Chart for Patient Suspected to have Ehrlichiosis after tick bite

Unité des Rickettsies, Faculté de médecine, 27 Bvd J.MOULIN,13005 Marseille,France. Tel (33) 04.91.32.43.75. Fax (33) 04.91.83.03.90

[e-mail: Philippe Brouqui @ Medecine.univ-mrs.fr ]

Date of onset of symptoms

Tick bite  (Ixodes spp)                                                                 Yes                     No

Hunters /contact with wild mammifere                                   Yes                     No

Forest activities                                                                             Yes                     No

Lyme positive serology                                                               Yes                     No

Fever (up to 38°C)                                                     Yes                             No

Chills                                              Yes                             No

Headaches                                     Yes                             No

Myalgia                                          Yes                             No

Arthralgia                                      Yes                             No

Vomiting                                                                    Yes                             No

Diarrhea                                                                     Yes                             No

Clinical evidence of pneumonia                           Yes                             No

Abnormal Chest X ray                                  Yes                             No

Rash                                                                            Yes                             No

Maculopapular                                               Yes                             No

Petechiae                                                         Yes                             No

Neurologic failure ( confusion)                              Yes                             No

Meningitis                                                       Yes                             No

Ehrlichia on  Giemsa stained blood film              Yes                             No

ASAT  > 50 UI/l                                                        Yes                             No

Leukocytes < 3,5 Giga/l                                           Yes                             No

Platelets < 150 Giga/l                                               Yes                             No

Elevated serum creatinine                                      Yes                             No

At presentation

1-Collect tick if possible and store it in sterile tube with blade ( For weeks)

          ( Used for PCR and cultivation of the causative organism )

2-Collect EDTA anticoagulated blood (5ml)

          ( Used for Cultivation and PCR) 

3-Perform a blood film and stained it with Giemsa

          ( Used for direct detection of morulae in polynuclear neutrophiles )

4-Perform the first serum sample

          ( For detection of antibodies to ehrlichia , rickettsia, and bartonella )

5-Fill up the clinical and epidemiological chart

          ( For clinical evaluation of cases)

Treat the patient (Doxycycline 200mg / Day in adults ) and schedule the second sera ( Day 10-15 after admission ) and the others ( 2 months and 6 months)

Send  : Tick, EDTA blood, blood film, and the first serum at one time overnight as soon as possible to :

Unité des Rickettsies, Faculté de médecine, 27 Bvd J.MOULIN,13005 Marseille,France. Tel (33) 04.91.32.43.75. Fax (33) 04.91.83.03.90

[e-mail: Philippe Brouqui @ Medecine.univ-mrs.fr ]