title: Dual infection with Ehrlichia chaffeensis and a spotted fever group rickettsia: a case report.
abstract: Well-documented cases of simultaneous human infection with more than one tick-borne pathogen are rare. To our knowledge only two dual infections have been reported: simultaneous human infection with the agent of human granulocytic ehrlichiosis and Borrelia burgdorferi and simultaneous human infection with B. burgdorferi and Babesia microti (1-2). Rocky Mountain spotted fever has long been known to be endemic in North Carolina; cases of human ehrlichial infection were recognized there soon after Ehrlichia chaffeensis was recognized as an important cause of tick-borne disease in the southeastern United States. Because both Rocky Mountain spotted fever and ehrlichiosis are prevalent in North Carolina, occasional cases of simultaneous human infection by rickettsial and ehrlichial agents would not be surprising; however, no such cases seem to have been reported.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA. Sexto002@mc.duke.edu
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: G R
authors.initials: GR
authors.lastname: Corey
authors.forename: C
authors.initials: C
authors.lastname: Carpenter
authors.forename: L Q
authors.initials: LQ
authors.lastname: Kong
authors.forename: T
authors.initials: T
authors.lastname: Gandhi
authors.forename: E
authors.initials: E
authors.lastname: Breitschwerdt
authors.forename: B
authors.initials: B
authors.lastname: Hegarty
authors.forename: S M
authors.initials: SM
authors.lastname: Chen
authors.forename: H M
authors.initials: HM
authors.lastname: Feng
authors.forename: X J
authors.initials: XJ
authors.lastname: Yu
authors.forename: J
authors.initials: J
authors.lastname: Olano
authors.forename: D H
authors.initials: DH
authors.lastname: Walker
authors.forename: S J
authors.initials: SJ
authors.lastname: Dumler
mesh_terms: D000328:Adult; D018469:Ehrlichia chaffeensis / Q000235:genetics / Q000302:isolation & purification; D016873:Ehrlichiosis / Q000150:complications* / Q000175:diagnosis; D005455:Fluorescent Antibody Technique; D005798:Genes, Bacterial; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012284:Rickettsia rickettsii / Q000302:isolation & purification; D012373:Rocky Mountain Spotted Fever / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D017422:Sequence Analysis, DNA; D012867:Skin / Q000382:microbiology