They have a very nonspecific clinical presentation. The diseases generally present as undifferentiated fever, but thrombocytopenia, leucopenia, and transaminitis are important laboratory features. [ncbi.nlm.nih.gov]

• Fever

  All 27 patients presented with a 2-5 d history of fever. None of the clinical signs or laboratory parameters monitored was helpful in predicting ehrlichiosis in this group with tick-associated fever conditions. [ncbi.nlm.nih.gov]

  HGA should be suspected in tick-bitten patients or those who have visited an endemic area and show symptoms of flu-like fever, leukopenia and thrombocytopenia (AU) [pesquisa.bvsalud.org]

• Chills

  Comparison of clinical signs and symptoms and laboratory findings in the two groups revealed significant differences: in patients with acute HGE there was a higher frequency of chills (4/9 versus 3/29, respectively; p = 0.0407), myalgia (8/9 versus 13 [ncbi.nlm.nih.gov]

  sweating, myalgia, nausea and vomiting, headache, shaking chills, coughing, severe pain–like being 'hit by a bus,' followed by septic state Management Doxycycline. [medical-dictionary.thefreedictionary.com]

• Fatigue

  Compared with 102 controls, patients were more likely to report recurrent or continuous fevers, chills, fatigue, and sweats. [ncbi.nlm.nih.gov]

  Dorfman Category: Infectious Disease > Bacteria > Ehrlichia > Anaplasmosis Published Date: 12/13/2012 A 64-year-old man was admitted with hypotension and respiratory failure after 3 weeks of fever, cough, fatigue, and headache. 7 years earlier he had [imagebank.hematology.org]

  Blood 2012 120:4911; doi: https://doi.org/10.1182/blood-2012-07-445817 A 64-year-old man was admitted with hypotension and respiratory failure after 3 weeks of low-grade fever, cough, fatigue, intermittent sweats, chronic diarrhea, and headache. [bloodjournal.org]

  Granulocitica Umana General population 86.43 HIV 63.96 Hip replacement 12.63 Lung cancer 32.69 Role limitations due to emotional problems Ehrlichiosi Granulocitica Umana General population 91.77 HIV 60.83 Hip replacement 69.53 Lung cancer 66.87 Energy fatigue [diseasemaps.org]

• Fishing

  Clin Lab Med 30:261–292 PubMedCentral CrossRef PubMed Google Scholar Newton PN, Rolain J-M, Rasachak B et al (2009) Sennetsu neorickettsiosis: a probable fish-borne cause of fever rediscovered in Laos. [link.springer.com]

  Hodzic E., Fish D., Maretzki C.M., De Silva A.M., Feng S., Barthold S. W.: "Acquisition and Transmission of the Agent of Human Granulocytic Ehrlichiosis by Ixodes scapularis Ticks." J. Clin. Microbiol. 36 (1998) 3574-3578. 5. [antibiotikamonitor.at]

  DOI PubMed Levin ML, Nicholson WL, Massung RF, Sumner JW, Fish D. Comparison of the reservoir competence of medium-sized mammals and Peromyscus leucopus for Anaplasma phagocytophilum in Connecticut. Vector Borne Zoonotic Dis. 2002 ; 2 : 125 – 36. [doi.org]

  J Infect Dis 1998;177:1422--5. des Vignes F, Piesman J, Heffernan R, Schulze TL, Stafford KC III, Fish D. [cdc.gov]

• Weakness

  Case 10-2005: A 73-year-old man with weakness and pain in the legs. N Engl J Med. 2005;13:1358-1364. Bakken JS, Dumler S. Human granulocytic anaplasmosis. Infectious diseases. Clinics of North America. ;22:433-448. Nahed I, Bloch K, Mc Bride J. [revistas.unicartagena.edu.co]

  […] symptoms may include: fever severe headache muscle aches (myalgia) chills and shaking, similar to the symptoms of influenza nausea vomiting loss of appetite unintentional weight loss abdominal pain cough diarrhea, aching joints sensitivity to light weakness [en.wikipedia.org]

