Chapter 14 : Human Monocytotropic Ehrlichiosis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Human Monocytotropic Ehrlichiosis, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816490/9781555812386_Chap14-1.gif /docserver/preview/fulltext/10.1128/9781555816490/9781555812386_Chap14-2.gif


This chapter first gives a brief history of human monocytotropic ehrlichiosis (HME), which is a zoonotic disease. From this brief history of HME, it is clear that rapid progress in understanding this newly emerged tick-borne zoonosis was facilitated both by its successful cultivation and by experimental studies of ticks linked to field observations. Epidemiological studies were furthered through the use of molecular techniques, and knowledge of HME expanded rapidly in the early to mid-1990s. Next, the chapter talks about biology of the etiologic agent. In the eastern United States, is maintained in an epizootic cycle involving the lone star tick () as the principal vector and the white-tailed deer () as a major vertebrate reservoir. This critical vector-host association places these two species at the core of epizootiology and strongly influences its geographic distribution and seasonality of transmission. HME caused by is endemic to the United States, with residents in the southeastern and south-central states at highest risk. The clinical recognition of HME can be difficult, since the spectrum of manifestations is broad and nonspecific, ranging from asymptomatic infection to mild self-limited symptoms to rapidly fatal disease. HME typically presents as an uncomplicated, acute, nonspecific febrile illness that resolves rapidly if treated with doxycycline, characteristic of many rickettsial infections. The chapter ends with a discussion on laboratory diagnosis, treatment and prevention of HME.

Citation: Dawson J, Ewing S, Davidson W, Childs J, Little S, Standaert S. 2005. Human Monocytotropic Ehrlichiosis, p 239-257. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch14
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of Figure 1
Figure 1

Electron micrograph of in the cytoplasm of a macrophage. Photograph appears courtesy of Cynthia Goldsmith (CDC).

Citation: Dawson J, Ewing S, Davidson W, Childs J, Little S, Standaert S. 2005. Human Monocytotropic Ehrlichiosis, p 239-257. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch14
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 2
Figure 2

Average annual incidence of HME through 2001, as derived from states reporting cases. The legend indicates incidence values stratified into quartiles.

Citation: Dawson J, Ewing S, Davidson W, Childs J, Little S, Standaert S. 2005. Human Monocytotropic Ehrlichiosis, p 239-257. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch14
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 3
Figure 3

(a) The average age-specific incidence of HME derived from states reporting cases; (b) month of onset for HME.

Citation: Dawson J, Ewing S, Davidson W, Childs J, Little S, Standaert S. 2005. Human Monocytotropic Ehrlichiosis, p 239-257. In Goodman J, Dennis D, Sonenshine D, Tick-Borne Diseases of Humans. ASM Press, Washington, DC. doi: 10.1128/9781555816490.ch14
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Allan, S. A., 2001. Ticks (Class Arachnida: Order Acarina), p. 72 106. In W. M. Samuel,, M. J. Pybus,, and A. A. Kocan (ed.), Parasitic Diseases of Wild Mammals, 2nd ed. Iowa State University Press, Ames, Iowa.
2. Alleman, A. R.,, A. F. Barbet,, M. V. Bowie,, H. L. Sorenson,, S. J. Wong,, and M. Belanger. 2000. Expression of a gene encoding the major antigenic protein 2 homolog of Ehrlichia chaffeensis and potential application for serodiagnosis. J. Clin. Microbiol. 38: 3705 3709.
3. Anderson, B. E.,, J. E. Dawson,, D. C. Jones,, and K. H. Wilson. 1991. Ehrlichia chaffeensis, a new species associated with human ehrlichiosis. J. Clin. Microbiol. 29: 2838 2842.
4. Anderson, B. E.,, J. W. Sumner,, J. E. Dawson,, T. Tzianabos,, C. R. Greene,, J. G. Olson,, D. B. Fishbein,, M. Olsen- Rasmussen,, B. P. Holloway,, E. H. George,, and A. F. Azad. 1992. Detection of the etiologic agent of human ehrlichiosis by polymerase chain reaction. J. Clin. Microbiol. 30: 775 780.
5. Anderson, B. E.,, K. G. Sims,, J. E. Olson,, J. E. Childs,, J. F. Piesman,, C. M. Happ,, G. O. Maupin,, and B. J. B. Johnson. 1993. Amblyomma americanum: a potential vector of human ehrlichiosis. Am. J. Trop. Med. Hyg. 49: 239 244.
6. Antony, S. J.,, J. S. Dumler,, and E. Hunter. 1995. Human ehrlichiosis in a liver transplant recipient. Transplantation 60: 879 881.
7. Anziani, O. S.,, S. A. Ewing,, and R. W. Barker. 1990. Experimental transmission of a granulocytic form of the tribe Ehrlichieae by Dermacentor variabilis and Amblyomma americanum to dogs. Am. J. Vet. Res. 51: 929 931.
8. Arguin, P. M.,, J. Singleton, Jr.,, L. D. Rotz,, E. Marston,, T. A. Treadwell,, K. Slater,, M. Chamberland,, A. Schwartz,, J. G. Olson,, J. E. Childs, and the Transfusion-Associated Tick-Borne Illness Task Force. 1999. An investigation of possible transmission of tick-borne Transfusion 39: 828 833.
9. Armstrong, R. W. 1992. Ehrlichiosis in a visitor to West Virginia. J. Med. 157: 182 184.
10. Barbour, A. G.,, G. O. Maupin,, G. J. Teltow,, C. J. Carter,, and J. Piesman. 1996. Identification of an uncultivable Borrelia species in the hard tick Amblyomma americanum: possible agent of a Lyme disease-like illness. J. Infect. Dis. 173: 403 409.
11. Belongia, E. A.,, K. D. Reed,, P. D. Mitchell,, C. P. Kolbert,, D. H. Persing,, J. S. Gill,, and J. J. Kazmierczak. 1997. Prevalence of granulocytic Ehrlichia infection among white-tailed deer in Wisconsin. J. Clin. Microbiol. 35: 1465 1468.
12. Bloemer, S. R.,, E. L. Snoddy,, J. C. Cooney,, and K. Fairbanks. 1986. Influence of deer exclusion on populations of lone star ticks and American dog ticks (Acari:Ixodidae). J. Econ. Entomol. 79: 679 683.
13. Bloemer, S. R.,, R. H. Zimmerman,, and K. Fairbanks. 1988. Abundance, attachment sites, and density estimators for lone star ticks (Acari: Ixodidae) infesting white-tailed deer. J. Med. Entomol. 25: 295 300.
