PubMed · 8043106
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P Brouqui, D Raoult. 1994-06-16. Human ehrlichiosis.. https://doi.org/10.1056/nejm199406163302418
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This report describes the data accumulated during the first 5 years of national surveillance for the human ehrlichioses in the United States and territories, from its initiation in 1997 through 2001. Reported cases of human monocytic and granulocytic ehrlichiosis (HME and HGE) and cases of "other ehrlichiosis" (OE), where the agent was unspecified, originated from 30 states. As anticipated, most HME cases were from the south-central and southeastern United States, while HGE was most commonly reported from the northeastern and upper-Midwestern region. State-level incident reports of 487 HME, 1,091 HGE, and 11 OE cases were evaluated. The average annual incidences of HME, HGE, and OE per million persons residing in states reporting disease were 0.7, 1.6, and 0.2, respectively. The median ages of HME (53 yr) and HGE cases (51 yr) were consistent with published patient series. Most (> 57%) ehrlichiosis patients were male. The results suggest that national surveillance for the ehrlichioses, although imperfect in coverage, will help define endemic regions and may be useful for monitoring long-term trends. Although the data appear representative of the demographic profiles established for HME and HGE, rigorous evaluation of the system is required. Methods are proposed for evaluating the quality and representativeness of HME and HGE surveillance data, using well-established surveillance systems for Rocky Mountain spotted fever and Lyme disease.
Tick-borne diseases are the most common vector-borne illnesses in the United States. Lyme disease is the most common, but several others also occur. The ehrlichioses have only been identified as agents of human disease in the United States in the past few decades, and knowledge about them is still evolving. Rocky Mountain spotted fever is relatively common and can be severe, especially in children, if the diagnosis is not made quickly. Tularemia has long been known to cause disease in humans, but there is renewed interest because of its potential as a biologic warfare agent. These diseases can be severe or even fatal. Most of them are easily treatable when identified early. These diseases result from a variety of infectious agents including bacteria, rickettsia, viruses and protozoa, or they may be caused by substances produced by the tick. Most of these diseases present initially with nonspecific symptoms and are often difficult to recognize. Few definitive diagnostic tests are available. Therefore, knowledge of the epidemiology and common presentations, as well as the diagnostic options and treatments available, are important issues for family physicians.