I was interested in the recent article by Telford and colleagues [1]. I have seen three documented cases of ehrlichiosis among patients from the eastern shore of Virginia. The first was that of a 61-year-old man admitted to our hospital in May 1994. He was acutely ill with conjunctivitis, hepatitis, pancreatitis, acute renal failure, leukopenia, and thrombocytopenia. He improved slowly after receiving doxycycline therapy. Ehrlichia antibody tests were done by National Health Laboratories at Herndon, Virginia. The acute titers to Ehrlichia IgM and IgG were 1:16 on 25 May 1994. On 9 June, the Ehrlichia IgM antibody titer was greater than 1:320, and the Ehrlichia IgG antibody titer was greater than 1:1024. The laboratory did not specify the Ehrlichia species for which the patient was tested.

The second case was that of a 73-year-old man who was hospitalized with fever, pneumonitis, and cytopenias. He developed acute hepatitis and acute renal failure. His IgG titer to Ehrlichia chaffeensis increased to greater than 1:1024. The patient died despite doxycycline therapy. The third case was that of a 69-year-old woman treated as an outpatient for headache, fever, chills, nausea, anorexia, and myalgias. Her laboratory results showed leukopenia, thrombocytopenia, and elevated liver enzyme levels. The IgM titer to E. chaffeensis was greater than 1:320.

In the last 2 years, our group has treated five other patients with Rickettsia-like illnesses (characterized by prominent fever and leukopenia) for which a diagnosis of Rocky Mountain spotted fever or ehrlichiosis could not be established.

The eastern shore of Virginia is a rural area infested with ticks. We frequently see cases of Lyme disease and Rocky Mountain spotted fever and now have unequivocal evidence of the presence of ehrlichiosis.