14. Brouqui, P.,, and D. Raoult. 1992. In vitro antibiotic susceptibility of the newly recognized agent of ehrlichiosis in humans, Ehrlichia chaffeensis. Antimicrob. Agents Chemother. 36: 2799 2803.
15. Brouqui, P.,, M. L. Birg,, and D. Raoult. 1994. Cytopathic effect, plaque formation, and lysis of Ehrlichia chaffeensis grown on continuous cell lines. Infect. Immun. 62: 405 411.
16. Buitrago, M. I.,, J. W. Ijdo,, P. Rinaudo,, H. Simon,, J. Copel,, J. Gadbaw,, R. Heimer,, E. Fikrig,, and F. J. Bia. 1998. Human granulocytic ehrlichiosis during pregnancy treated successfully with rifampin. Clin. Infect. Dis. 27: 213 215.
17. Buller, R. S.,, M. Arens,, S. P. Hmiel,, C. D. Paddock,, J. W. Sumner,, Y. Rikihisa,, A. Unver,, M. Gaudreault-Keener,, F. A. Manian,, A. M. Liddell,, N. Schmulewitz,, and G. A. Storch. 1999. Ehrlichia ewingii, a newly recognized agent of human ehrlichiosis. N. Engl. J. Med. 341: 148 155.
18. Burket, C. T.,, C. N. Vann,, R. R. Pinger,, C. L. Chatot,, and F. E. Steiner. 1998. Minimum infection rate of Amblyomma americanum (Acari: Ixodidae) by Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) in southern Indiana. J. Med. Entomol. 35: 653 659.
19. Carpenter, C. F.,, T. K. Gandhi,, L. K. Kong,, G. R. Corey,, S. M. Chen,, D. H. Walker,, J. S. Dumler,, E. Breitschwerdt,, B. Hegarty,, and D. J. Sexton. 1999. The incidence of ehrlichial and rickettsial infection in patients with unexplained fever and recent history of tick bite in central North Carolina. J. Infect. Dis. 180: 900 903.
20. Centers for Disease Control and Prevention. 1997. Case definitions for infectious conditions under public health surveillance. Morb. Mortal. Wkly. Rep. 46(RR-10): 4647.
21. Centers for Disease Control and Prevention. 2000. Surveillance for Lyme disease—United States, 1992-1998. CDC Surveillance Summaries, April 28, 2000. Morb. Mortal. Wkly. Rep. 49(SS-3): 111.
22. Carpenter, C. F. Centers for Disease Control and Prevention. 2001. Summary of notifiable diseases, United States, 1999. Morb. Mortal. Wkly. Rep. 48: 1 104.
23. Chen, S.-M.,, V. L. Popov,, H.-M. Feng,, J. Wen,, and D. H. Walker. 1995. Cultivation of Ehrlichia chaffeensis in mouse embryo, Vero, BGM, and L929 cells and study of Ehrlichia-induced cytopathic effect and plaque formation. Infect. Immun. 63: 647 655.
24. Chen, S.-M.,, X.-J. Yu,, V. L. Popov,, E. L. Westerman,, F. G. Hamilton,, and D. H. Walker. 1997. Genetic and antigenic diversity of Ehrlichia chaffeensis: comparative analysis of a novel human strain from Oklahoma and previously isolated strains. J. Infect. Dis. 175: 856 863.
25. Childs, J. E.,, J. W. Sumner,, W. L. Nicholson,, R. F. Massung,, S. M. Standaert,, and C. D. Paddock. 1999. Outcome of diagnostic tests using samples from patients with culture-proven human monocytic ehrlichiosis: implications for surveillance. J. Clin. Microbiol. 37: 2997 3000.
26. Childs, J. E.,, J. H. McQuiston,, J. W. Sumner,, W. L. Nicholson,, J. A. Comer,, R. F. Massung,, S. M. Standaert,, and C. D. Paddock. 1999. Human monocytic ehrlichiosis due to Ehrlichia chaffeensis: how do we count the cases? In D. Raoult and P. Brouqui (ed.), p. 287 293. Rickettsiae and Rickettsial Diseases at the Turn of the Third Millennium. Elsevier, Paris, France.
27. Childs, J. E.,, and C. D. Paddock. 2002. The ascendancy of Amblyomma americanum as a vector of pathogens affecting humans in the United States. Annu. Rev. Entomol. 48: 307 337.
28. Comer, J. A.,, W. L. Nicholson,, J. W. Sumner,, J. G. Olson,, and J. E. Childs. 1999. Diagnosis of human ehrlichiosis by PCR assay of acute-phase serum. J. Clin. Microbiol. 37: 31 34.
29. Comer, J. A.,, W. L. Nicholson,, C. D. Paddock,, J. W. Sumner,, and J. E. Childs. 2000. Detection of antibodies reactive with Ehrlichia chaffeensis in the raccoon. J. Wildlife Dis. 36: 705 712.
30. Cooley, R. A.,, and G. M. Kohls. 1944. The genus Amblyomma (Ixodidae) in the U. S. J. Parasitol. 30: 77 111.
31. Dalton, M. J.,, M. J. Clarke,, R. C. Holman,, J. W. Krebs,, D. B. Fishbein,, J. G. Olson,, and J. E. Childs. 1995. National surveillance for Rocky Mountain spotted fever, 1981-1992: epidemiologic summary and evaluation of risk factors for fatal outcome. Am. J. Trop. Med. Hyg. 52: 405 413.
32. Davidson, W. R.,, D. A. Siefken,, and L. H. Creekmore. 1994. Seasonal and annual abundance of Amblyomma americanum (Acari: Ixodidae) in central Georgia. J. Med. Entomol. 31: 67 71.
33. Davidson, W. R.,, J. M. Lockhart,, D. E. Stallknecht,, and E. W. Howerth. 1999. Susceptibility of red and gray foxes to infection by Ehrlichia chaffeensis. J. Wildlife Dis. 35: 696 702.
34. Davidson, W. R.,, J. M. Lockhart,, D. E. Stallknecht,, E. W. Howerth,, J. E. Dawson,, and Y. Rechav. 2001. Persistent Ehrlichia chaffeensis infection in white-tailed deer. J. Wildlife Dis. 37: 538 546.
35. Dawson, J. E.,, Y. Rikihisa,, S. A. Ewing,, and D. B. Fishbein. 1991. Serologic diagnosis of human ehrlichiosis using two Ehrlichia canis isolates. J. Infect. Dis. 163: 564 567.
