Division of Epidemiology and Health Planning
275 East Main Street
Frankfort, KY 40621
502-564-3418 or 3261
What Is Ehrlichiosis?
Ehrlichiosis is caused by several bacterial species in the genus Ehrlichia that affect humans and animals. Currently there are four ehrlichial species that are known to cause disease in humans. Human monocytic ehrlichiosis (HME) from infection with Ehrlichia chaffeensis is the ehrlichial disease most often reported in Kentucky and other southeastern and midwestern states. Six or fewer confirmed cases per year have been reported in Kentucky since 1991.
How Ehrlichiosis Is Spread?
Human monocytic ehrlichiosis is spread by the bite of an infected tick. The lone star tick, Amblyomma americanum is the primary vector for HME. Other known vectors of ehrlichiosis in the United States are the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus). Ticks become infected with ehrlichiae while feeding on blood from the host animal in their larval or nymphal state. Whitetail deer are the major host of the lone star ticks. The tick develops into the next stage and the ehrlichiae are then transmitted to the following host during the feeding process. Both the nymphal and adult stages are probably capable of transmitting the ehrlichiae to the next host.
The Symptoms Of Ehrlichiosis
The incubation period for ehrlichiosis is usually 5-10 days following the tick bite, but can be up to 21 days. The most common symptoms include fever, headache, loss of appetite, muscle aches, and fatigue. Other symptoms sometimes reported are nausea, vomiting, diarrhea, cough, joint pains, confusion and rash. Rash is uncommon in adult patients, but about 60% of pediatric patients exhibit rash. Ehrlichiosis can be a severe illness and many patients require hospitalization. Severe cases may have prolonged fever, kidney failure, blood clotting disorders, meningoencephalitis, adult respiratory distress syndrome, seizures, or coma. It is possible that many infected persons have no symptoms or symptoms so mild that they do not seek medical attention.
How Eehrlichiosis Is Diagnosed
Diagnosis is based on clinical and laboratory findings. Routine laboratory tests indicative of ehrlichiosis include low white blood cell count, low platelet count, and elevated liver enzymes. Confirmation of ehrlichiosis can be difficult as some of the tests have limited availability and interpretation can be complex.
The Treatment For Ehrlichiosis
Appropriate antibiotic treatment with tetracyclines should be initiated immediately by a health care provider when ehrlichiosis is suspected based on the clinical signs and the possibility of exposure to the tick vector. Treatment should not be delayed waiting for laboratory confirmation. Fever usually subsides within 24-72 hours after treatment with the proper antibiotic. Preventive therapy in non-ill patients who have had recent tick bites is not warranted.
How To Prevent Ehrlichiosis
Limiting exposure to ticks reduces the likelihood of ehrlichial infection. In persons exposed to tick-infested habitats, prompt careful inspection and removal of crawling or attached ticks is an important method of preventing disease. It may take several hours of attachment before microorganisms are transmitted from the tick to the host.
It is unreasonable to assume that a person can completely eliminate activities that may result in tick exposure. Therefore, prevention measures should be aimed at personal protection:
Wear light-colored clothing -- this will allow you to see ticks that are crawling on your clothing.
Tuck your pants legs into your socks so that ticks cannot crawl up the inside of your pants legs.
Apply repellants to discourage tick attachment. Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days. Repellents containing DEET (n, n-diethyl-m-toluamide) can be applied to the skin, but will last only a few hours before reapplication is necessary. Use DEET with caution on children because adverse reactions have been reported.
Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Remove any tick you find on your body.