  Other CNS manifestations include seizures, meningismus, cranial nerve palsies, focal weakness, and coma. A lymphocytic pleocytosis can be observed in the CSF in approximately 50% of patients with HME who undergo lumbar puncture ( 103 ). [cdc.gov]

• Cough

  […] rickettsia-like organism genetically similar to E phagocytophila and E equi, transmitted by the Lyme disease tick, which may be associated with Lyme disease Clinical High fever, chills, sweating, myalgia, nausea and vomiting, headache, shaking chills, coughing [medical-dictionary.thefreedictionary.com]

  Dorfman Category: Infectious Disease > Bacteria > Ehrlichia > Anaplasmosis Published Date: 12/13/2012 A 64-year-old man was admitted with hypotension and respiratory failure after 3 weeks of fever, cough, fatigue, and headache. 7 years earlier he had [imagebank.hematology.org]

  Blood 2012 120:4911; doi: https://doi.org/10.1182/blood-2012-07-445817 A 64-year-old man was admitted with hypotension and respiratory failure after 3 weeks of low-grade fever, cough, fatigue, intermittent sweats, chronic diarrhea, and headache. [bloodjournal.org]

  Signs and symptoms may include: fever severe headache muscle aches (myalgia) chills and shaking, similar to the symptoms of influenza nausea vomiting loss of appetite unintentional weight loss abdominal pain cough diarrhea, aching joints sensitivity to [en.wikipedia.org]

  […] up to 685 patients ( Table ), the most frequent manifestations are malaise (94%), fever (92%), myalgia (77%), and headache (75%); a minority have arthralgia or involvement of the gastrointestinal tract (nausea, vomiting, diarrhea), respiratory tract (cough [medscape.com]

• Dyspnea

  In late September 2004, a 30-year-old man (patient 2) with high fever was admitted for an evident palmar and oral erythema, edema of the labium, very intense arthralgia, myalgia, and dyspnea. [ncbi.nlm.nih.gov]

  Despite antibacterial drug coverage and negative blood, urine, and throat cultures, the patient continued to be febrile and decompensated with dyspnea, hypoxia, and an elevation in troponin. [doi.org]

  Some potential complications in individuals with Human Granulocytic Anaplasmosis may include: Dyspnea or shortness of breath Problems with blood clotting process Bleeding in the gastrointestinal tract Damage to liver Respiratory failure Kidney failure [dovemed.com]

• Vomiting

  In early September 2004, a 69-year-old woman (patient 1) was admitted to the Infectious Diseases Institute of Sassari for rickettsiosis like-syndrome: high fever (39.5-40 degrees C), dyspnea, reduced consciousness, vomiting, and cutaneous rash. [ncbi.nlm.nih.gov]

  Infection by Ehrlichia chaffeensis, a rickettsia-like organism genetically similar to E phagocytophila and E equi, transmitted by the Lyme disease tick, which may be associated with Lyme disease Clinical High fever, chills, sweating, myalgia, nausea and vomiting [medical-dictionary.thefreedictionary.com]

  Diseases and Disorders section features more than 300 new figures and tables, as well as 20 new topics including: cyclic vomiting syndrome, traveler’s diarrhea, chronic pruritus, post-herpetic neuralgia, enteropathic arthritis, and hoarding disorder. [books.google.de]

  She was admitted to Connecticut Children’s Medical Center the following day for persistent fever and the onset of abdominal pain, loose stools, and bilious vomiting. [pediatrics.aappublications.org]

• Nausea

  […] diseases Infection by Ehrlichia chaffeensis, a rickettsia-like organism genetically similar to E phagocytophila and E equi, transmitted by the Lyme disease tick, which may be associated with Lyme disease Clinical High fever, chills, sweating, myalgia, nausea [medical-dictionary.thefreedictionary.com]

  Non-specific symptoms, which normally occur within 1-2 weeks following tick bite, may be mild to severe and include fever, chills, malaise, headache, muscle aches and pain, and nausea. [twp.freehold.nj.us]

  Diagnosis of human ehrlichiosis has been difficult because the patient's clinical course is often mild and nonspecific, including fever, myalgias, arthralgias, and nausea. [mayomedicallaboratories.com]