36. Dawson, J. E.,, B. E. Anderson,, D. B. Fishbein,, J. L. Sanchez,, C. S. Goldsmith,, K. H. Wilson,, and C. W. Duntley. 1991. Isolation and characterization of an Ehrlichia sp. from a patient diagnosed with human ehrlichiosis. J. Clin. Microbiol. 29: 2741 2745.
37. Dawson, J. E.,, and S. A. Ewing. 1992. Susceptibility of dogs to infection with Ehrlichia chaffeensis, causative agent of human ehrlichiosis. Am. J. Vet. Res. 53: 1322 1327.
38. Dawson, J. E.,, F. J. Candal,, V. G. George,, and E. W. Ades. 1993. Human endothelial cells as an alternative to DH82 cells for isolation of Ehrlichia chaffeensis, E. canis, and Rickettsia rickettsii. Pathobiology 61: 293 296.
39. Dawson, J. E.,, J. E. Childs,, K. L. Biggie,, C. Moore,, D. E. Stallknecht,, J. Shaddock,, J. Bouseman,, E. Hofmeister,, and J. G. Olson. 1994. White-tailed deer as a potential reservoir of Ehrlichia spp. J. Wildlife Dis. 30: 162 168.
40. Dawson, J. E.,, D. E. Stallknecht,, E. W. Howerth,, C. Warner,, K. Biggie,, W. R. Davidson,, J. M. Lockhart,, V. F. Nettles,, J. G. Olson,, and J. E. Childs. 1994. Susceptibility of whitetailed deer ( Odocoileus virginianus) to infection with Ehrlichia chaffeensis, the etiologic agent of human ehrlichiosis. J. Clin. Microbiol. 32: 2725 2728.
41. Dawson, J. E.,, C. K. Warner,, V. Baker,, S. A. Ewing,, D. E. Stallknecht,, W. R. Davidson,, A. A. Kocan,, J. M. Lockhart,, and J. G. Olson. 1996. Ehrlichia-like 16S rDNA sequence from wild white-tailed deer ( Odocoileus virginianus). J. Parasitol. 82: 52 58.
42. Dawson, J. E.,, K. L. Biggie,, C. K. Warner,, K. Cookson,, S. Jenkins,, J. F. Levine,, and J. G. Olson. 1996. Polymerase chain reaction evidence of Ehrlichia chaffeensis, an etiologic agent of human ehrlichiosis, in dogs from southeast Virginia. Am. J. Vet. Res. 57: 1175 1179.
43. Dawson, J. E.,, and A. M. Marty,. 1997. Ehrlichiosis, p. 49 59. In C. R. Horsburgh, Jr.,, and A. M. Nelson (ed.), Pathology of Emerging Infections. American Society for Microbiology, Washington, D.C.
44. Dawson, J. E.,, C. D. Paddock,, C. K. Warner,, P. W. Greer,, J. H. Bartlett,, S. A. Ewing,, U. G. Munderloh,, and S. R. Zaki. 2001. Tissue diagnosis of Ehrlichia chaffeensis in patients with fatal ehrlichiosis by use of immunohistochemistry, in situ hybridization, and polymerase chain reaction. Am. J. Trop. Med. Hyg. 65: 603 609.
45. Devereaux, C. E. 1997. Human monocytic ehrlichiosis presenting as febrile diarrhea. J. Clin. Gastroenterol. 25: 544 545.
46. Dobson, A.,, and J. Foufopoulos. 2001. Emerging infectious pathogens of wildlife. Philos. Trans. R. Soc. Lond. B Biol. Sci. 356: 1001 1012.
47. Dugan, V. G.,, S. E. Little,, D. E. Stallknecht,, and A. D. Beall. 2000. Natural infection of domestic goats with Ehrlichia chaffeensis. J. Clin. Microbiol. 38: 448 449.
48. Dumler, J. S.,, P. Brouqui,, J. Aronson,, J. P. Taylor,, and D. H. Walker. 1991. Identification of Ehrlichia in human tissue. N. Engl. J. Med. 325: 1109 1110. (Letter.)
49. Dumler, J. S.,, J. E. Dawson,, and D. H. Walker. 1993. Human ehrlichiosis: hematopathology and immunohistologic detection of Ehrlichia chaffeensis. Hum. Pathol. 24: 391 396.
50. Dumler, J. S.,, W. L. Sutker,, and D. H. Walker. 1993. Persistent infection with Ehrlichia chaffeensis. Clin. Infect. Dis. 17: 903 905.
51. Dumler, J. S.,, and D. H. Walker. 2001. Tick-borne ehrlichioses. Lancet Infect. Dis. 6: 21 28.
52. Dumler, J. S.,, A. F. Barbet,, C. Bekker,, G. A. Dasch,, G. H. Palmer,, S. C. Ray,, Y. Rikihisa,, and F. R. Rurangirwa. 2001. Reorganization of genera in the families Rickettsiaceae and Anaplasmataceae in the order Rickettsiales: unification of some species of Ehrlichia with Anaplasma, Cowdria with Ehrlichia and Ehrlichia with Neorickettsia, descriptions of six new species combinations and designations of Ehrlichia equi and ‘HGE agent’ as subjective synonyms of Ehrlichia phagocytophila. Int. J. Syst. Evol. Microbiol. 51: 2145 2165.
53. Dunn, B. E.,, T. P. Monson,, J. S. Dumler,, C. C. Morris,, A. B. Westbrook,, J. L. Duncan,, J. E. Dawson,, K. G. Sims,, and B. E. Anderson. 1992. Identification of Ehrlichia chaffeensis morulae in cerebrospinal fluid mononuclear cells. J. Clin. Microbiol. 30: 2207 2210.
54. Edwards, M. S. 1994. Ehrlichiosis in children. Semin. Ped. Infect. Dis. 5: 143 147.
55. Eng, T. R.,, J. R. Harkess,, D. B. Fishbein,, J. E. Dawson,, C. N. Greene,, M. A. Redus,, and F. T. Satalowich. 1990. Epidemiologic, clinical, and laboratory findings of human ehrlichiosis in the United States, 1988. JAMA 264: 2251 2258.
56. Estrada-Peña, A.,, and F. Jongejan. 1999. Ticks feeding on humans: a review of records on human-biting Ixodoidea with special reference to pathogen transmission. Exp. Appl. Acarol. 23: 685 715.
57. Everett, E. D.,, K. A. Evans,, R. B. Henry,, and G. McDonald. 1994. Human ehrlichiosis in adults after tick exposure; diagnosis using polymerase chain reaction. Ann. Intern. Med. 120: 730 735.
