ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

Ehrlichiosis With Difficulty In Breathing, Skin Rash And Muscle Pains - An Infection That Accompanies Lyme's Disease

Updated on December 1, 2015

Detection of Ehrlichiosis

Human blood smear showing morula -a colony of Ehrilicia
Human blood smear showing morula -a colony of Ehrilicia | Source

A Word About The Lesser Known Organisms Ehrlichia

Ehrlichia species are small, gram-negative bacteria that grow in membrane-bound vacuoles within the host cells, in which they multiply to form intracytoplasmic colonies, the morulae (the Latin word for mulberry).

They have a special affinity for human white blood cells, both the granulocytes (neutrophils, eosinophils, and basophils) and the monocytes (macrophages). These cells form a line of defense of our body and provide protection against harmful microbes. Thus, this disease attacks and paralyzes our immune system.

Ehrlichiosis is a tick-borne zoonosis, with its main animal reservoirs being deer and dogs.

Clinically ehrlichiosis consists of two main variants:

  • Human Monocytic Ehrlichiosis (HME) caused by Ehrlichia chaffeensis.
  • Human Granulocytic Ehrlichiosis (HGE) caused by Ehrlichia phagocytophillia.

The peak incidence of the monocytic disease is from May through July. The disease is more common in men (75%) and is associated with increased outdoor exposure. Most individuals recall tick bites or exposure during 3 weeks before the onset of illness; usually these events take place during the season of greatest tick activity, that is from April to September. It is more common in rural areas. The median age of individuals affected is 44 years and the white-tailed rat is an important reservoir.

The bacteria causing granulocytic ehrlichiosis are transmitted along with Lyme's borrelia, both having a common vector Ixodes spp. of ticks. The infection peaks in July (summer months) and again in November, but cases occur throughout the year in warmer areas where the ticks remain viable. Its main animal reservoirs are the white-footed mouse, deer, horses, cattle, sheep and other mammals. This disease also predominantly affects males (79% of cases) and older persons (median age being 58 years).

Infected deer tick bite
Infected deer tick bite | Source

Signs and Symptoms of Human Monocytic Ehrlichiosis

Human Monocytic Ehrlichiosis has an incubation period of 1-2 weeks (9 days) after the bite from an infected deer tick or a dog tick. Only one-third of the persons who seroconvert actually become ill. Its major vector is the Lone Star Tick (Amblyomma americanum).

The disease is seen primarily in the Southeast, mid-Atlantic and South Central states of the USA and also has a global endemicity (Isreal, Japan, and Mexico) also showing cases.

The disease begins to show with vague, non-specific symptoms consisting of fever, chills, headache, muscle ache, nausea, vomiting, pharyngitis, diarrhea, lymph node enlargement and feeling unwell.

Less common symptoms include gastric upsets, cough, difficulty in breathing and confusion.

A non-specific skin rash consisting of minute patches, small pimple-like lesions or hemorrhages develops on the trunk, especially, in the children.

Other signs include conjunctival injection, hemorrhages on the palate and swelling of hands and feet, along with desquamation or peeling of skin.

Severe complications consist of infection of the brain and its covering meninges (meningoencephalitis) leading to seizures and coma, kidney failure, acute respiratory distress, disseminated intravascular coagulation (clots forming in blood vessels throughout the body) and pericarditis (inflammation of the membrane covering the heart) and opportunistic fungal or viral infections.

Manifestations of Human Granulocytic Ehrlichiosis

Human Granulocytic Ehrlichiosis presents with symptoms similar to those of the monocytic disease, but the rash is conspicuous for its absence. After an incubation period of 8 days, the infected individual develops a flu-like illness with fever, chills, malaise, headache, nausea and vomiting in the decreasing order of frequency. Some individuals develop a cough or confusion later in the course. Seizures are rare.

Severe complications of this disease can include shock, kidney failure and respiratory distress.

Neurological manifestations consisting of meningoencephalitis, weakness of face and demyelination can develop.

