis in rickettsial diseases: a pathogenetic role for CD8 T lymphocytes in human monocytic ehrlichiosis (HME)? BMC Infect Dis. 2006;6:121.[Abstract][Full Text]
50. Ismail N, Stevenson HL, Walker DH. Role of tumor necrosis factor alpha (TNF-alpha) and interleukin-10 in the pathogenesis of severe murine monocytotropic ehrlichiosis: increased resistance of TNF receptor p55- and p75-deficient mice to fatal ehrlichial infection. Infect Immun. 2006;74:1846-1856.[Abstract][Full Text]
51. Goodman JL, Nelson CM, Klein MB, et al. Leukocyte infection by the granulocytic ehrlichiosis agent is linked to expression of a selectin ligand. J Clin Invest. 1999;103:407-412.[Abstract][Full Text]
52. Herron MJ, Nelson CM, Larson J, et al. Intracellular parasitism by the human granulocytic ehrlichiosis bacterium through the P-selectin ligand, PSGL-1. Science. 2000;288:1653-1656.[Abstract]
53. Bedner E, Burfeind P, Hsieh TC, et al. Cell cycle effects and induction of apoptosis caused by infection of HL-60 cells with human granulocytic ehrlichiosis pathogen measured by flow and laser scanning cytometry. Cytometry. 1998;33:47-55.[Abstract]
54. Hsieh TC, Aguero-Rosenfeld ME, Wu JM, et al. Cellular changes and induction of apoptosis in human promyelocytic HL-60 cells infected with the agent of human granulocytic ehrlichiosis (HGE). Biochem Biophys Res Commun. 1997;232:298-303.[Abstract]
55. Yoshiie K, Kim HY, Mott J, et al. Intracellular infection by the human granulocytic ehrlichiosis agent inhibits human neutrophil apoptosis. Infect Immun. 2000 Mar;68(3):1125-33.[Abstract][Full Text]
56. Lepidi H, Bunnell JE, Martin ME, et al. Comparative pathology, and immunohistology associated with clinical illness after Ehrlichia phagocytophila-group infections. Am J Trop Med Hyg. 2000 Jan;62(1):29-37.[Abstract][Full Text]
57. Thomas LD, Hongo I, Bloch KC, et al. Human ehrlichiosis in transplant recipients. Am J Transplant. 2007 Jun;7(6):1641-7.[Abstract][Full Text]
58. Paddock CD, Folk SM, Shore GM, et al. Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus. Clin Infect Dis. 2001 Nov 1;33(9):1586-94.[Abstract]
59. Safdar N, Love RB, Maki DG. Severe Ehrlichia chaffeensis infection in a lung transplant recipient: a review of ehrlichiosis in the immunocompromised patient. Emerg Infect Dis.2002 Mar;8(3):320-3.[Abstract][Full Text]
60. Peters TR, Edwards KM, Standaert SM. Severe ehrlichiosis in an adolescent taking trimethoprim-sulfamethoxazole. Pediatr Infect Dis J. 2000 Feb;19(2):170-2.[Abstract]
61. Fishbein DB, Kemp A, Dawson JE, et al. Human ehrlichiosis: prospective active surveillance in febrile hospitalized patients. J Infect Dis. 1989 Nov;160(5):803-9.[Abstract]
62. Bakken JS, Krueth J, Wilson-Nordskog C, et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA. 1989 Nov;160(5):803-9.[Abstract]
63. Horowitz HW, Aguero-Rosenfeld ME, McKenna DF, et al. Clinical and laboratory spectrum of culture-proven human granulocytic ehrlichiosis: comparison with culture-negative cases. Clin Infect Dis. 1998 Nov;27(5):1314-7.[Abstract]
64. Schutze GE, Jacobs RF. Human monocytic ehrlichiosis in children. Pediatrics. 1997 Jul;100(1):E10.[Abstract]
65. Schutze GE. Ehrlichiosis. Pediatr Infect Dis J. 2006 Jan;25(1):71-2.[Abstract]
66. Weil AA, Baron EL, Brown CM, et al. Clinical findings and diagnosis in human granulocytic anaplasmosis: a case series from Massachusetts. Mayo Clin Proc. 2012 Mar;87(3):233-9.[Abstract]
67. Hamilton KS, Standaert SM, Kinney MC. Characteristic peripheral blood findings in human ehrlichiosis. Mod Pathol. 2004 May;17(5):512-7.[Abstract][Full Text]
68. Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States. MMWR Recomm Rep. 2016 May 13;65(2):1-44.[Abstract][Full Text]
69. Dumler JS, Madigan JE, Pusterla N, et al. Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clin Infect Dis. 2007 Jul 15;45 Suppl 1:S45-51.[Abstract]
70. Bakken JS, Dumler JS. Human granulocytic ehrlichiosis. Clin Infect Dis. 2000 Aug;31(2):554-60.[Abstract]
71. Olano J, Walker DH. Current recommendations for diagnosis and treatment of human ehrlichiosis. Infect Med. 2002;19:318-325.