  Symptoms may seem like the flu (influenza), and may include: Fever and chills Headache Muscle aches Nausea Other possible symptoms: Diarrhea Fine pinhead-sized areas of bleeding into the skin (petechial rash) Flat red rash (maculopapular rash), which [nlm.nih.gov]

• Erythema

  Three of the patients had coinfection with Lyme borreliosis, which presented as erythema migrans. All 27 patients presented with a 2-5 d history of fever. [ncbi.nlm.nih.gov]

  […] infiltrates, acute respiratory distress syndrome [ARDS]), liver, or central nervous system. [4,5,6,7] Rash is observed in 6%, although no specific rash has been associated with HGA and co-infection with Borrelia burgdorferi, which can cause simultaneous erythema [medscape.com]

• Myalgia

  Comparison of clinical signs and symptoms and laboratory findings in the two groups revealed significant differences: in patients with acute HGE there was a higher frequency of chills (4/9 versus 3/29, respectively; p = 0.0407), myalgia (8/9 versus 13 [ncbi.nlm.nih.gov]

  However, they said, “In the meantime, B. miyamotoi infection should be included in the differential diagnosis of patients presenting in Lyme disease-endemic areas with unexplained fever, headache, myalgia, elevated hepatic aminotransferase levels, and [acphospitalist.org]

  Cf Human monocytic ehrlichiosis. hu·man gran·u·lo·cyt·ic ehr·lich·i·o·sis (HGE) ( hū'măn gran'yū-lō-sit'ik er-lik'ē-ō'sis ) A febrile disease causing headache and myalgia and sometimes involving the respiratory, digestive, and central nervous systems; [medical-dictionary.thefreedictionary.com]

• Arthralgia

  Statistically significant differences were found only for arthralgia (P=0.026) and elevated concentration of C-reactive protein (P=0.003); both variables were found more often in patients with acute HGE. [ncbi.nlm.nih.gov]

• Headache

  Cf Human monocytic ehrlichiosis. hu·man gran·u·lo·cyt·ic ehr·lich·i·o·sis (HGE) ( hū'măn gran'yū-lō-sit'ik er-lik'ē-ō'sis ) A febrile disease causing headache and myalgia and sometimes involving the respiratory, digestive, and central nervous systems; [medical-dictionary.thefreedictionary.com]

  The patient developed high fever, myalgia, headache and dyspnoea. Doxycycline treatment resulted in a dramatic improvement. [ncbi.nlm.nih.gov]

• Confusion

  Other symptoms may include confusion, hemorrhages, and renal failure. Diagnosis An initial diagnosis is based on the patient’s symptoms and laboratory tests. [aldf.com]

  Fever and Altered Mental Status Posted by • May 17th, 2013 In the latest Case Record of the Massachusetts General Hospital, 76-year-old man with chronic renal disease was admitted to this hospital because of fever, worsening renal function, and confusion [blogs.nejm.org]

  This is easily confused with other illnesses such as influenza or other tickborne zoonoses such as Lyme disease, babesiosis, and Rocky Mountain spotted fever. [mayomedicallaboratories.com]

  The bacterium that causes HGA has a confusing history. Initially, it was known as Ehrlichia phagocytophila or E. equi, and at one time it was thought to be the cause of human granulocytic ehrlichiosis. [extension.entm.purdue.edu]

• Polyneuropathy

  […] include a septic or toxic shock-like syndrome, coagulopathy, atypical pneumonitis/acute respiratory distress syndrome (ARDS), acute abdominal syndrome, rhabdomyolysis, myocarditis, acute renal failure, hemorrhage, brachial plexopathy, demyelinating polyneuropathy [medscape.com]

  "Demyelinating Polyneuropathy Associated with Human Granulocytic Ehrlichiosis." Clin. Infect. Dis. 27 (1998) 1322-1323. 26. [antibiotikamonitor.at]

  In contrast, peripheral neuropathies, including brachial plexopathy, demyelinating polyneuropathy, and even isolated facial palsy, are more common with HGA and can persist for weeks or months [ 6 ]. [dx.doi.org]

