Ehrlichiosis in Thailand
Source: Heppner DG, et al. Lancet 1997;350:785-786.
Intrigued by the occurrence of unexplained febrile illness in people with negative blood smears from the Kanchanaburi Province of Western Thailand (along the Burmese border), Heppner and colleagues tested serum collected from 50 healthy volunteers living in the area for ehrlichial and rickettsial infection. Most were local farmers or forestry workers.
Fully 44% of the specimens were positive for E. chaffeensis, but none were positive for E. sennetsu. High titers in nine specimens suggested recent infection. Sixteen (32%) had antibodies to R. rickettsia, including eight of those with antibody to E. chaffeensis.
Based on these data, ehrlichiosis should be included in the differential diagnosis of fever in travelers who have recently returned from Thailand (the median incubation period is 7 days), especially those who are malaria-smear negative, irrespective of a documented history of tick exposure or the presence of rash. Fewer than one-half of adults with ehrlichiosis have rash, which is often maculopapular and may be petechial. In addition, patients often present with severe headache, chills, myalgias, arthralgias, and, less often, diarrhea, lymphadenopathy, and pulmonary infiltrates. Renal failure, respiratory failure, and shock may occur in a minority of infected individuals.
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