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Human Granulocytic Ehrlichiosis: A Case Series from a Medical Center in New York State

Maria E. Aguero-Rosenfeld, MD; Harold W. Horowitz, MD; Gary P. Wormser, MD; Donna F. McKenna, RN, CANP; John Nowakowski, MD; Jose Munoz, MD; and J. Stephen Dumler, MD
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From New York Medical College and Westchester County Medical Center, Valhalla, New York; and The Johns Hopkins Medical Institutions, Baltimore, Maryland. Note: The contents of this manuscript are solely the responsibility of the authors and do not represent the official views of the Centers for Disease Control and Prevention or the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acknowledgments: The authors thank Eleanor Shields, Lois DeLungo, Odile Levrat, Olga McDermott, Kristin Asanovich, Jen Walls, and Dan Edelman for their excellent technical assistance and Dan Byrne for statistical analysis. Grant Support: In part by Cooperative Agreement U50/CCU 210280 from the Centers for Disease Control and Prevention (Dr. Wormser), grants RO1-AR41508 (Drs. Nowakowski and Wormser) and RO1-AR43135 (Dr. Wormser) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a Research Initiative Support Award by the University of Maryland School of Medicine, and Grant-in-Aid award BG2094 by the Maryland Chapter of the American Heart Association (Dr. Dumler). Requests for Reprints: Maria E. Aguero-Rosenfeld, MD, Clinical Laboratories, Room 1J-11a, Westchester County Medical Center, Valhalla, NY 10595. Current Author Addresses: Dr. Aguero-Rosenfeld: Clinical Laboratories, Room 1J-11a, Westchester County Medical Center, Valhalla, NY 10595.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(11):904-908. doi:10.7326/0003-4819-125-11-199612010-00006
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Background: Human granulocytic ehrlichiosis (HGE) is a newly described illness with few reports in the literature.

Objective: To describe the clinical and laboratory features of HGE.

Design: Case series.

Setting: Tertiary care facility in New York State.

Patients: 18 adult patients with HGE.

Measurements: Epidemiologic, clinical, and laboratory features; treatment; and outcome of patients with HGE.

Results: Patients presented with such symptoms as fever (94%) and myalgia or arthralgia (78%). Thirteen patients (71%) recalled being bitten by a tick before onset of symptoms. Leukopenia or thrombocytopenia was seen in 82% of patients, and abnormal liver enzyme levels were seen in 81%. Results of polymerase chain reaction were positive in 9 of 12 patients (75%); morulae were seen in 3 of 12 patients (25%); and the agent that causes HGE was cultured from 2 patients. All but one patient (94%) developed antibodies to Ehrlichia equi. Five patients (28%) were briefly hospitalized, and none died. All patients were successfully treated with doxycycline.

Conclusions: The illness associated with HGE in these patients from the northeastern United States was more mild than that originally described in reports of HGE in the midwestern United States.





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