Human granulocyte ehrlichiosis (HGE) is a zoonotic infection caused by a rickettsia-like agent. The infection is acquired by contact with Ixodes ticks carrying the HGE agent. The deer mouse is the animal reservoir and, overall, the epidemiology is very much like that of Lyme disease and babesiosis. HGE is most prevalent in the upper Midwest and in other areas of the United States that are endemic for Lyme disease. Since its first description in 1994, there have been approximately 50 cases of HGE described in the upper Midwest.
The cellular target in HGE cases is the neutrophil. The organisms exist in membrane-lined vacuoles within the cytoplasm of infected host cells. Ehrlichial inclusions, called morulae, contain variable numbers of organisms. Single organisms, wrapped in vacuolar membranes have also been observed in the cytoplasm. Ehrlichia species occur in small electron-dense and large electron-lucent forms, but a clear life cycle has not been elucidated.
Diagnosis of human ehrlichiosis has been difficult because the patient's clinical course is often mild and nonspecific, including fever, myalgias, arthralgias, and nausea. This is easily confused with other illnesses such as influenza or other tickborne zoonoses such as Lyme disease, babesiosis, and Rocky Mountain spotted fever. Clues to the diagnosis of ehrlichiosis in a patient with an acute febrile illness after tick exposure include laboratory findings of leukopenia or thrombocytopenia and elevated serum aminotransferase levels. However, these findings may also be present in patients with Lyme disease or babesiosis.