What is Ehrlichiosis? Symptoms, Causes, & Treatment

Ehrlichiosis is a bacterial infection you can get from tick bites, specifically from infected lone star ticks and blacklegged ticks. This illness happens when bacteria called Ehrlichia enter your bloodstream and attack your white blood cells, which are part of your immune system.

While ehrlichiosis might sound alarming, it's completely treatable with antibiotics when caught early. Most people recover fully within a few weeks of starting treatment, and serious complications are rare when the infection is diagnosed and treated promptly.

What are the symptoms of ehrlichiosis?

Ehrlichiosis symptoms typically appear 1 to 2 weeks after a tick bite, though they can show up anywhere from a few days to a month later. The early signs often feel like having the flu, which can make this condition tricky to identify at first.

Here are the most common symptoms you might experience:

• Fever and chills that come on suddenly
• Severe headache that doesn't respond well to over-the-counter pain relievers
• Muscle aches throughout your body
• Fatigue that feels more intense than typical tiredness
• Nausea and vomiting
• Loss of appetite
• Confusion or feeling mentally foggy

Some people also develop a rash, though this happens less frequently than with other tick-borne diseases like Rocky Mountain spotted fever. The rash, when it appears, usually shows up as small, flat, pink or red spots.

In rare cases, more serious symptoms can develop if the infection progresses without treatment. These might include severe confusion, difficulty breathing, bleeding problems, or signs of organ dysfunction. However, these severe complications are uncommon when ehrlichiosis is treated appropriately with antibiotics.

What causes ehrlichiosis?

Ehrlichiosis is caused by bacteria from the Ehrlichia family that live inside ticks. When an infected tick bites you and stays attached for several hours, these bacteria can enter your bloodstream and cause infection.

The main types of bacteria that cause ehrlichiosis include:

• Ehrlichia chaffeensis, spread by lone star ticks
• Ehrlichia ewingii, also spread by lone star ticks
• Anaplasma phagocytophilum, spread by blacklegged ticks (also called deer ticks)

These ticks pick up the bacteria when they feed on infected animals like deer, dogs, or rodents. The bacteria then live in the tick's body and can be passed to humans during future blood meals.

It's important to know that ehrlichiosis cannot spread from person to person through casual contact, coughing, or touching. You can only get it through the bite of an infected tick that has been attached to your skin for at least several hours.

When to see a doctor for ehrlichiosis?

You should contact your healthcare provider if you develop flu-like symptoms within a month of spending time in areas where ticks are common, especially if you remember being bitten by a tick. Early treatment makes a significant difference in how quickly you recover.

Seek medical attention promptly if you experience fever, headache, muscle aches, and fatigue after potential tick exposure. Don't wait for symptoms to worsen, as ehrlichiosis responds best to treatment when started early in the infection.

Get emergency medical care right away if you develop severe symptoms like high fever above 103°F, severe confusion, difficulty breathing, persistent vomiting, or signs of bleeding. While these serious complications are rare, they require immediate medical attention.

Remember that you don't need to wait until you find a tick on your body to seek care. Many people with ehrlichiosis don't recall seeing or removing a tick, since these tiny creatures can be as small as a poppy seed.

What are the risk factors for ehrlichiosis?

Your risk of getting ehrlichiosis increases based on where you live, work, or spend recreational time. Understanding these risk factors can help you take appropriate precautions when you're in tick-prone areas.

Geographic and environmental factors that increase your risk include:

• Living in or visiting the southeastern, south-central, and mid-Atlantic United States
• Spending time in wooded, brushy, or grassy areas
• Camping, hiking, hunting, or gardening in tick habitats
• Having pets that spend time outdoors and might bring ticks home

Certain personal factors can also affect your risk. People over 40 years old tend to get ehrlichiosis more often, possibly because they spend more time in outdoor activities. Men are diagnosed with ehrlichiosis slightly more frequently than women, likely due to higher rates of outdoor occupational and recreational exposure.

If you have a weakened immune system due to medications, medical conditions, or treatments like chemotherapy, you might be at higher risk for more severe symptoms if you do contract ehrlichiosis.

What are the possible complications of ehrlichiosis?

Most people with ehrlichiosis recover completely with proper antibiotic treatment, but complications can develop if the infection goes untreated or isn't caught early enough. These complications are more likely in people with weakened immune systems or other underlying health conditions.

Potential complications that can develop include:

• Respiratory problems, including difficulty breathing or pneumonia
• Bleeding disorders due to low platelet counts
• Kidney dysfunction or failure
• Heart problems, including inflammation of the heart muscle
• Central nervous system complications like seizures or coma
• Secondary infections due to a compromised immune system

In very rare cases, untreated ehrlichiosis can be life-threatening, particularly in older adults or people with compromised immune systems. However, with prompt diagnosis and appropriate antibiotic treatment, the vast majority of people recover fully without any lasting effects.

The good news is that these serious complications are quite uncommon when ehrlichiosis is treated appropriately. This is why seeking medical care early when you have symptoms after tick exposure is so important.

How can ehrlichiosis be prevented?

