Moderately or severely ill patients may require hospitalization for diagnosis and treatment. Early treatment is critical. Consider the possibility of ehrlichiosis when patients have a febrile illness and a history of recent tick exposure. Doxycycline remains the preferred drug for persons with ehrlichiosis. [1, 2]
Continue treatment until the patient has been afebrile for at least 3 days and for 10-14 days depending on the severity of illness. Guidelines for the diagnosis and management of tick-borne diseases have been established by the CDC. 
Deterrence and Prevention
Deterrence and prevention of ehrlichiosis includes the following:
Wear light-colored clothes
Tuck pants into socks
Use insect repellent
Regularly examine the body for ticks
Promptly remove ticks; a feeding period of 3-48 h is required before disease is transmitted. Cover exposed areas of the skin with insect repellents containing N,N -diethyl-meta-toluamide (DEET). In children, carefully use insect repellents on exposed skin; avoid the face and hands to prevent systemic absorption.
After returning from wooded and/or tick-infested areas, individuals should check themselves carefully for ticks. If found, ticks should be removed carefully and a physician should be consulted.
Any of several commercial devices should be used, if possible, to remove ticks. Alternatively, ticks can be removed by grasping them with fine tweezers at the point of attachment and pulling slowly and steadily. The aim is to remove the mouthparts from the site of insertion without damaging the insect.
After removal, the skin should be disinfected. Check to make sure that the tick head is not still embedded.
Some have recommended keeping the tick in a jar along with a damp paper towel in the refrigerator for a month or so, in case symptoms develop, as it may help to identify what (if any) infection has been transmitted.
Trying to burn the tick; smothering it in alcohol, petroleum jelly, or similar substance; or twisting or rubbing the tick off is not recommended. These methods have not been shown to decrease the time the tick remains embedded and risk breaking the tick body open and releasing otherwise-contained bacteria.
No role exists for the use of antimicrobial prophylaxis after a tick bite in the prevention of human monocytic ehrlichiosis (HME) or human granulocytic anaplasmosis (HGA) due to the low rate of subsequent infection.
An infectious disease specialist should be consulted for any patient with an acute febrile illness and a recent history of tick exposure.
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