72. Aguero-Rosenfeld ME, Horowitz HW, Wormser GP, et al. Human granulocytic ehrlichiosis: a case series from a medical center in New York State. Ann Intern Med. 1996 Dec 1;125(11):904-8.[Abstract]
73. Comer JA, Nicholson WL, Sumner JW, et al. Diagnosis of human ehrlichiosis by PCR assay of acute-phase serum. J Clin Microbiol. 1999 Jan;37(1):31-4.[Abstract][Full Text]
74. Comer JA, Nicholson WL, Olson JG, et al. Serologic testing for human granulocytic ehrlichiosis at a national referral center. J Clin Microbiol. 1999 Mar;37(3):558-64.[Abstract][Full Text]
75. Paddock CD, Childs JE. Ehrlichia chaffeensis: a prototypical emerging pathogen. Clin Microbiol Rev. 2003 Jan;16(1):37-64.[Abstract][Full Text]
76. Walker DH. Task Force on Consensus Approach for Ehrlichiosis. Diagnosing human ehrlichioses: current status and recommendations. ASM News. 2000;66:287-290.
77. Olano JP, Walker DH. Human ehrlichioses. Med Clin North Am. 2002 Mar;86(2):375-92.[Abstract]
78. Bakken JS, Haller I, Riddell D, et al. The serological response of patients infected with the agent of human granulocytic ehrlichiosis. Clin Infect Dis. 2002;34:22-27.[Abstract]
79. Walls JJ, Aguero-Rosenfeld M, Bakken JS, et al. Inter- and intralaboratory comparison of Ehrlichia equi and human granulocytic ehrlichiosis (HGE) agent strains for serodiagnosis of HGE by the immunofluorescent-antibody test. J Clin Microbiol. 1999 Sep;37(9):2968-73.[Abstract][Full Text]
80. Everett ED, Evans KA, Henry RB, et al. Human ehrlichiosis in adults after tick exposure: diagnosis using polymerase chain reaction. Ann Intern Med. 1994 May 1;120(9):730-5.[Abstract]
81. Anderson BE, Sumner JW, Dawson JE, et al. Detection of the etiologic agent of human ehrlichiosis by polymerase chain reaction. J Clin Microbiol. 1992 Apr;30(4):775-80.[Abstract][Full Text]
82. Sirigireddy KR, Ganta RR. Multiplex detection of Ehrlichia and Anaplasma species pathogens in peripheral blood by real-time reverse transcriptase-polymerase chain reaction. J Mol Diagn.2005 May;7(2):308-16.[Abstract]
83. Doyle CK, Labruna MB, Breitschwerdt EB, et al. Detection of medically important Ehrlichia by quantitative multicolor TaqMan real-time polymerase chain reaction of the dsb gene. J Mol Diagn.2005 Oct;7(4):504-10.[Abstract]
84. Bakken JS, Dumler JS. Clinical diagnosis and treatment of human granulocytotropic anaplasmosis. Ann N Y Acad Sci. 2006 Oct;1078:236-47.[Abstract]
85. Bakken JS, Dumler JS, Chen SM, et al. Human granulocytic ehrlichiosis in the upper Midwest United States: a new species emerging? JAMA. 1994 Jul 20;272(3):212-8.[Abstract]
86. Courtney JW, Dryden RL, Wyleto P, et al. Characterization of Anaplasma phagocytophila and Borrelia burgdorferi genotypes in Ixodes scapularis ticks from Pennsylvania. Ann N Y Acad Sci. 2003 Jun;990:131-3.[Abstract]