58. Ewing, S. A.,, E. M. Johnson,, and K. M. Kocan. 1987. Human infection with Ehrlichia canis. N. Engl. J. Med. 317: 899. ( Letter.)
59. Ewing, S. A.,, J. E. Dawson,, A. A. Kocan,, R. W. Barker,, C. K. Warner,, R. J. Panciera,, J. C. Fox,, K. M. Kocan,, and E. F. Blouin. 1995. Experimental transmission of Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) among white-tailed deer by Amblyomma americanum (Acari: Ixodidae). J. Med. Entomol. 32: 368 374.
60. Felz, M. W.,, and L. A. Durden. 1999. Attachment site of four tick species (Acari: Ixodidae) parasitizing humans in Georgia and South Carolina. J. Med. Entomol. 36: 361 364.
61. Fichtenbaum, C. J.,, L. R. Peterson,, and G. J. Weil. 1993. Ehrlichiosis presenting as a life-threatening illness with features of the toxic shock syndrome. Am. J. Med. 95: 351 357.
62.Fishbein D. B., L. A. Sawyer, C. J. Holland, E. B. Hayes, W. Okoroanyanwu, D. Williams, K. Sikes, M. Ristic, and J. E. McDade. 1987. Unexplained febrile illnesses after exposure to ticks. Infection with an Ehrlichia? JAMA 257: 31003104.
63. Fishbein, D. B.,, A. Kemp,, J. E. Dawson,, N. R. Greene,, M. A. Redus,, and D. H. Fields. 1989. Human ehrlichiosis: prospective active surveillance in febrile hospitalized patients. J. Infect. Dis. 160: 803 809.
64. Fishbein, D. B.,, and J. E. Dawson,. 1991. Ehrlichiae, p. 1054 1058. In A. Balows,, W. J. Hausler,, K. L. Herrmann,, H. D. Isenberg,, and H. J. Shadomy (ed.), Manual of Clinical Microbiology, 5th ed. American Society for Microbiology, Washington, D.C.
65. Fishbein, D. B.,, J. E. Dawson,, and L. E. Robinson. 1994. Human ehrlichiosis in the United States, 1985 to 1990. Ann. Intern. Med. 120: 736 743.
66. Gardner, S. L.,, R. C. Holman,, J. W. Krebs,, R. Berkelman,, and J. E. Childs. 2003. National surveillance for the human ehrlichioses in the United States, 1997-2001, and proposed methods for evaluation of data quality. Ann. N. Y. Acad. Sci. 990: 80 89.
67. Haile, D. G.,, and G. A. Mount. 1987. Computer simulation of population dynamics of the lone star tick, Amblyomma americanum (Acari: Ixodidae). J. Med. Entomol. 24: 356 369.
68. Harkess, J. R.,, S. A. Ewing,, J. M. Crutcher,, J. Kudlac,, G. McKee,, and G. R. Istre. 1989. Human ehrlichiosis in Oklahoma. J. Infect. Dis. 159: 576 579.
69. Heo, E. J.,, J. H. Park,, J. R. Koo,, M. S. Park,, M. Y. Park,, J. S. Dumler,, and J. S. Chae. 2002. Serologic and molecular detection of Ehrlichia chaffeensis and Anaplasma phagocytophila (human granulocytic ehrlichiosis agent) in Korean patients. J. Clin. Microbiol. 40: 3082 3085.
70. Ijdo, J. W.,, C. Wu,, L. A. Magnarelli,, K. C. Stafford III,, J. F. Anderson,, and E. Fikrig. 2000. Detection of Ehrlichia chaffeensis DNA in Amblyomma americanum ticks in Connecticut and Rhode Island. J. Clin. Microbiol. 38: 4655 4656.
71. Irving, R. P.,, R. R. Pinger,, C. N. Vann,, J. B. Olesen,, and F. E. Steiner. 2000. Distribution of Ehrlichia chaffeensis (Rickettsiales: Rickettsiaeceae) in Amblyomma americanum in southern Indiana and prevalence of E. chaffeensis-reactive antibodies in white-tailed deer in Indiana and Ohio in 1998. J. Med. Entomol. 37: 595 600.
72. Jackson, L. K.,, D. M. Gaydon,, and J. Goddard. 1996. Seasonal activity and relative abundance of Amblyomma americanum in Mississippi. J. Med. Entomol. 33: 128 131.
73. Jackson R. T.,, and J. W. Jackson. 1997. Ehrlichiosis with systemic sepsis syndrome. Tenn. Med. 90: 185 186.
74. James, A. M.,, D. Liveris,, G. P. Wormser,, I. Schwartz,, M. A. Monteclavo,, and B. J. Johnson. 2001. Borrelia lonestari infection after a bite by an Amblyomma americanum tick. J. Infect. Dis. 183: 1810 1814.
75. Javed, M. Z.,, M. Srivastava,, S. Zhang,, and M. Kandathil. 2001. Concurrent babesiosis and ehrlichiosis in an elderly host. Mayo Clin. Proc. 76: 563 565.
76. Klein, M. B.,, C. M. Nelson,, and J. L. Goodman. 1997. Antibiotic susceptibility of the newly cultivated agent of human granulocytic ehrlichiosis: promising activity of quinolones and rifamycins. Antimicrob. Agents Chemother. 41: 76 79.
77. Kocan, A. A.,, S. A. Ewing,, D. Stallknecht,, G. L. Murphy,, S. Little,, L. C. Whitworth,, and R. W. Barker. 2000. Attempted transmission of Ehrlichia chaffeensis among white-tailed deer by Amblyomma maculatum. J. Wildlife Dis. 36: 592 594.
78. Kocan, A. A.,, G. C. Levesque,, L. C. Whitworth,, G. L. Murphy,, S. A. Ewing,, and R. W. Barker. 2000. Naturally occurring Ehrlichia chaffeensis infection in coyotes from Oklahoma. Emerg. Infect. Dis. 6: 477 480.
79. Kordick, S. K.,, E. B. Breitschwerdt,, B. C. Hegarty,, K. L. Southwick,, C. M. Colitz,, S. I. Hancock,, J. M. Bradley,, R. Rumbough,, J. T. McPherson,, and J. N. MacCormack. 1999. Coinfection with multiple tick-borne pathogens in a Walker hound kennel in North Carolina. J. Clin. Microbiol. 37: 2631 2638.