Concurrent illness with Ehrlichiosis, Babesiosis and Lyme's disease can occur in the same individual as all the three are transmitted by the same common vector, Ixodes spp of ticks. It is possible that microbial infections in this situation lead to a more severe disease than infection with a single agent.

Individuals with granulocytic ehrlichiosis appear to be older and sicker than those with acute Lyme's disease.

Ehrlichia sennetsu causes an infectious mononucleosis-like illness, the sennutsu fever in the Far-East.

Ehrlichiosis - the disease

  • Ehrlichia species are small Gram-negative bacteria that can only grow within host cells.
  • Ehrlichiosis is a tick-borne zoonosis with its main animal reservoirs being dogs, deer, horses and cattle.
  • In Human Monocytic Ehrlichiosis, the cells most commonly infected are monocytes and macrophages. The disease begins as a flu-like illness with skin rash, difficulty in breathing, and if untreated can complicate into acute respiratory failure and disseminated intravascular coagulation.
  • Human Granulocytic Ehrlichiosis occurs concurrently with Babesiosis and Lyme's disease and runs a more aggressive course.
  • Doxycycline is the treatment of choice for both variants.
  • The disease can be prevented by wearing protective clothing and use of tick repellents.

Laboratory Findings and Detection of Ehrlichiosis

Blood test reports of a person suffering from Ehrlichiosis are something like -

  • Reduced Platelet Counts (50,000-140,000/micro liter).
  • Reduced White Cell Counts (up to 3500/micro liter).
  • Elevation in Liver Enzymes (Aspartate and Alanine Amino Transferase).
  • Elevation in serum creatinine levels).

Ehrlichiosis can be detected by the following methods:

  • Microscopic examination of white blood cells for the presence of morulae.
  • Indirect immunofluorescence assay of acute and convalescent samples.
  • Polymerase chain reaction (PCR).
  • Protein Immunoblotting.
  • Direct Cultivation.

Variants of Ehrlichiosis

Human Monocytic Ehrilchiosis
Human Granulocytic Ehrlichiosis
Major cell target
April through September
Year round
Associated diseases
Usually occurs alone
Occurs with Babesiosis and Lyme's disease

Areas endemic of Ehrlichiosis

Areas of tick distribution
Areas of tick distribution | Source

Treatment and Prognosis of Ehrlichiosis

The usual treatment of choice is the antibiotic Doxycycline in a dose of 100 mg twice a day orally or as an intravenous injection. The same antibiotic is also administered to children suffering from this disease.

Defervescence occurs within 1 or 2 days. Therapy for 5-7 days is effective but should be continued for at least two weeks if Lyme's disease coinfection is suspected.

The median duration of disease is 1-2 weeks and clinical course ranges from symptomless seroconversion to multi-organ failure.

The disease runs a more aggressive course in the following situations:

  • Immunosuppression (organ transplant recipients, HIV patients, those on steroid therapy).
  • Individuals with a cough, diarrhea and enlarged lymph nodes.

The granulocytic form of the disease can be associated with opportunistic infections (disseminated candidiasis and aspergillosis) in immunosuppressed individuals.

Follow Precautions to prevent Ehrlichiosis

Wear covered clothes and apply tick repellants
Wear covered clothes and apply tick repellants | Source

Ways to Prevent Ehrlichiosis

The best preventive measure is to avoid tick bites in endemic areas.

Valuable precautions include the following:

  • Wearing of protective clothing.
  • Use of tick repellents on the skin.
  • Careful, frequent checking of the body with prompt removal of the ticks.

Ehrlichia infection is most likely controlled by a combination of cellular and antibody-mediated immune mechanisms.

Successful treatment is followed by an unusual rebound in lymphocyte counts.


    0 of 8192 characters used
    Post Comment

    No comments yet.


    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at:

    Show Details
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the or domains, for performance and efficiency reasons. (Privacy Policy)
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)