Ehrlichia ewingii

If Ehrlichia Is Suspected Treat Immediately!

Symptoms can include fever, headache, malaise and myalgia. Gastrointestinal symptoms have been described and rash is rare.

Although E. ewingii infection has been considered more common in persons who are immunosuppressed, recent passive surveillance data indicated that most (74%) reported cases were not in persons with documented immunosuppression.

Similar to E. chaffeensis ehrlichiosis, patients with E. ewingii ehrlichiosis commonly have leukopenia, thrombocytopenia and elevated hepatic transaminase levels. E. ewingii has a predilection for granulocytes, and morulae might be observed in granulocytes during examination of a blood smear, bone marrow, or CSF.

Ehrlichia muris-Like Agent

EML agent ehrlichiosis is associated with fever (87%), malaise (76%), headache (67%), and myalgia (60%). Rash is reported in 12% of described cases. Thrombocytopenia (67%), lymphopenia (53%), leukopenia (39%), elevated levels of hepatic transaminases (78%), and anemia (36%) are described. Morulae have not been observed yet in peripheral blood cells of patients infected with the EML agent.


Symptoms of anaplasmosis can appear 5–14 days after the bite of an infected tick and can include fever (92%–100%), headache (82%), malaise (97%), myalgia (77%), and shaking chills.

Rash is present in <10% of patients. Gastrointestinal symptoms may occur. Patients with anaplasmosis typically seek medical care later in the course of illness (4–8 days after onset) than patients with other tickborne rickettsial diseases (2–4 days after onset).

Severe or life-threatening manifestations are less frequent with anaplasmosis than with RMSF or E. chaffeensis ehrlichiosis. ARDS, peripheral neuropathies, DIC-like coagulopathies, hemorrhagic manifestations, rhabdomyolysis, pancreatitis, and acute renal failure have been reported.

Severe anaplasmosis can also resemble toxic shock syndrome, TTP, or hemophagocytic syndromes.

Serious and fatal opportunistic viral and fungal infections during the course of anaplasmosis infection have been described.

Approximately 7% of hospitalized patients require admission to the intensive care unit. Predictors of a more severe course of anaplasmosis include a delay in diagnosis and treatment.

Lab Findings

Characteristic laboratory findings in anaplasmosis include thrombocytopenia, leukopenia, elevated hepatic transaminase levels, increased numbers of immature neutrophils, and mild anemia.

Similar to ehrlichiosis, lymphocytosis can be present during the recovery period.

CSF evaluation typically does not reveal any abnormalities.

Blood smear examination might reveal morulae within granulocytes.

Bone marrow is usually normocellular or hypercellular in acute anaplasmosis, and morulae might be observed.

Additional Lab Information Here-




Treatment for Spotted Fevers,

Ehrlichiosis & Anaplasmosis

Doxycycline is the drug of choice for treatment of all tickborne rickettsial diseases in patients of all ages, including children, and should be initiated immediately in persons with signs and symptoms suggestive of rickettsial disease.

The recommended dose of doxycycline for the treatment of tickborne rickettsial diseases is 100 mg twice daily (orally or intravenously) for adults and 2.2 mg/kg body weight twice daily (orally or intravenously) for children weighing <100 lbs (45 kg).

Severe or complicated disease could require longer treatment courses.

Patients with evidence of organ dysfunction, severe thrombocytopenia, mental status changes, or the need for supportive therapy should be hospitalized.

Other important considerations for hospitalization include social factors, the likelihood that the patient can and will take oral medications, and existing comorbid conditions, including the patient’s immune status.

Certain patients with tickborne rickettsial disease can be treated on an outpatient basis with oral medication, particularly if a reliable caregiver is available in the home and the patient adheres to follow-up medical care.

A critical step is for clinicians to keep in close contact with patients who are treated as outpatients to ensure that they are responding to therapy as expected.

Patients should be monitored closely because of the potential for rapid decline in untreated patients with tickborne rickettsial diseases, especially among those with RMSF.

Management of severely ill patients with tickborne rickettsial disease should include assessment of fluid and electrolyte balance. Vasopressors and careful fluid management might be needed when the illness is complicated by hypotension or renal failure.

Patients with RMSF can develop ARDS or pulmonary infiltrates related to microvascular leakage that might be erroneously attributed to cardiac failure or pneumonia.

Doxycycline is excreted into breast milk at low levels; however, the extent of absorption by nursing infants is unknown.

Transmission of R. rickettsii, A. phagocytophilum, and E. ewingii via transfusion of infected blood products has been reported. Among tickborne rickettsial diseases, anaplasmosis is the most frequently associated with transfusion-acquired infection.

Transmission of A. phagocytophilumdespite leukoreduction of red blood cells and platelets has occurred. Transfusion-acquired R. rickettsii infection, reported in 1978, was transmitted in whole blood stored for 9 days,

Cases of transplant-acquired ehrlichiosis associated with a common deceased donor have been reported.

Tests to detect spotted fevers may not indicate a person was exposed during the first several weeks of infection. Never wait for tests results or depend on a negative test result if RMSF is suspected. Treat immediately. RMSF can be treated with antibiotics.