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Lyme Coinfection Series-Ehrlichia

By Beth Aust, RN, Holistic Health Coach

This is a continuation of our Lyme and coinfection series to help educate you.

“Education is the most powerful weapon which you can use to change the world” – Nelson Mandela

Stats & Facts:

Ehrlichiosis is the general name used to describe diseases caused by the bacteria Ehrlichia chaffeensis, E. ewingii, or E. muris eauclairensis in the United States. In the year 2000, only 200 cases of ehrlichiosis were reported. In 2019, the number of reported cases rose to 2,093 cases.

Ehrlichiosis was first recognized as a human disease in the United States in the late 1980s but did not become a reportable disease until 1999, with the first data reported in 2000.

Ticks that transmit ehrlichiosis (HME, or Human Monocytic Ehrlichiosis) include Amblyomma americanum (lone star) and Dermacentor variabilis (American dog). Ixodes scapularis (deer tick or black legged tick) and Ixodes pacificus (western black legged tick) ticks have been shown to carry the ehrlichiosis bacterium, but to date, transmission is still in question.

People with compromised immune systems (e.g., resulting from cancer treatments, advanced HIV infection, prior organ transplants, or some medications) might be at increased risk for severe disease.

Symptoms of Ehrlichia:

Most patients develop symptoms one to two weeks after the tick bite, and over 70% will have fever, chills, severe headache, and myalgias. Less common symptoms include nausea and vomiting, as well as confusion. A maculopapular rash (easily distinguishable from Rocky Mountain spotted fever) can also occur. As with many other tick-borne diseases, the symptoms are largely non-specific, thus confounding diagnosis.

Testing & Diagnosis:

A blood test (PCR and or IgG/IgM) can identify Ehrlichiosis however may take several weeks for the results. If your healthcare provider suspects you have ehrlichiosis, he/she may prescribe antibiotics while you await the results.

Common findings on conventional blood tests include leukopenia (low white blood count), thrombocytopenia (low platelet count), and elevated serum transaminases (elevated liver function studies).

IgG antibodies can remain high for years after the infection, and false positive results have been associated with many other conditions, including several tick-borne diseases (Lyme disease, Rocky Mountain spotted fever, and Q fever).

Patients are most likely to be infected with Ehrlichia in spring and summer months, though cases occur into autumn as well. Unlike Lyme disease and Rocky Mountain spotted fever, ehrlichiosis strikes older people preferentially, probably due to immunological host factors.

In Conclusion:

Ehrlichia is not commonly or typically thought of for testing and as the symptoms are similar to Lyme Disease, often time IMOFCNY providers will test a panel of coinfections including Ehrlichiosis in their new patient orders to obtain a full evaluation.

This is part of our Lyme Disease and Coinfection series, please be sure to check out the blog or subscribe to our newsletter for more.


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