title: Human granulocytic ehrlichiosis as a common cause of tick-associated fever in Southeast Sweden: report from a prospective clinical study.
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.
authors.affiliation: Department of Clinical Microbiology, Kalmar County Hospital, Sweden. anneli.bjoersdorff@ltkalmar.se
authors.forename: Anneli
authors.initials: A
authors.lastname: Bjöersdorff
authors.forename: Bengt
authors.initials: B
authors.lastname: Wittesjö
authors.forename: Johan
authors.initials: J
authors.lastname: Berglun
authors.forename: Robert F
authors.initials: RF
authors.lastname: Massung
authors.forename: Ingvar
authors.initials: I
authors.lastname: Eliasson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001179:Arthropod Vectors; D001733:Bites and Stings / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D004536:Ehrlichia / Q000235:genetics / Q000302:isolation & purification; D016873:Ehrlichiosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D015787:Erythema Chronicum Migrans / Q000150:complications; D005260:Female; D005334:Fever / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008193:Lyme Disease / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012698:Serologic Tests; D013548:Sweden; D013987:Ticks / Q000382:microbiology / Q000502:physiology*