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Reinfection with the Agent of Human Granulocytic Ehrlichiosis

Harold W. Horowitz, MD; Maria Aguero-Rosenfeld, MD; J. Stephen Dumler, MD; Donna F. McKenna, ANP; Tze-chen Hsieh, PhD; Joseph Wu, PhD; Ira Schwartz, PhD; and Gary P. Wormser, MD
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From New York Medical College, Valhalla, New York; and Johns Hopkins Medical Institutions, Baltimore, Maryland. Acknowledgments: The authors thank Jobby Jacob, Mehdi Baluch, Fatemeh Kalantarpour, Shoba Varda, Susan Bittker, and Denise Cooper for technical assistance and Diane Holmgren for coordination of research activities. Grant Support: In part by the Westchester County Department of Health (grant CMC-2502 to Dr. Horowitz and grants HLT27017, HLT27018, and HLT27019 to Dr. Aguero-Rosenfeld); the Centers for Disease Control and Prevention (Cooperative Agreement U50/CCU 210280 to Dr. Wormser); the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant R01-AR41511 to Dr. Schwartz); Group 99, Inc., and the Philip Morris Co. (to Dr. Wu); and the National Institute of Allergy and Infectious Diseases (grant R01-AI41213-01 to Dr. Dumler). Requests for Reprints: Harold Horowitz, MD, Division of Infectious Diseases, Westchester Medical Center, Room 209, Macy Pavilion, Valhalla, NY 10595. Current Author Addresses: Drs. Horowitz, Aguero-Rosenfeld, Hsieh, Wu, Schwartz, and Wormser and Ms. McKenna: Westchester Medical Center, Macy Pavilion, Valhalla, NY 10595. Dr. Dumler: Department of Pathology, Division of Medical Microbiology, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21201.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(6):461-463. doi:10.7326/0003-4819-129-6-199809150-00007
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Human granulocytic ehrlichiosis is an acute febrile illness caused by a still-unnamed organism, the human granulocytic ehrlichiosis agent, that is closely related to the veterinary pathogens Ehrlichia equi and E. phagocytophila[13]. Human granulocytic ehrlichiosis has been reported in an increasingly broad geographic area of the United States [12] and in Europe [4]. Like Borrelia burgdorferi and Babesia microti, the etiologic agents of Lyme disease and babesiosis, respectively [5], the agent of human granulocytic ehrlichiosis is transmitted by Ixodes scapularis ticks [5]. We report what we believe to be the first documented case of reinfection with the human granulocytic ehrlichiosis agent in a woman in whom human granulocytic ehrlichiosis had been diagnosed approximately 2 years previously. This case indicates that a single episode of infection may not confer long-term protection against reinfection.

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