eMedicine Specialties > Emergency Medicine > Infectious Diseases

Tick-Borne Diseases, Ehrlichiosis: Follow-up

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Sep 17, 2008

Follow-up

Inpatient & Outpatient Medications

  • Continue doxycycline for 3 days after defervescence, for a minimum of 5-7 days.

Deterrence/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 by using forceps. (A feeding period of 3-48 h is required before disease is transmitted.)

Complications

  • Compared with other patients, elderly patients have a higher risk of death.
  • Laboratory test results are necessary to make the diagnosis.
  • An alternative antibiotic for children aged 8 years or younger and for pregnant patients is not available.

Prognosis

  • A favorable outcome is associated with the early use of antibiotics.
  • Many cases of HGA and HME may be subclinical and self-limited.

Miscellaneous

Medicolegal Pitfalls

  • Failure to determine a history of tick bite
  • Failure to consider the diagnosis in patients with flulike symptoms during the summer season
 


More on Tick-Borne Diseases, Ehrlichiosis

Overview: Tick-Borne Diseases, Ehrlichiosis
Differential Diagnoses & Workup: Tick-Borne Diseases, Ehrlichiosis
Treatment & Medication: Tick-Borne Diseases, Ehrlichiosis
Follow-up: Tick-Borne Diseases, Ehrlichiosis
References
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References

  1. 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. Dec 1 1996;125(11):904-8. [Medline].

  2. Bakken JS, Dumler JS, Chen SM, et al. Human granulocytic ehrlichiosis in the upper Midwest United States. A new species emerging?. JAMA. Jul 20 1994;272(3):212-8. [Medline].

  3. Bakken JS, Krueth J, Wilson-Nordskog C, et al. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. JAMA. Jan 17 1996;275(3):199-205. [Medline].

  4. Buller RS, Arens M, Hmiel SP, et al. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N Engl J Med. Jul 15 1999;341(3):148-55. [Medline].

  5. CDC. Human Ehrlichiosis. Available at http://www.cdc.gov/ncidod/dvrd/ehrlichia/Index.htm. Accessed September 4, 2008.

  6. Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep. Mar 31 2006;55(RR-4):1-27. [Medline].

  7. Dumler JS, Bakken JS. Ehrlichial diseases of humans: emerging tick-borne infections. Clin Infect Dis. May 1995;20(5):1102-10. [Medline].

  8. Fishbein DB, Dawson JE, Robinson LE. Human ehrlichiosis in the United States, 1985 to 1990. Ann Intern Med. May 1 1994;120(9):736-43. [Medline].

  9. Hamburg BJ, Storch GA, Micek ST, Kollef MH. The importance of early treatment with doxycycline in human ehrlichiosis. Medicine (Baltimore). Mar 2008;87(2):53-60. [Medline].

  10. Heilpern KL. Update: human ehrlichiosis--Maryland and Wisconsin, 1994. Ann Emerg Med. Jul 1998;32(1):108-10. [Medline].

  11. Maeda K, Markowitz N, Hawley RC, et al. Human infection with Ehrlichia canis, a leukocytic rickettsia. N Engl J Med. Apr 2 1987;316(14):853-6. [Medline].

  12. McQuiston JH, McCall CL, Nicholson WL. Ehrlichiosis and related infections. J Am Vet Med Assoc. Dec 15 2003;223(12):1750-6. [Medline].

  13. Ochoa WG, Wedro BC, Firary SA. Images in emergency medicine. Human ehrlichiosis. Ann Emerg Med. Nov 2005;46(5):470, 478. [Medline].

  14. Prince LK, Shah AA, Martinez LJ, Moran KA. Ehrlichiosis: making the diagnosis in the acute setting. South Med J. Aug 2007;100(8):825-8. [Medline].

  15. Schaffner W, Standaert SM. Ehrlichiosis--in pursuit of an emerging infection. N Engl J Med. Jan 25 1996;334(4):262-3. [Medline].

  16. Strle F. Human granulocytic ehrlichiosis in Europe. Int J Med Microbiol. Apr 2004;293 Suppl 37:27-35. [Medline].

  17. Walker DH, Dumler JS. Emergence of the ehrlichioses as human health problems. Emerg Infect Dis. Jan-Mar 1996;2(1):18-29. [Medline].

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Further Reading

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Keywords

tick-borne disease, ehrlichiosis, Ehrlichia ewingii, Ehrlichia phagocytophila, human granulocytic ehrlichiosis, HGE, human monocytic ehrlichiosis, HME, vector-borne disease, tick-borne disease, Anaplasma phagocytophilum, human granulocytotropic anaplasmosis, HGA

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Contributor Information and Disclosures

Author

Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Charles V Pollack, Jr, MD, MA, FACEP, Professor, Department of Emergency Medicine, University of Pennsylvania College of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
Charles V Pollack, Jr, MD, MA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: sanofi-aventis Honoraria Consulting; sanofi-aventis Honoraria Speaking and teaching; Schering-Polugh Honoraria Consulting; Schering-Plough Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; GlaxoSmithKline Grant/research funds Other

 
 
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