Reinfection with the Agent of Human Granulocytic Ehrlichiosis
- Harold W. Horowitz, MD;
- Maria Aguero-Rosenfeld, MD;
- J. Stephen Dumler, MD;
- Donna F. McKenna, ANP;
- Tze-chen Hsieh, PhD;
- Joseph Wu, PhD;
- Ira Schwartz, PhD; and
- Gary P. Wormser, MD
- From New York Medical College, Valhalla, New York; and Johns Hopkins Medical Institutions, Baltimore, Maryland. Acknowledgments: The authors thank Jobby Jacob, Mehdi Baluch, Fatemeh Kalantarpour, Shoba Varda, Susan Bittker, and Denise Cooper for technical assistance and Diane Holmgren for coordination of research activities. Grant Support: In part by the Westchester County Department of Health (grant CMC-2502 to Dr. Horowitz and grants HLT27017, HLT27018, and HLT27019 to Dr. Aguero-Rosenfeld); the Centers for Disease Control and Prevention (Cooperative Agreement U50/CCU 210280 to Dr. Wormser); the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant R01-AR41511 to Dr. Schwartz); Group 99, Inc., and the Philip Morris Co. (to Dr. Wu); and the National Institute of Allergy and Infectious Diseases (grant R01-AI41213-01 to Dr. Dumler). Requests for Reprints: Harold Horowitz, MD, Division of Infectious Diseases, Westchester Medical Center, Room 209, Macy Pavilion, Valhalla, NY 10595. Current Author Addresses: Drs. Horowitz, Aguero-Rosenfeld, Hsieh, Wu, Schwartz, and Wormser and Ms. McKenna: Westchester Medical Center, Macy Pavilion, Valhalla, NY 10595. Dr. Dumler: Department of Pathology, Division of Medical Microbiology, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD 21201.
Human granulocytic ehrlichiosis is an acute febrile illness caused by a still-unnamed organism, the human granulocytic ehrlichiosis agent, that is closely related to the veterinary pathogens Ehrlichia equi and E. phagocytophila[1-3]. Human granulocytic ehrlichiosis has been reported in an increasingly broad geographic area of the United States [1, 2] and in Europe [4]. Like Borrelia burgdorferi and Babesia microti, the etiologic agents of Lyme disease and babesiosis, respectively [5], the agent of human granulocytic ehrlichiosis is transmitted by Ixodes scapularis ticks [5]. We report what we believe to be the first documented case of reinfection with the human granulocytic ehrlichiosis agent in a woman in whom human granulocytic ehrlichiosis had been diagnosed approximately 2 years previously. This case indicates that a single episode of infection may not confer long-term protection against reinfection.
Case Report
In July 1995, a 60-year-old woman who lives in an area of Westchester County, New York, that is endemic for Lyme disease and human granulocytic ehrlichiosis presented with a 5-day history of fever (body temperatures up to 40 °C). At presentation, the patient reported rigors, headache, fatigue, myalgia, and anorexia. She noted that she had been bitten by ticks twice within 2 weeks before the illness developed. In June 1994, she was treated with doxycycline for Lyme disease associated with erythema migrans. Her medical history did not feature other infectious problems that would suggest an immune deficiency, and she …
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