2000 Associates' Presentations
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Erlichiosis as an Emerging Tick-Borne Illness
Raza A., MD, Kabir L, MD, Marshfield Clinic/St. Joseph's Hospital, Marshfield, WI
Background: Human Granulocytic Erlichiosis is a potentially fatal and increasingly common tick-borne infection that is recently becoming more prevalent in endemic areas. Myalgias, thrombocytopenia, elevated liver enzymes and leukopenia describes the acute febrile illness. Initial diagnosis is difficult as symptoms are nonspecific, serologies are often times initially negative and Morulae (intracellular inclusions) may not be seen.
Objective: To discuss the epidemiology and clinical presentation of HGE. To show that this tick-borne illness is getting more prevalent, but underdiagnosed and is a reportable case in Wisconsin.
Case Presentation: A 67 y.o. male referred for evaluation of 4 days of fevers/chills (103), fatigue and recent history of outdoor activities (without any recall of a tick bite). Initial labs showed normal WBC, followed by leukopenia, a left shift, thrombocytopenia and rising LFT's. He was treated with I/V Rocephin for 3 days without any benefit. Morulae were spotted on peripheral blood film and a treatment of doxicycline 100 mg PO initiated with rapid clinical improvement within 36 yrs., although patient was found to be seronegative.
Discussion: 1)HGE is now a reportable disease and is prevalent in the endemic areas (NW WI, CT and Northern MN). 2) Transmission is by deer tick (Ixodes scapularis). 3) Common clinical findings are acute onset of high fever/chills, myalgias and headaches. Labs show gradual leukocytopenia, left shift, thrombocytopenia and abnormal LFT's. 4) Infection has been reported to occur in conjunction with Lyme's disease and can cause false positive Lyme's test. 5) Reinfection is reported.
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