80. Kramer, V. L.,, M. P. Randolph,, L. T. Hui,, W. E. Irwin,, A. G. Gutierrez,, and D. J. Vugia. 1999. Detection of the agents of human ehrlichioses in ixodid ticks from California. Am. J. Trop. Med. Hyg. 60: 62 65.
81. LaBarre, R.. 1994. Absence of Ehrlichia chaffeensis in West Texas tick vectors and identification of Rickettsia-like organism with shared antigenicity, D-37. Abstr. 94th Gen. Meet. Am. Soc. Microbiol. 1994. American Society for Microbiology, Washington, D.C.
82. Lee, E.,, and Y. Rikihisa. 1996. Lack of tumor necrosis factor alpha, interleukin-6 (IL-6), and granulocyte-macrophage colony-stimulating factor expression but presence of IL-1β, IL-8, and IL-10 expression in human monocytes exposed to viable or killed Ehrlichia chaffeensis. Infect. Immun. 64: 4211 4219.
83. Lee, E.,, and Y. Rikihisa. 1997. Anti- Ehrlichia chaffeensis antibody induces potent proinflammatory cytokine mRNA expression in human monocytes exposed to E. chaffeensis through sustained reduction of Iĸβ-a and activation of NF-ĸβ. Infect. Immun. 65: 2890 2897.
84. Liddell, A. M.,, J. W. Sumner,, C. D. Paddock,, Y. Rikihisa,, A. Unver,, R. S. Buller,, and G. A. Storch. 2002. Reinfection with Ehrlichia chaffeensis in a liver transplant recipient. Clin. Infect. Dis. 34: 1644 1647.
85. Little, S. E.,, J. E. Dawson,, J. M. Lockhart,, D. E. Stallknecht,, C. K. Warner,, and W. R. Davidson. 1997. Development and use of specific polymerase chain reaction for the detection of an Ehrlichia-like organism in white-tailed deer. J. Parasitol. 33: 246 253.
86. Little, S. E.,, D. E. Stallknecht,, J. M. Lockhart,, J. E. Dawson,, and W. R. Davidson. 1998. Natural co-infection of a white-tailed deer ( Odocoileus virginianus) population with three Ehrlichia spp. J. Parasitol. 84: 897 901.
87. Little, S. E.,, and E. W. Howerth. 1999. Ehrlichia chaffeensis in archived tissues of a white-tailed deer. J. Wildlife Dis. 35: 596 599.
88. Lockhart, J. M.,, W. R. Davidson,, J. E. Dawson,, and D. E. Stallknecht. 1995. Temporal association of Amblyomma americanum with the presence of Ehrlichia chaffeensis-reactive antibodies in white-tailed deer. J. Wildlife Dis. 31: 119 124.
89. Lockhart, J. M.,, W. R. Davidson,, D. E. Stallknecht,, and J. E. Dawson. 1996. Site-specific geographic association between Amblyomma americanum (Acari: Ixodidae) infestations and Ehrlichia chaffeensis-reactive (Rickettsiales: Ehrlichieae) antibodies in white-tailed deer. J. Med. Entomol. 33: 153 158.
90.Lockhart J. M., W. R. Davidson, D. E. Stallknecht, J. E. Dawson, and S. E. Little. 1997. Natural history of Ehrlichia chaffeensis in the Piedmont physiographic province of Georgia. J. Parasitol. 83: 887894.
91. Lockhart, J. M.,, W. R. Davidson,, D. E. Stallknecht,, J. E. Dawson,, and E. W. Howerth. 1997. Isolation of Ehrlichia chaffeensis from white-tailed deer ( Odocoileus virginianus) confirms their role as natural reservoir hosts. J. Clin. Microbiol. 35: 1681 1686.
92. Lockhart, J. M.,, and W. R. Davidson. 1999. Evaluation of C3H/HeJ mice for xenodiagnosis of infection with Ehrlichia chaffeensis. J. Vet. Diag. Investig. 11: 55 59.
93. Maeda, K. M.,, M. Markowitz,, R. C. Hawley,, M. Ristic,, D. Cox,, and J. E. McDade. 1987. Human infection with Ehrlichia canis, a leukocytic rickettsia. N. Engl. J. Med. 316: 853 856.
94. Magnarelli, L. A.,, J. F. Anderson,, K. C. Stafford III,, and J. S. Dumler. 1997. Antibodies to multiple tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in white-footed mice. J. Wildlife Dis. 33: 466 473.
95. Magnarelli, L. A.,, J. W. Ijdo,, K. C. Stafford III,, and E. Fikrig. 1999. Infections of granulocytic ehrlichiae and Borrelia burgdorferi in white-tailed deer in Connecticut. J. Wildlife Dis. 35: 266 274.
96. Marshall, G. S.,, R. F. Jacobs,, G. E. Schutze,, H. Paxton,, S. C. Buckinghan,, J. P. Devincenzo,, M. A. Jackson,, V. H. San Joaquin,, S. M. Standaert,, and C. R. Woods. 2002. Ehrlichia chaffeensis seroprevalence among children in the Southeast and south-central regions of the United States. Arch. Pediatr. Adolesc. Med. 156: 166 170.
97. Martin, G. S.,, B. W. Christman,, and S. M. Standaert. 1999. Rapidly fatal infection with Ehrlichia chaffeensis. N. Engl. J. Med. 341: 763 764.
98. Marty, A. M.,, J. S. Dumler,, G. Imes,, H. P. Brusman,, L. L. Smrkovski,, and D. M. Frisman. 1995. Ehrlichiosis mimicking thrombotic thrombocytopenic purpura. Case report and pathological correlation. Hum. Pathol. 26: 920 925.
99. Mathisen, G.,, P. J. Weis,, and C. A. Kennedy. 1993. Pneumonia, aseptic meningitis, and leukopenia in a 28-year-old man. Clin. Infect. Dis. 16: 809 815.
100. Maurin, M.,, C. Abergel,, and D. Raoult. 2001. DNA gyrasemediated natural resistance to fluoroquinolones in Ehrlichia spp. Antimicrob. Agents Chemother. 45: 2098 2105.
101. McCall, C. L.,, A. T. Curns,, J. S. Singleton,, J. A. Comer,, J. G. Olson,, L. D. Rotz,, T. A. Treadwell,, P. Arguin,, and J. E. Childs. 2001. Fort Chaffee revisited; the epidemiology of tick-borne diseases at a persistent focus. Vector Borne Zoonotic Dis. 2: 119 127.