• Dizziness

  New algorithms offer important diagnostic information on 19 added conditions, including allergic reaction to vaccines, cardiac arrest, occupational asthma, urinary tract infection, and vertigo and dizziness. [books.google.de]

  Physical examination revealed an acutely ill man; the patient had a fever of 103.5 º F (39.7 º C) and experienced dizziness and low blood pressure when he stood up (orthostatic hypotension). [cdc.gov]

• Vertigo

  New algorithms offer important diagnostic information on 19 added conditions, including allergic reaction to vaccines, cardiac arrest, occupational asthma, urinary tract infection, and vertigo and dizziness. [books.google.de]

• Hyponatremia

  Leukopenia, thrombocytopenia, mild hyponatremia, and mildly elevated hepatic transaminase levels are common and particularly useful clinical features of TBRD, although the absence of these features does not exclude a diagnosis of TBRD. [cdc.gov]

• Human Parvovirus B19

  Maculopapular rashes might occur in association with multiple conditions, including human herpesvirus 6 infection (i.e., roseola), human parvovirus B19, enteroviral infection (e.g., coxsackievirus and echovirus), Epstein-Barr virus infection, disseminated [cdc.gov]

Early detection and treatment with tetracycline drugs appear to offer the best chance for complete recovery. [ncbi.nlm.nih.gov]

[…] added to the treatment regimen on October 1. [elbiruniblogspotcom.blogspot.com]

Doxycycline is the treatment of choice for HGE but may cause permanent staining of teeth in children younger than 8 years of age. We report successful treatment of HGE with rifampin in 2 children, 4 and 6 years old. [pediatrics.aappublications.org]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.de]

(Outcomes/Resolutions) The prognosis of Human Granulocytic Anaplasmosis is determined by the age and general health of the affected individual The outcome is generally good for healthy individuals, with prompt treatment However, if complications arise [dovemed.com]

[…] is the invasion of and replication in the body by any of various microbial agents—including bacteria, viruses, fungi, protozoans, and worms—as well as the reaction of Infectious Diseases articles covering symptoms, diagnosis, epidemiology, treatment, prognosis [cannafumarieinox.it]

Lyme Disease Treatment and Prognosis Centers for Disease Control and Prevention [On-line information]. Available online at http://www.cdc.gov/ncidod/dvbid/lyme/ld_humandisease_treatment.htm. Accessed March 2009. Mayo Clinic Staff (2008 May 2). [labtestsonline.it]

Although the clinical manifestations of HME and HGE are similar, the type of leukocyte infected, the etiologic agent, and the tick vector are distinct. [ncbi.nlm.nih.gov]

A phagocytophilum is the etiologic agent for human granulocytic anaplasmosis (HGA), a tick-borne illness that is endemic to New England. Intracytoplasmic morulae are seen in neutrophils in 60% to 80% of cases. [imagebank.hematology.org]

Our patient demonstrated the typical epidemiological, clinical and laboratory features of human granulocytic ehrlichiosis and responded to treatment with doxycycline. [ncbi.nlm.nih.gov]

All three patients had clinical, laboratory, and pathophysiologic findings on bone marrow biopsy and peripheral blood smears consistent with HGE, and responded to doxycycline therapy. [ncbi.nlm.nih.gov]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.de]

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Human granulocyte ehrlichiosis (HGE) is a zoonotic infection caused by a rickettsia-like agent. [mayomedicallaboratories.com]

The HGE agent did not prevent O(2-) generation in human peripheral blood monocytes derived from the same individual. This neutrophil-specific prevention of O(2-) generation by the HGE agent would be critical in survival of the HGE agent. [ncbi.nlm.nih.gov]

DOI PubMed Waxman M ; Centers for Disease Control and Prevention. Update on emerging infections: news from the Centers for Disease Control and Prevention. Anaplasma phagocytophilum transmitted through blood transfusion - Minnesota 2007. [doi.org]

Courtesy of the Centers for Disease Control and Prevention. Ehrlichiosis incidence by age. Courtesy of the Centers for Disease Control and Prevention. [emedicine.com]