Ehrlichiosis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

There are four primary illnesses linked to an Ehrlichia infection, they are: Human ehrlichiosis ewingii (HEE), Human Monocytotropic Ehrlichiosis, Ehrlichiosis muris-like (EML), Human Granulocytotropic Anaplasmosis. Although clinical manifestations appear similar, certain characteristics will differ and may be helpful in an accurate differential diagnosis. Ehrlichiosis infections must also be differentiated from other tick-borne diseases that cause fever, chills, headaches, body ache, and rash. When trying to differentiate ehrlichiosis from other infections, it is important to recognize that the clinical manifestations of ehrlichiosis greatly resemble those of other tick-borne illnesses, especially those caused by the Rickettsiae family.

Differential Diagnosis

Differentiating between ehrlichia diseases:

Disease	Common Symptoms
Human ehrlichiosis ewingii (HEE)	Similar symptoms to those of HME and HGA. Although not much has been documented due to the minor amount of reported cases.
Human Monocytotropic Ehrlichiosis	More Severe than HGA and HEE. Clinical manifestations include gastrointestinal symptoms, headaches, myalgias, and arthralgias. It’s been documented that 20% of infected patients have neurological manifestations, CNS complications, potential seizures and coma. Potential rash, however the rash may indicate a co-infection between Rocky Mountain Spotted Fever and Ehrlichiosis.
Ehrlichiosis muris-like (EML)	Common symptoms include fever, malaise, thrombocytopenia, and lymphopenia.
Human Granulocytotropic Anaplasmosis	Fever, headache, and myalgias. Rash is uncommon, and CNS disorders as well as neurological issues have been reported in less than 1%.

Examples of tick-borne diseases that may be misdiagnosed for ehrlichiosis may be found in the table below:

Disease	Symptoms
Bacterial Infection
Borreliosis (Lyme Disease) ^[1]	Flu-like illness, fatigue, fever, arthritis, neuroborreliosis, cranial nerve palsy, carditis and erythema migrans.
Relapsing Fever ^[2]	Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental state, painful urination, rash, and rigors.
Typhus (Rickettsia)
Rocky Mountain spotted fever	Fever, alterations in mental state, myalgia, rash, and headaches.
Helvetica Spotted Fever ^[3]	Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches.
Ehrlichiosis Anaplasmosis ^[4]	Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults).
Tularemia ^[5]	Ulceroglandular, Glandular, Oculoglandular, Oroglandular, Pneumonic, Typhoidal.
Viral Infection
Tick-borne meningoencephalitis ^[6]	Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Late Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis.
Colorado tick fever ^[7]	Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents itself in nearly 50% of infected patients.
Crimean-Congo Hemorrhagic Fever	Initially infected patients will likely feel a few of the following symptoms; headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception.
Protozoan Infection
Babesiosis ^[8]	Non-specific flu like symptoms.

References

↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.

[Lyme_CDC”-1] Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015

[TBRF_CDC”-2] Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015

[RMSF_CDC”-3] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015

[Ehrlichiosis_CDC”-4] Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015

[Tulameria_CDC”-5] Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015

[TBE_CDC”-6] General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015

[GenTickDis_CDC”-7] General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015

[Babesiosis_CDC”-8] Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.

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Ehrlichiosis differential diagnosis

Overview

Differential Diagnosis

References

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