102. McDade, J. E. 1990. Ehrlichiosis—a disease of animals and humans. J. Infect. Dis. 161: 609 617.
103. McKechnie, D. B.,, K. S. Slater,, J. E. Childs,, R. F. Massung,, and C. D. Paddock. 2000. Survival of Ehrlichia chaffeensis in refrigerated, ADSOL-treated RBCs. Transfusion 40: 1041 1047.
104. McQuiston, J. H.,, C. D. Paddock,, R. C. Holman,, and J. E. Childs. 1999. The human ehrlichioses in the United States. Emerg. Infect. Dis. 5: 635 642.
105. Means, R. G.,, and D. J. White. 1997. New distribution records of Amblyomma americanum (L.) (Acari: Ixodidae) in New York State. J. Vector Ecol. 22: 133 145.
106. Moore, V. A.,, A. S. Varela,, M. J. Yabsley,, W. R. Davidson,, and S. E. Little. 2003. Detection of Borrelia lonestari, putative agent of STARI (southern tick-associated rash illness), in white-tailed deer ( Odocoileus virginianus) from the southeastern United States. J. Clin. Microbiol. 41: 424 427.
107. Morris, J. G., Jr.,, and M. Potter. 1997. Emergence of new pathogens as a function of changes in host susceptibility. Emerg. Infect. Dis. 3: 435 441.
108. Moskovitz, M.,, R. Fadden,, and T. Min. 1991. Human ehrlichiosis: a rickettsial disease associated with severe cholestasis and multisystemic disease. J. Clin. Gastroenterol. 13: 86 90.
109. Mueller-Anneling, L.,, M. J. Gilchrist,, and P. S. Thorne. 2000. Ehrlichia chaffeensis antibodies in white-tailed deer, Iowa, 1994 and 1996. Emerg. Infect. Dis. 6: 397 400.
110. Murphy, G. L.,, S. A. Ewing,, L. C. Whitworth,, J. C. Fox,, and A. A. Kocan. 1998. A molecular and serologic survey of Ehrlichia canis, E. chaffeensis, and E. ewingii in dogs and ticks from Oklahoma. Vet. Parasitol. 79: 325 339.
111. Nutt, A. K.,, and J. Raufman. 1999. Gastrointestinal and hepatic manifestations of human ehrlichiosis: 8 cases and a review of the literature. Dig. Dis. 17: 37 43.
112. Ohashi, N.,, A. Unver,, N. Zhi,, and Y. Rikihisa. 1998. Cloning and characterization of multigenes encoding the immunodominant 30-kilodalton major outer membrane proteins of Ehrlichia canis and application of the recombinant protein for serodiagnosis. J. Clin. Microbiol. 36: 2671 2680.
113. Okada, H.,, T. Tajima,, M. Kawahara,, and Y. Rikihisa. 2001. Ehrlichial proliferation and acute hepatocellular necrosis in immunocompetent mice experimentally infected with the HF strain of Ehrlichia, closely related to Ehrlichia chaffeensis. J. Comp. Pathol. 124: 165 171.
114. Olano, J. P.,, E. Masters,, L. Cullman,, W. Hoegrefe,, X. J. Yu,, and D. H. Walker,. 1999. Human monocytotropic ehrlichiosis (HME): epidemiological, clinical and laboratory diagnosis of a newly emergent infection in the United States, p. 262 268. In D. Raoult, and P. Brouqui (ed.), Rickettsiae and Rickettsial Diseases at the Turn of the Third Millennium. Elsevier, Paris, France.
115. Olano, J. P.,, and D. H. Walker. 2002. Human ehrlichioses. Med. Clin. North Am. 86: 375 392.
116. Paddock, C. D.,, J. W. Sumner,, G. M. Shore,, D. C. Bartley,, R. C. Elie,, J. G. McQuade,, C. R. Martin,, C. S. Goldsmith,, and J. E. Childs. 1997. Isolation and characterization of Ehrlichia chaffeensis strains from patients with fatal ehrlichiosis J. Clin. Microbiol. 35: 2496 2502.
117. Paddock, C. D.,, S. M. Folk,, G. M. Shore,, L. J. Machado,, M. M. Huycke,, L. N. Slater,, A. M. Liddell,, R. S. Buller,, G. A. Storch,, T. P. Monson,, D. Rimland,, J. W. Sumner,, J. Singleton,, K. C. Bloch,, Y. W. Tang,, S. M. Standaert,, and J. E. Childs. 2001. Infections with Ehrlichia chaffeensis and Ehrlichia ewingii in persons coinfected with human immunodeficiency virus. Clin. Infect. Dis. 33: 1586 1594.
118. Paddock, C. D.,, and J. E. Childs. 2003. Ehrlichia chaffeensis: a prototype emerging pathogen. Clin. Microbiol. Rev. 16: 37 64.
119. Patel, R. G.,, and M. A. Byrd. 1999. Near fatal acute respiratory distress syndrome in a patient with human ehrlichiosis. South Med. J. 92: 333 335.
120. Patrick, C. D.,, and J. A. Hair. 1977. Seasonal abundance of lone star ticks on white-tailed deer. Environ. Entomol. 6: 263 269.
121. Patrick, C. D. 1978. White-tailed deer utilization of three different habitats and its influence on lone star tick populations. J. Parasitol. 64: 1100 1106.
122. Pearce, C. J.,, M. E. Conrad,, P. E. Nolan,, D. B. Fishbein,, and J. E. Dawson. 1988. Ehrlichiosis: a cause of bone marrow hypoplasia in humans. Am. J. Hematol. 28: 53 55.
123. Petersen, L. R.,, L. A. Sawyer,, D. B. Fishbein,, P. W. Kelley,, R. J. Thomas,, L. A. Magnarelli,, M. Redus,, and J. E. Dawson. 1989. An outbreak of ehrlichiosis in members of an Army Reserve unit exposed to ticks. J. Infect. Dis. 159: 562 568.
124. Pick, N.,, I. Potasman,, C. Strenger,, A. Keysary,, and I. Schwartz. 2000. Ehrlichiosis associated vasculitis. J. Intern. Med. 247: 674 678.
125. Ratnasamy, N.,, E. D. Everett,, W. E. Roland,, G. McDonald,, and C. W. Caldwell. 1996. Central nervous system manifestations of human ehrlichiosis. Clin. Infect. Dis. 23: 314 319.
126. Rawlings, J. 1996. Human ehrlichiosis in Texas. J. Spir. Tick-borne Dis. 3: 94 97.
127. Reddy, G. R.,, and C. P. Streck. 1999. Variability in the 28-kDa surface antigenic protein multigene locus of isolates of the emerging disease agent Ehrlichia chaffeensis suggest that it plays a role in immune invasion. Mol. Cell. Biol. Res. Commun. 1: 167 175.
