Approach

Ehrlichiosis and anaplasmosis have a broad differential due to multi-systemic involvement and the absence of specific clinical features.[59][60] A presumptive diagnosis can be made in all patients with potential tick exposure/demonstrated tick bite combined with fever of abrupt onset, characteristic constitutional symptoms, leukopenia and/or thrombocytopenia, and elevated LFTs. Definitive diagnosis is confirmed by serology studies or polymerase chain reactions (PCR). A high index of suspicion is required for diagnosis of infection, even in endemic areas.[61]

Ehrlichiosis and anaplasmosis are nationally notifiable diseases, and healthcare providers should notify local health departments. The Centers for Disease Control and Prevention is notified through the National Electronic Telecommunications System for Surveillance.

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