87. Dumler JS, Brouqui P. Molecular diagnosis of human granulocytic anaplasmosis. Expert Rev Mol Diagn. 2004 Jul;4(4):559-69.[Abstract]
88. Gusa AA, Buller RS, Storch GA, et al. Identification of a p28 gene in Ehrlichia ewingii: evaluation of gene for use as a target for a species-specific PCR diagnostic assay. J Clin Microbiol. 2001 Nov;39(11):3871-6.[Abstract]
89. Thompson C, Spielman A, Krause PJ. Coinfecting deer-associated zoonoses: Lyme disease, babesiosis, and ehrlichiosis. Clin Infect Dis. 2001 Sep 1;33(5):676-85.[Abstract]
90. Krause PJ, Telford SR 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. 1996 Jun 5;275(21):1657-60.[Abstract]
91. Benach JL, Coleman JL, Habicht GS, et al. Serological evidence for simultaneous occurrences of Lyme disease and babesiosis. J Infect Dis. 1985 Sep;152(3):473-7.[Abstract]
92. Magnarelli LA, Dumler JS, Anderson JF, et al. Coexistence of antibodies to tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in human sera. J Clin Microbiol. 1995 Nov;33(11):3054-7.[Abstract][Full Text]
93. Nadelman RB, Horowitz HW, Hsieh TC, et al. Simultaneous human granulocytic ehrlichiosis and Lyme borreliosis. N Engl J Med. 1997 Jul 3;337(1):27-30.[Abstract][Full Text]
94. Mather TN, Telford SR 3rd, Moore SI, et al. Borrelia burgdorferi and Babesia microti: efficiency of transmission from reservoirs to vector ticks (Ixodes dammini). Exper Parasitol. 1990 Jan;70(1):55-61.[Abstract]
95. Aguero-Rosenfeld ME. Laboratory aspects of tick-borne diseases: lyme, human granulocytic ehrlichiosis and babesiosis. Mt Sinai J Med. 2003 May;70(3):197-206.[Abstract]
96. van Dam AP, Kuiper H, Vos K, et al. Different genospecies of Borrelia burgdorferi are associated with distinct clinical manifestations of Lyme borreliosis. Clin Infect Dis. 1993 Oct;17(4):708-17.[Abstract]
97. Conrad PA, Kjemtrup AM, Carreno RA, et al. Description of Babesia duncani n.sp. (Apicomplexa: Babesiidae) from humans and its differentiation from other piroplasms. Int J Parasitol. 2006 Jun;36(7):779-89.[Abstract]
98. Centers for Disease Control and Prevention. Babesiosis. Oct 2017 [internet publication].[Full Text]
99. Eng TR, Harkess JR, Fishbein DB, et al. Epidemiologic, clinical, and laboratory findings of human ehrlichiosis in the United States, 1988. JAMA. 1990 Nov 7;264(17):2251-8.[Abstract]
100. Olano JP, Hogrefe W, Seaton B, et al. Clinical manifestations, epidemiology, and laboratory diagnosis of human monocytotropic ehrlichiosis in a commercial laboratory setting. Clin Diagn Lab Immunol. 2003 Sep;10(5):891-6.[Abstract][Full Text]
101. Olano JP. Human ehrlichioses. In: Raoult D, Parola, P, ed. Rickettsial diseases. New York, NY: Informa Healthcare USA; 2007:213-222.
