Human granulocytic ehrlichiosis as a common cause of tick-associated fever in Southeast Sweden: report from a prospective clinical study

Scand J Infect Dis. 2002;34(3):187-91. doi: 10.1080/00365540110080061.

Abstract

Between May and December 1998, tick-associated febrile illness was prospectively studied in Southeast Sweden in order to assess the occurrence of human granulocytic ehrlichiosis (HGE). Inclusion criteria were fever (> or = 38.0 degrees C), with or without headache, myalgia or arthralgia in patients with an observed tick bite or tick exposure within 1 month prior to onset of symptoms. Patients with clinical signs of Lyme borreliosis were included. Of the 27 patients included, we identified 4 cases of HGE. 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. None of the clinical signs or laboratory parameters monitored was helpful in predicting ehrlichiosis in this group with tick-associated fever conditions. Within the HGE-negative group (n = 23), 12 patients had clinical or laboratory signs of Lyme borreliosis. For 11 patients, the aetiology of the fever remained unclear. Our results suggest that HGE is common in tick-infested areas of Southeast Sweden, and may occur as a coinfection of Lyme borreliosis. Granulocytic ehrlichiosis should be suspected in patients who present with tick-associated fever, with or without erythema migrans. Ehrlichia serology and PCR should be employed to confirm the diagnosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Animals
  • Arthropod Vectors
  • Bites and Stings / complications
  • Bites and Stings / epidemiology
  • Bites and Stings / microbiology
  • Child
  • Ehrlichia / genetics
  • Ehrlichia / isolation & purification
  • Ehrlichiosis / complications*
  • Ehrlichiosis / diagnosis
  • Ehrlichiosis / epidemiology*
  • Ehrlichiosis / microbiology
  • Erythema Chronicum Migrans / complications
  • Female
  • Fever / complications*
  • Fever / epidemiology
  • Fever / microbiology
  • Humans
  • Lyme Disease / complications
  • Lyme Disease / epidemiology
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prospective Studies
  • Serologic Tests
  • Sweden
  • Ticks / microbiology
  • Ticks / physiology*