Ehrlichiae are small, gram-negative, obligately intracellular bacteria that reside within a phagosome. The first human ehrlichial
infection was recognized in the United States in 1987. It was later shown to be caused by a new species, Ehrlichia chaffeensis. In 1994, an ehrlichial pathogen within neutrophils that is closely related to the known veterinary pathogens E. equi and E. phagocytophila was found to infect humans. Molecular methods were required to detect, characterize, and identify these fastidious and uncultivated bacteria. Subsequently, E. chaffeensis
infection was documented in more than 400 patients in 30 states, Europe, and Africa. Likewise, approximately 170 cases of human granulocytic
ehrlichiosis have been diagnosed, most since 1994, predominantly in the upper midwestern and northeastern states, but also in northern California. The disease caused by ehrlichiae is generally undifferentiated but is often associated with
leukopenia,
thrombocytopenia, and elevated serum hepatic
transaminase levels in tick-exposed patients.
Infection ranges from subclinical to fatal;
tetracycline appears to be an effective
therapy. The emergence of these two newly recognized tickborne
infections as threats to human health is probably due to increased clinical cognizance, but as in other emerging tickborne
infections, it is likely that the rapid increase in identified cases signals a true emergence of disease associated with a changing vector-host ecology.