102. Centers for Disease Control and Prevention. Ehrlichiosis and anaplasmosis: 2008 case definition. January 2008 [internet publication].[Full Text]
103. Brouqui P, Dumler JS, Raoult D, et al. Antigenic characterization of ehrlichiae: protein immunoblotting of Ehrlichia canis, Ehrlichia sennetsu, and Ehrlichia risticii. J Clin Microbiol. 1992 May;30(5):1062-6.[Abstract][Full Text]
104. Chen SM, Dumler JS, Feng HM, et al. Identification of the antigenic constituents of Ehrlichia chaffeensis. Am J Trop Med Hyg. 1994 Jan;50(1):52-8.[Abstract]
105. Chen SM, Cullman LC, Walker DH. Western immunoblotting analysis of the antibody responses of patients with human monocytotropic ehrlichiosis to different strains of Ehrlichia chaffeensis and Ehrlichia canis. Clin Diagn Lab Immunol. 1997 Nov;4(6):731-5.[Abstract][Full Text]
106. Wong SJ, Brady GS, Dumler JS. Serological responses to Ehrlichia equi, Ehrlichia chaffeensis, and Borrelia burgdorferi in patients from New York State. J Clin Microbiol. 1997 Sep;35(9):2198-205.[Abstract][Full Text]
107. Yu XJ, Crocquet-Valdes P, Cullman LC, et al. The recombinant 120-kilodalton protein of Ehrlichia chaffeensis, a potential diagnostic tool. J Clin Microbiol. 1996 Nov;34(11):2853-5.[Abstract][Full Text]
108. Unver A, Felek S, Paddock CD, et al. Western blot analysis of sera reactive to human monocytic ehrlichiosis and human granulocytic ehrlichiosis agents. J Clin Microbiol. 2001 Nov;39(11):3982-6.[Abstract][Full Text]
109. Tajima T, Zhi N, Lin Q, et al. Comparison of two recombinant major outer membrane proteins of the human granulocytic ehrlichiosis agent for use in an enzyme-linked immunosorbent assay. Clin Diagn Lab Immunol. 2000 Jul;7(4):652-7.[Abstract][Full Text]
110. Luo T, Zhang X, Nicholson WL, et al. Molecular characterization of antibody epitopes of Ehrlichia chaffeensis ankyrin protein 200 and tandem repeat protein 47 and evaluation of synthetic immunodeterminants for serodiagnosis of human monocytotropic ehrlichiosis. Clin Vaccine Immunol. 2010 Jan;17(1):87-97.[Abstract][Full Text]
111. Dumler JS, Brouqui P, Aronson J, et al. Identification of Ehrlichia in human tissue. N Engl J Med. 1991 Oct 10;325(15):1109-10.[Abstract]
112. Yu X, Brouqui P, Dumler JS, et al. Detection of Ehrlichia chaffeensis in human tissue by using a species-specific monoclonal antibody. J Clin Microbiol. 1993 Dec;31(12):3284-8.[Abstract][Full Text]
113. Bakken JS, Krueth J, Tilden RL, et al. Serological evidence of human granulocytic ehrlichiosis in Norway. Eur J Clin Microbiol Infect Dis. 1996;15:829-832.[Abstract]
114. Dumler JS, Dotevall L, Gustafson R, et al. A population-based seroepidemiologic study of human granulocytic ehrlichiosis and Lyme borreliosis on the west coast of Sweden. J Infect Dis. 1997;175:720-722.[Abstract]
115. Brouqui P, Dumler JS. Serologic evidence of human monocytic and granulocytic ehrlichiosis in Israel. Emerg Infect Dis. 2000;6:314-315.[Abstract]
116. Heo EJ, Park JH, Koo JR, et al. Serologic and molecular detection of Ehrlichia chaffeensis and Anaplasma phagocytophila (human granulocytic ehrlichiosis agent) in Korean patients. J Clin Microbiol. 2002 Aug;40(8):3082-5.[Abstract][Full Text]