128. Rikihisa, Y. 1991. The tribe Ehrlichieae and ehrlichial diseases. Clin. Microbiol. Rev. 4: 286 308.
129. Rikihisa, Y. 1999. Clinical and biological aspects of infection caused by Ehrlichia chaffeensis. Microbes Infect. 1: 367 376.
130. Ristic, M,. 1986. Pertinent characteristics of leukocytic rickettsiae of humans and animals, p. 182 187. In L. Leive (ed.), Microbiology- 1986. American Society for Microbiology, Washington, D.C.
131. Ristic, M.,, and D. L. Huxsoll,. 1984. Ehrlichiae, p. 704 709. In N. R. Krieg, and J. G. Holt (ed.), Bergey’s Manual of Systematic Bacteriology, vol. 1. The Williams & Wilkins Co., Baltimore, Md.
132. Rohrbach, B. W.,, J. R. Harkess,, and J. Kudlac. 1987. Human ehrlichiosis: a cause of “Oklahoma Tick Fever”? Okla. St. Dep. Health Commun. Dis. Bull. 87: 1.
133. Rohrbach, B. W.,, J. R. Harkess,, S. A. Ewing,, J. Kudlac,, G. L. McKee,, and G. R. Istre. 1990. Epidemiologic and clinical characteristics of persons with serologic evidence of E. canis infection. Am. J. Public Health 80: 442 445.
134. Roland, W. E.,, E. D. Everett,, T. L. Cyr,, S. Z. Hasan,, C. B. Dommarju,, and G. A. McDonald. 1998. Ehrlichia chaffeensis in Missouri ticks. Am. J. Trop. Med. Hyg. 59: 641 643.
135. Rydkina, E.,, V. Roux,, and D. Raoult. 1999. Determination of the genome size of Ehrlichia spp., using pulsed field gel electrophoresis. FEMS Microbiol. Lett. 176: 73 78.
136. Rynkiewicz, D.,, and L. X. Liu. 1994. Human ehrlichiosis in New England. N. Engl. J. Med. 330: 292. ( Letter.)
137. Safdar, N.,, R. B. Love,, and D. G. Maki. 2002. Severe Ehrlichia chaffeensis infection in a lung transplant recipient: a review of ehrlichiosis in the immunocompromised patient. Emerg. Infect. Dis. 8: 320 323.
138. Semnter, P. J.,, J. R. Saurer,, and J. A. Hair. 1973. The ecology and behavior of the lone star tick (Acarina: Ixodidae). IV. Abundance and seasonal distribution in different habitat types. J. Med. Entomol. 10: 618 628.
139. Sexton, D. J.,, G. R. Corey,, C. Carpenter,, L. Q. Kong,, T. Gandhi,, E. Breitschwerdt,, B. Hegarty,, S. M. Chen,, H. M. Feng,, X. J. Yu,, J. Olano,, D. H. Walker,, and J. S. Dumler. 1998. Dual infection with Ehrlichia chaffeensis and a spotted fever group rickettsia: a case report. Emerg. Infect. Dis. 4: 311 316.
140. Shea, K. W.,, A. J. Calio,, N. C. Klein,, and B. A. Cunha. 1995. Rhabdomyolysis associated with Ehrlichia chaffeensis infection. Clin. Infect. Dis. 21: 1056 1057.
141. Shibata, S.-I.,, M. Y. Kawahara,, Y. Rikihisa,, H. Fujita,, Y. Watanabe,, C. Suto,, and T. Ito. 2000. New ehrlichia species closely related to Ehrlichia chaffeensis isolated from Ixodes ovatus ticks in Japan. J. Clin. Microbiol. 38: 1331 1338.
142. Smith, S.,, A. E. Sehdev,, P. S. Sehdev,, R. Jacobs,, and J. S. Dumler. 2002. Human monocytic ehrlichiosis presenting as acute appendicitis during pregnancy. Clin. Infect. Dis. 35: 99 102.
143. Sonenshine, D. E.,, and G. J. Levy. 1971. The ecology of the lone star tick Amblyomma americanum (L.) in two contrasting habitats in Virginia (Acari: Ixodidae). J. Med. Entomol. 8: 623 635.
144. Sotomayor, E. A.,, V. L. Popov,, H. Feng,, D. H. Walker,, and J. P. Olano. 2001. Animal model of fatal human monocytotropic ehrlichiosis. Am. J. Pathol. 158: 757 769.
145. Standaert, S. M.,, J. E. Dawson,, W. Schaffner,, J. E. Childs,, K. L. Biggie,, J. Singleton, Jr.,, R. R. Gerhardt, M. L. Knight, and R. H. Hutcheson. 1995. Ehrlichiosis in a golf-oriented retirement community. N. Engl. J. Med. 333: 420 425.
146. Standaert, S. M.,, L. A. Clough,, W. Schaffner,, J. S. Adams,, and K. M. Neuzil. 1998. Neurologic manifestations of human monocytic ehrlichiosis. Infect. Dis. Clin. Pract. 7: 358 362.
147. Standaert, S. M.,, T. Yu,, M. A. Scott,, J. E. Childs,, C. D. Paddock,, W. Nicholson,, J. Singleton,, and M. J. Blaser. 2000. Primary isolation of Ehrlichia chaffeensis from patients with febrile illnesses: clinical and molecular characteristics. J. Infect. Dis. 181: 1082 1088.
148. Steiner, F. E.,, R. R. Pinger,, and C. N. Vann. 1999. Infection rates of Amblyomma americanum (Acari: Ixodidae) by Ehrlichia chaffeensis (Rickettsiales: Ehrlichieae) and prevalence of E. chaffeensis-reactive antibodies in white-tailed deer in southern Indiana, 1997. J. Med. Entomol. 36: 715 719.
149. Stromdahl, E. Y.,, S. R. Evans,, J. J. O’Brien,, and A. G. Guttierez. 2001. Prevalence of infection in ticks submitted to the human tick test kit program of the U.S. Army Center for Health Promotion and Preventive Medicine. J. Med. Entomol. 38: 67 74.
150. Sumner, J. W.,, W. L. Nicholson,, and R. F. Massung. 1997. PCR amplification and comparison of nucleotide sequences from the groESL heat shock operon of Ehrlichia species. J. Clin. Microbiol. 35: 2087 2092.
