title: The incidence of ehrlichial and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina.
abstract: We examined the clinical and laboratory findings of a consecutive series of patients from central North Carolina presenting with fever and a history of tick bite within the preceding 14 days. Evidence of a tick-transmitted pathogen was detected in 16 of 35 patients enrolled over a 2-year period. Nine patients were infected with Ehrlichia chaffeensis, and 6 were infected with a spotted fever group rickettsia; 1 patient had evidence of coinfection with E. chaffeensis and a spotted fever group rickettsia. Four patients had detectable antibodies against the human granulocytic ehrlichiosis agent; however, only 2 had a 4-fold antibody titer rise without detectable antibodies against E. chaffeensis. The other 2 were thought to have cross-reacting antibodies to E. chaffeensis. We conclude that ehrlichial infections may be as common as spotted fever group rickettsial infections in febrile patients from central North Carolina with a recent history of tick bite.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Carpenter
authors.forename: T K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: L K
authors.initials: LK
authors.lastname: Kong
authors.forename: G R
authors.initials: GR
authors.lastname: Corey
authors.forename: S M
authors.initials: SM
authors.lastname: Chen
authors.forename: D H
authors.initials: DH
authors.lastname: Walker
authors.forename: J S
authors.initials: JS
authors.lastname: Dumler
authors.forename: E
authors.initials: E
authors.lastname: Breitschwerdt
authors.forename: B
authors.initials: B
authors.lastname: Hegarty
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
mesh_terms: D000328:Adult; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D015897:Comorbidity; D018469:Ehrlichia chaffeensis / Q000302:isolation & purification; D016873:Ehrlichiosis / Q000097:blood / Q000453:epidemiology*; D005335:Fever of Unknown Origin / Q000097:blood / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007299:Insect Bites and Stings; D007958:Leukocyte Count; D009657:North Carolina / Q000453:epidemiology; D010976:Platelet Count; D016133:Polymerase Chain Reaction; D012281:Rickettsia / Q000302:isolation & purification; D012282:Rickettsia Infections / Q000097:blood / Q000453:epidemiology*; D013987:Ticks
chemical_list: D000907:Antibodies, Bacterial