Ehrlichiosis and Anaplasmosis
Ehrlichiosis and anaplasmosis are similar tick-borne illnesses that cause flu-like symptoms, including fever, muscle aches and headache. Signs and symptoms of ehrlichiosis and anaplasmosis usually appear within 14 days after a tick bite.
If treated quickly with appropriate antibiotics, you’ll likely recover within a few days. Untreated ehrlichiosis and anaplasmosis can result in serious or life-threatening complications.
The best way to prevent these infections is to avoid tick bites. Tick repellents, thorough body checks after being outside and proper removal of ticks are your best defenses against these tick-borne diseases.
Signs and symptoms of ehrlichiosis and anaplasmosis are generally the same, although they usually are more severe in ehrlichiosis. Symptoms of ehrlichiosis and anaplasmosis, which vary widely from person to person, include:
- Moderate fever
- Chills
- Headache
- Muscles aches or pains
- General feeling of being unwell
- Joint pain
- Nausea
- Vomiting
- Diarrhea
- Loss of appetite
Additional signs and symptoms associated with ehrlichiosis but rarely with anaplasmosis include:
- Confusion or changes in mental state
- Rash
Some people may be infected and not develop symptoms.
When to see a doctor
The time from getting a bite to showing signs and symptoms is usually five to 14 days. If you develop any of the signs or symptoms after a tick bite or after a possible exposure to ticks, see your doctor.
Ehrlichiosis and anaplasmosis are caused by different bacteria.
Ehrlichiosis is caused by different species of ehrlichia bacteria. The Lone Star tick — found in south-central, southeastern and eastern coastal states — is the primary carrier of bacteria causing ehrlichiosis. Black-legged ticks, commonly called deer ticks, in the Upper Midwest are less common carriers.
Anaplasmosis is caused by the bacterium Anaplasma phagocytophilum. It’s primarily carried by deer ticks in the Upper Midwest, northeastern states and central Canadian provinces. It’s also carried by the Western black-legged tick in Western coastal states and other tick species in Europe and Asia.
The ehrlichia and anaplasma species belong to the same family of bacteria. Although each bacterium appears to have a specific target among immune system cells in the host, all of these infectious agents generally cause the same symptoms.
Tick bites and infection
Ticks feed on blood by latching onto a host and feeding until they’re swollen to many times their normal size. Ticks can pick up bacteria from a host, such as a deer, and then spread the bacteria to another host, such as a human. The spread of the bacteria from the tick to the host probably occurs about 24 hours after the tick has begun feeding.
Other ways bacteria spreads
Spread of the bacteria causing ehrlichiosis or anaplasmosis is possible through blood transfusions, from mother to fetus, or through direct contact with an infected, slaughtered animal.
Ticks live near the ground in wooded or brushy areas. They do not fly or jump, so they can only reach a host who brushes up against them. Factors that increase your risk of a tick bite include:
- Being outdoors in warm spring and summer months
- Participating in activities in wooded areas, such as camping, hiking or hunting
- Wearing clothes that leave your skin exposed in tick-friendly habitat
Without prompt treatment, ehrlichiosis and anaplasmosis can have serious effects on an otherwise healthy adult or child. People with weakened immune systems are at a higher risk of more-serious and life-threatening complications.
Complications of an untreated infection may include:
- Kidney failure
- Respiratory failure
- Heart failure
- Damage to the central nervous system
- Seizures
- Coma
- Severe secondary infections
The best way to steer clear of ehrlichiosis or anaplasmosis is to avoid tick bites when you are outdoors. Most ticks attach themselves to your lower legs and feet as you walk or work in grassy, wooded areas or overgrown fields. After a tick attaches to your body, it usually crawls upward to find a location to burrow into your skin.
If you are going to be working or playing in an area that is a likely tick habitat, follow these tips to protect yourself.
Tick-borne infections are difficult to diagnose based solely on signs and symptoms because they are similar to many other common conditions. Therefore, a history of a known tick bite or possible exposure to ticks is an important piece of information in making a diagnosis. Your doctor will also conduct a physical exam and order tests.
If you have ehrlichiosis or anaplasmosis, the following results are likely found from blood tests:
- Low count of white blood cells, which are disease-fighting cells of the immune system
- Low count of blood platelet cells, which are essential for blood-clotting
- Elevated liver enzymes that may indicate abnormal liver function
Tests of your blood may also indicate a tick-borne infection by detecting one of the following:
- Specific genes unique to the bacteria
- Antibodies to the bacteria created by your immune system
If your doctor diagnoses ehrlichiosis or anaplasmosis — or suspects a diagnosis based on the symptoms and clinical findings — you’ll begin treatment with the antibiotic doxycycline (Doryx, Vibramycin, others).
You’ll take the drugs at least three days after you no longer have a fever and your doctor has observed improvement in other signs of disease. The minimum treatment is five to seven days. More serious illness may require two to three weeks of antibiotic treatment.
If you’re pregnant or allergic to doxycycline, your doctor may prescribe the antibiotic rifampin (Rifadin, Rimactane, others).
References
- Bennett JE, et al. Ticks, including tick paralysis. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 19, 2020.
- Goldman L, et al., eds. Rickettsial infections. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 19, 2020.
- Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. 5th ed. Centers for Disease Control and Prevention; 2018. http://www.cdc.gov/lyme/healthcare/clinicians.html. Accessed Oct. 19, 2020.
- Sexton DJ. Human ehrlichiosis and anaplasmosis. https://www.uptodate.com/contents/search. Accessed Oct. 19, 2020.
- Nelder MP, et al. Recent emergence of Anaplasma phagocytophilum in Ontario, Canada: Early serological and entomological indicators. American Journal of Tropical Medicine and Hygiene. 2019; doi:10.4269/ajtmh.19-0166.
- Tick removal and testing. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/removal/index.html. Accessed Oct. 19, 2020.
- Preventing tick bites on people. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/prev/on_people.html. Accessed Oct. 19, 2020.
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