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Section 3. Summaries of Infectious Diseases
Ehrlichia Infections
(Human Ehrlichioses)Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Human ehrlichioses in the United States are attributable to at least 3 distinct tickborne pathogens: Ehrlichia chaffeensis (human monocytic ehrlichiosis [HME]), Anaplasma (formerly Ehrlichia) phagocytophila agent (human granulocytic ehrlichiosis [HGE]), and Ehrlichia ewingii (Table 3.4, p 267). These 3 infections have different causes but similar signs, symptoms, and clinical courses. All are acute, systemic, febrile illnesses that are similar clinically to Rocky Mountain spotted fever but often demonstrate leukopenia, anemia, and hepatitis and are associated less commonly with rash. The febrile illness often is accompanied by one or more systemic manifestations, including headache, chills, malaise, myalgia, arthralgia, nausea, vomiting, anorexia, and acute weight loss. Rash is variable in appearance and location, typically develops approximately 1 week after onset of illness, and occurs only in approximately 60% of children and 25% of adults with reported cases of HME and fewer than 10% of people with HGE. Diarrhea, abdominal pain, cough, or change in mental status occur rarely. More severe manifestations of these diseases include pulmonary infiltrates, bone marrow hypoplasia, respiratory failure, encephalopathy, meningitis, disseminated intravascular coagulation, spontaneous hemorrhage, and renal failure. Ehrlichia species do not cause the vasculitis or endothelial damage characteristic of other rickettsial diseases. Anemia, hyponatremia, thrombocytopenia, increased liver transaminase concentrations, and cerebrospinal fluid abnormalities (ie, pleocytosis with a predominance of lymphocytes and increased total protein concentration) are common. Symptoms typically last 1 to 2 weeks, and recovery generally occurs
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