Which conditions should be included in the differential diagnosis for ehrlichiosis?

Updated: Jun 22, 2021
  • Author: Chinelo N Animalu, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Other differential diagnostic possibilities include typhoid fever, malaria, and babesiosis. All of these infectious diseases manifest as acute, undifferentiated, febrile illnesses with a paucity of physical signs. The diagnosis of typhoid fever and malaria are suggested by an appropriate epidemiologic profile and/or travel history. Exposure to large Dermacentor ticks would suggest RMSF, whereas exposure to small Ixodes ticks would suggest the possibility of babesiosis.

Other diseases that share clinical and laboratory findings of ehrlichial disease, particularly in patients with rash, include meningococcemia, toxic shock syndrome, murine typhus, Q fever, typhoid fever, leptospirosis, hepatitis, enteroviral infection, influenza, bacterial sepsis, endocarditis, and Kawasaki disease.

If a history of tick bite and outdoor activities exist with these symptoms, the physician should consider other tickborne febrile illnesses such as Rocky Mountain spotted fever, relapsing fever, tularemia, Lyme borreliosis, Colorado tick fever, and babesiosis.

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