Human monocytic ehrlichiosis

Epidemiology
• Transmitted by tick vector (lone star tick)

• Seen in southeastern & south central United States

Clinical Manifestations

• Flu-like illness (high fever, headache, myalgias, chills)

• Neurologic symptoms (confusion)

• Rash is uncommon (<30% in adults) ("Rocky Mountain spotted fever without the spots")

Lab Findings

• Leukopenia & t hrombocytopenia
• Elevated liver enzymes & lactate dehydrogenase

Diagnosis

• Intracytoplasmic morulae in monocytes
• Polymerase chain reaction testing for E chaffeensis/E ewingii

Treatment

• Empiric doxycycline while awaiting confirmatory testing