Preventing ehrlichiosis centers around avoiding tick bites and quickly removing any ticks that do attach to your body. Since there's no vaccine for ehrlichiosis, these protective measures are your best defense against infection.

When spending time in areas where ticks might be present, you can protect yourself by:

• Wearing long pants and long-sleeved shirts, preferably light-colored so you can spot ticks easily
• Tucking your pants into your socks to create a barrier
• Using EPA-registered insect repellents containing DEET on exposed skin
• Treating clothing and gear with permethrin-based products
• Staying on marked trails and avoiding brushy, overgrown areas when possible

After spending time outdoors, check your entire body for ticks, paying special attention to areas like your scalp, behind your ears, underarms, and groin. Don't forget to check your clothing and any pets that were with you.

If you find a tick attached to your skin, remove it promptly using fine-tipped tweezers. Grasp the tick as close to your skin as possible and pull upward with steady pressure. Clean the bite area with soap and water or rubbing alcohol afterward.

How is ehrlichiosis diagnosed?

Diagnosing ehrlichiosis can be challenging because its early symptoms are very similar to many other illnesses, including the flu. Your doctor will likely start by asking about your recent activities, particularly any time spent outdoors in areas where ticks are common.

Your healthcare provider will perform a physical examination and may order several blood tests to help confirm the diagnosis. These tests might include a complete blood count, which often shows low white blood cell counts, low platelet counts, and elevated liver enzymes in people with ehrlichiosis.

More specific tests can detect ehrlichiosis bacteria or your body's immune response to them. These include PCR tests that look for bacterial DNA and antibody tests that check for your immune system's response to the infection. However, antibody tests may not show positive results in the first week of illness.

Sometimes your doctor might start antibiotic treatment based on your symptoms and risk factors, even before test results come back. This approach makes sense because early treatment is crucial, and waiting for test results could delay important care.

What is the treatment for ehrlichiosis?

The primary treatment for ehrlichiosis is antibiotics, specifically doxycycline, which is highly effective against the bacteria that cause this infection. Most people start feeling better within 24 to 48 hours of beginning antibiotic treatment.

Your doctor will typically prescribe doxycycline for 7 to 14 days, depending on how severe your symptoms are and how quickly you respond to treatment. It's crucial to take the entire course of antibiotics, even if you start feeling better before finishing all the pills.

For people who cannot take doxycycline, such as pregnant women or those with certain allergies, alternative antibiotics like rifampin might be used. However, doxycycline remains the first-choice treatment because it's most effective against ehrlichiosis bacteria.

Most people with ehrlichiosis can be treated at home with oral antibiotics. However, if you have severe symptoms or complications, you might need to be hospitalized for intravenous antibiotics and supportive care like IV fluids or monitoring of organ function.

How to manage ehrlichiosis symptoms at home?

While taking your prescribed antibiotics is the most important part of treatment, there are several things you can do at home to help manage your symptoms and support your recovery. Rest and staying well-hydrated are particularly important as your body fights the infection.

For fever and body aches, you can use over-the-counter medications like acetaminophen or ibuprofen, following the package directions. These can help you feel more comfortable while the antibiotics work to clear the infection.

Make sure to drink plenty of fluids, especially water, to prevent dehydration from fever and help your body eliminate the infection. Eating light, easily digestible foods can help if you're experiencing nausea or loss of appetite.

Getting adequate rest is crucial for your immune system to effectively fight the infection. Don't push yourself to return to normal activities too quickly – give your body time to recover fully.

Keep track of your symptoms and contact your healthcare provider if they worsen or don't improve within a few days of starting antibiotics. Most people notice significant improvement within 48 hours of beginning treatment.

How should you prepare for your doctor appointment?

Before your appointment, write down all your symptoms and when they started, even if they seem minor. Include details about any recent outdoor activities, travel, or potential tick exposure, as this information helps your doctor assess your risk for ehrlichiosis.

Bring a list of all medications you're currently taking, including over-the-counter drugs and supplements. Also, note any allergies you have to medications, as this affects which antibiotics your doctor can safely prescribe.

If you found and removed a tick, try to remember when and where this happened. If you saved the tick, bring it with you in a sealed container – this can sometimes help with diagnosis, though it's not necessary for treatment.

Prepare questions you want to ask your doctor, such as how long you should expect to feel sick, when you can return to work or normal activities, and what warning signs should prompt you to seek immediate care.

What's the key takeaway about ehrlichiosis?

Ehrlichiosis is a treatable bacterial infection transmitted by tick bites that responds excellently to antibiotic therapy when caught early. The most important things to remember are that prevention through tick avoidance is your best protection, and prompt medical care after tick exposure can prevent serious complications.

If you develop flu-like symptoms after spending time in tick-prone areas, don't hesitate to contact your healthcare provider, even if you don't remember being bitten. Early diagnosis and treatment with doxycycline typically lead to full recovery within a few weeks.

By taking appropriate precautions when outdoors and seeking medical attention promptly when symptoms develop, you can protect yourself and your family from this tick-borne illness. Remember that ehrlichiosis is completely preventable and highly treatable with the right approach.