117. Park JH, Heo EJ, Choi KS, et al. Detection of antibodies to Anaplasma phagocytophilum and Ehrlichia chaffeensis antigens in sera of Korean patients by western immunoblotting and indirect immunofluorescence assays. Clin Diagn Lab Immunol. 2003 Nov;10(6):1059-64.[Abstract][Full Text]
118. Guillaume B, Heyman P, Lafontaine S, et al. Seroprevalence of human granulocytic ehrlichiosis infection in Belgium. Eur J Clin Microbiol Infect Dis. 2002;21:397-400.[Abstract]
119. Heppner DG, Wongsrichanalai C, Walsh DS, et al. Human ehrlichiosis in Thailand. Lancet. 1997;350:785-786.[Abstract]
120. Centers for Disease Control and Prevention. Rickettsial diseases. CDC yellow book 2024: health information for international travel. May 2023 [internet publication].[Full Text]
121. Thomas RJ, Dumler JS, Carlyon JA. Current management of human granulocytic anaplasmosis, human monocytic ehrlichiosis and Ehrlichia ewingii ehrlichiosis. Expert Rev Anti Infect Ther. 2009 Aug;7(6):709-22.[Abstract][Full Text]
122. Branger S, Rolain JM, Raoult D. Evaluation of antibiotic susceptibilities of Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum by real-time PCR. Antimicrob Agents Chemother. 2004 Dec;48(12):4822-8.[Abstract][Full Text]
123. Maurin M, Abergel C, Raoult D. DNA gyrase-mediated natural resistance to fluoroquinolones in Ehrlichia spp. Antimicrob Agents Chemother. 2001 Jul;45(7):2098-105.[Abstract][Full Text]
124. Maurin M, Bakken JS, Dumler JS. Antibiotic susceptibilities of Anaplasma (Ehrlichia) phagocytophilum strains from various geographic areas in the United States. Antimicrob Agents Chemother. 2003 Jan;47(1):413-5.[Abstract][Full Text]
125. Rolain JM, Maurin M, Bryskier A, et al. In vitro activities of telithromycin (HMR 3647) against Rickettsia rickettsii, Rickettsia conorii, Rickettsia africae, Rickettsia typhi, Rickettsia prowazekii, Coxiella burnetii, Bartonella henselae, Bartonella quintana, Bartonella bacilliformis, and Ehrlichia chaffeensis. Antimicrob Agents Chemother. 2000 May;44(5):1391-3.[Abstract][Full Text]
126. Brouqui P, Raoult D. In vitro antibiotic susceptibility of the newly recognized agent of ehrlichiosis in humans, Ehrlichia chaffeensis. Antimicrob Agents Chemother. 1992 Dec;36(12):2799-803.[Abstract][Full Text]
127. Klein MB, Nelson CM, Goodman JL. Antibiotic susceptibility of the newly cultivated agent of human granulocytic ehrlichiosis: promising activity of quinolones and rifamycins. Antimicrob Agents Chemother. 1997 Jan;41(1):76-9.[Abstract][Full Text]
128. Horowitz HW, Hsieh TC, Aguero-Rosenfeld ME, et al. Antimicrobial susceptibility of Ehrlichia phagocytophila. Antimicrob Agents Chemother. 2001 Mar;45(3):786-8.[Abstract][Full Text]
129. Hunfeld KP, Bittner T, Rodel R, et al. New real-time PCR-based method for in vitro susceptibility testing of Anaplasma phagocytophilum against antimicrobial agents. Int J Antimicrob Agents. 2004 Jun;23(6):563-71.[Abstract]
130. Dhand A, Nadelman RB, Aguero-Rosenfeld M, et al. Human granulocytic anaplasmosis during pregnancy: case series and literature review. Clin Infect Dis. 2007 Sep 1;45(5):589-93.[Abstract]
131. Purvis JJ, Edwards MS. Doxycycline use for rickettsial disease in pediatric patients. Pediatr Infect Dis J. 2000 Sep;19(9):871-4.[Abstract]
132. Pickering LK, ed. Red book: report of the Committee on Infectious diseases, 28th ed. Elk Grove Village, IL: American Academy of Pediatrics.
