Abstract | December 16, 2022
Four Ticks, Three Problems, Two Rare Diseases, One Night in a Rural ED
Learning Objectives
- Note the differences in Anaplasma and Ehrlichia infections and presentations (including the spectrum).
- Reenforce that while the physical exam is often taken for granted, it certainly helped realize the underlying cause in this case.
- Realize that medicine truly is a “team sport” where everyone plays a role in helping patients, from EMS, nurses, doctors, lab techs, emergency department, ICU, wards, and follow-ups.
An 82-year-old man presented to a rural emergency department with early acute respiratory distress syndrome requiring BiPAP and ICU admission. He was found to have intracellular bacteria on the blood smear in both neutrophils and monocytes while in the emergency department (see figure 1, next page). Later in the hospital stay he had confirmed Anaplasma and Ehrlichia co-infection with pathology and serology. Both of these bacteria are rare in the state of Mississippi (Incidence of Anaplasma and Ehrlichia 0.67 per million and 3.7 per million, respectively). On physical exam, the patient was found to have four ticks attached to him for an unknown length of time. Additionally the patient was found to have pancytopenia with urosepsis, believed to be secondary to the tick-born illnesses. Alone, these infections cause significant morbidity (hospitalization rates up to 50%) and mortality (0.5-3.0%). While there have been several case reports and textbook mentions of Anaplasma co-infections, these have been with Borrelia and Babesia… not Ehrlichia.