151. Sumner, J. W.,, J. E. Childs,, and C. D. Paddock. 1999. Molecular cloning and characterization of the Ehrlichia chaffeensis variable-length PCR target: an antigen-expressing gene that exhibits interstrain variation. J. Clin. Microbiol. 37: 1447 1453.
152. Sumner, J. W.,, G. A. Storch,, R. S. Buller,, A. M. Liddell,, S. L. Stockham,, Y. Rikihisa,, S. Messenger,, and C. D. Paddock. 2000. PCR amplification and phylogenetic analysis of groESL operon sequences from Ehrlichia ewingii and Ehrlichia muris. J. Clin. Microbiol. 38: 2746 2749.
153. Telford, S. R. III, and J. E. Dawson. 1996. Persistent infection of C3H/HeJ mice by Ehrlichia chaffeensis. Vet. Microbiol. 52: 103 112.
154. Thompson, C.,, A. Spielman,, and P. J. Krause. 2001. Coinfecting deer-associated zoonoses: Lyme disease, babesiosis, and ehrlichiosis. Clin. Infect. Dis. 33: 676 685.
155. Uhaa, I. J.,, J. D. Maclean,, C. R. Green,, and D. B. Fishbein. 1992. A case of human ehrlichiosis acquired in Mali: clinical and laboratory findings. Am. J. Trop. Med. Hyg. 46: 161 164.
156. Unver, A.,, S. Felek,, C. D. Paddock,, N. Zhi,, H. W. Horowitz,, G. P. Wormser,, L. C. Cullman,, and Y. Rikihisa. 2001. Western blot analysis of sera reactive to human monocytic ehrlichiosis and human granulocytic ehrlichiosis agents. J. Clin. Microbiol. 39: 3982 3986.
157. U.S. Census Bureau. 2001. Profiles of general demographic characteristics; 2000 census of population and housing, United States. U.S. Department of Commerce, Washington D.C.
158. Walls, J. J.,, K. M. Asanovich,, J. S. Bakken,, and J. S. Dumler. 1998. Serologic evidence of a natural infection of whitetailed deer with the agent of human granulocytic ehrlichiosis in Wisconsin and Maryland. Clin. Diag. Lab. Immunol. 5: 762 765.
159. Walker, D. H.,, A. G. Barbour,, J. H. Oliver,, R. S. Lane,, J. S. Dumler,, D. T. Dennis,, D. H. Persing,, A. F. Azad,, and E. Mc- Sweegan. 1996. Emerging bacterial zoonotic and vector-borne diseases: ecological and epidemiological factors. JAMA 275: 463 469.
160. Walker, D. H., and the Task Force on Consensus Approach for Ehrlichiosis (CAFÉ). 2000. Diagnosing human ehrlichioses: current status and recommendations. ASM News 66: 287 290.
161. Weaver, R. A.,, G. Virella,, and A. Weaver. 1999. Ehrlichiosis with severe pulmonary manifestations despite early treatment. South Med. J. 92: 336 339.
162. Whitlock, J. E.,, Q. Q. Fang,, L. A. Durden,, and J. H. Oliver, Jr. 2000. Prevalence of Ehrlichia chaffeensis (Rickettsiales: Rickettsiaceae) in Amblyomma americanum (Acari: Ixodidae) from the Georgia coast and barrier islands. J. Med. Entomol. 37: 276 280.
163. Williams, J. D.,, R. M. Snow,, and J. G. Arciniegas. 1995. Myocardial involvement in a patient with human ehrlichiosis. Am. J. Med. 98: 414 415.
164. Winslow, G. M.,, E. Yager,, K. Shilo,, D. N. Collins,, and F. K. Chu. 1998. Mechanisms of immunity to Ehrlichia chaffeensis. Infect. Immun. 66: 3892 3899.
165. Wolf, L.,, T. McPherson,, B. Harrison,, B. Engber,, A. Anderson,, and P. Whitt. 2000 . Prevalence of Ehrlichia ewingii in Amblyomma americanum in North Carolina. J. Clin. Microbiol. 38: 2795. ( Letter.)
166. Wong, S. J.,, G. S. Brady,, and J. S. Dumler. 1997. Serological responses to Ehrlichia equi, Ehrlichia chaffeensis, and Borrelia burgdorferi in patients from New York State. J. Clin. Microbiol. 35: 2198 2205.
167. Yabsley, M. J.,, A. S. Varela,, C. M. Tate,, V. G. Dugan,, D. E. Stallknecht,, S. E. Little,, and W. R. Davidson. 2002. Ehrlichia ewingii infection in white-tailed deer ( Odocoileus virginianus). Emerg. Infect. Dis. 8: 668 671.
168. Yabsley, M. J.,, V. G. Dugan,, D. E. Stallknecht,, S. E. Little,, J. M. Lockhart,, J. E. Dawson,, and W. R. Davidson. 2003. Evaluation of a prototype Ehrlichia chaffeensis surveillance system using white-tailed deer ( Odocoileus virginianus) as natural sentinels. Vector Borne Zoonotic Dis. 3: 195 207.
169. Yabsley, M. J.,, S. E. Little,, E. J. Sims,, V. G. Dugan,, D. E. Stallknecht,, and W. R. Davidson. 2003. Molecular variation in the variable-length PCR target and 120-kilodalton antigen genes of Ehrlichia chaffeensis from white-tailed deer ( Odocoileus virginianus). J. Clin. Microbiol. 41: 5202 5206.
170. Yevich, S. J.,, J. L. Sanchez,, R. F. Defraites,, C. C. Rives,, J. E. Dawson,, I. J. Uhaa,, B. J. Johnson,, and D. B. Fishbein. 1995. Seroepidemiology of infections due to spotted fever group rickettsiae and Ehrlichia species in military personnel exposed in areas of the United States where such infections are endemic. J. Infect. Dis. 171: 1266 1273.
171. Yu, X.,, P. Brouqui,, J. S. Dumler,, and D. Raoult. 1993. Detection of Ehrlichia chaffeensis in human tissue by using a species-specific monoclonal antibody. J. Clin. Microbiol. 31: 3284 3288.
172. Yu, X. J.,, P. Crocquet-Valdes,, L. C. Cullman,, and D. H. Walker. 1996. The recombinant 120-kilodalton protein of Ehrlichia chaffeensis, a potential diagnostic tool. J. Clin. Microbiol. 34: 2853 2855.
173. Yu, X. J.,, J. W. McBride,, and D. H. Walker. 1999. Genetic diversity of the 28-kilodalton outer membrane protein gene in human isolates of Ehrlichia chaffeensis. J. Clin. Microbiol. 37: 1137 1143.

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error