133. Lantos P, Krause PJ. Ehrlichiosis in children. Semin Pediatr Infect Dis. 2002 Oct;13(4):249-56.[Abstract]
134. Dumler JS, Bakken JS. Human ehrlichioses: newly recognized infections transmitted by ticks. Annu Rev Med. 1998;49:201-13.[Abstract]
135. Paparone PW, Ljubich P, Rosman GA, et al. Ehrlichiosis with pancytopenia and ARDS. N J Med. 1995 Jun;92(6):381-5.[Abstract]
136. Weaver RA, Virella G, Weaver A. Ehrlichiosis with severe pulmonary manifestations despite early treatment. South Med J. 1999 Mar;92(3):336-9.[Abstract]
137. Patel RG, Byrd MA. Near fatal acute respiratory distress syndrome in a patient with human ehrlichiosis. South Med J. 1999 Mar;92(3):333-5.[Abstract]
138. Modi KS, Dahl DC, Berkseth RO, et al. Human granulocytic ehrlichiosis presenting with acute renal failure and mimicking thrombotic thrombocytopenic purpura: a case report and review. Am J Nephrol. 1999;19(6):677-81.[Abstract]
139. Shea KW, Calio AJ, Klein NC, et al. Rhabdomyolysis associated with Ehrlichia chaffeensis infection. Clin Infect Dis. 1995 Oct;21(4):1056-7.[Abstract]
140. Grzeszczuk A, Barat N, Bakken JS, et al. Anaplasmosis in humans. In: Raoult D, Parola, P, ed. Rickettsial diseases. New York, NY: Informa Healthcare USA; 2007:223-236.
141. Carter N, Miller NR. Fourth nerve palsy caused by Ehrlichia chaffeensis. J Neuroophthalmol. 1997 Mar;17(1):47-50.[Abstract]
142. Bhalla V, Rodgers B, Lin J. Sudden sensorineural hearing loss in human monocytic ehrlichiosis. Ear Nose Throat J. 2017 Aug;96(8):328-342.[Abstract]
143. Williams JD, Snow RM, Arciniegas JG. Myocardial involvement in a patient with human ehrlichiosis. Am J Med. 1995 Apr;98(4):414-5.[Abstract]
144. Jahangir A, Kolbert C, Edwards W, et al. Fatal pancarditis associated with human granulocytic ehrlichiosis in a 44-year-old man. Clin Infect Dis. 1998 Dec;27(6):1424-7.[Abstract]
145. Shah SS, McGowan JP. Rickettsial, ehrlichial and Bartonella infections of the myocardium and pericardium. Front Biosci. 2003 Jan 1;8:e197-201.[Abstract]
146. Bakken JS, Erlemeyer SA, Kanoff RJ, et al. Demyelinating polyneuropathy associated with human granulocytic ehrlichiosis. Clin Infect Dis. 1998 Nov;27(5):1323-4.[Abstract]
147. Horowitz HW, Marks SJ, Weintraub M, et al. Brachial plexopathy associated with human granulocytic ehrlichiosis. Neurology. 1996 Apr;46(4):1026-9.[Abstract]
148. Khoury JK, Khoury NC, Schaefer D, et al. A tick-acquired red meat allergy. Am J Emerg Med. 2018 Feb;36(2):341.e1-341.e3.[Abstract]
149. van Nunen SA. Tick-induced allergies: mammalian meat allergy and tick anaphylaxis. Med J Aust. 2018 Apr 16;208(7):316-321.[Abstract]
150. Pattanaik D, Lieberman P, Lieberman J, et al. "The changing face of anaphylaxis in adults and adolescents". Ann Allergy Asthma Immunol. 2018 Jul 20. pii: S1081-1206(18)30580-5.[Abstract]