Fever, Rash, and Elevated Transaminases

Morulae

Ehrlichiosis: patient had +Ag panel 4 sp Ehrlichia (E. canis, E. equis, E. risticii, & E sennetsu), IFA for E. canis was positive 1:640 that declined over next 4 months

Human ehrlichiosis tick borne zoonosis, most pts give tick exposure history a month prior to presentation. Peak May-Aug, rural/suburbs, any state but mostly south central & SE related to lone star tick Amblyomma americanum & white tail deer 🦌

Human monocytic ehrlichiosis (HME): half of pts require hospitalization & can have life threatening illness in 9% of cases.

Rash is rare in adults, leukopenia, thrombocytopenia, abnormal LFTs are frequent. Diagnosis based on epidemiological clue & clinical picture, blood smear: morulae in leukocytes, start doxycycline, seroconversion or 4 fold ⬆️in Ab titer from acute to convalescent phase

Human granulocytic anaplasmosis (HGA) peaks in June-Nov suburban NE & Midwest, similar to Lyme distribution due to shared Ixodes tick vector. 4-36% coinfected w/lyme or Babesia. Prospective studies show 2% coinfection w/Lyme though.

Originally tweeted by Indiana University Infectious Diseases Fellowship (@IUIDfellowship) on 30 June, 2020.

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