- Endemic Northeast/Northern Mid-west US
- Can co-infect w/lyme and anaplasmosis
- Walking in an endemic area wearing shorts, t-shirts and not using tick repellent (e.g. DEET containing products)
- Most common in summer months
- 1-4 w after infxn
- Subacute fever, chills, sweats, HA, fatigue, muscle aches, nausea/vomiting
- Most are asymptomatic and have self-limited disease
- Increased risk for severe disease if immunosuppressed, s/p splenectomy
- In severe cases: hemolytic anemia, kidney, liver injury, respiratory distress
- Signs of severe illness if fulminant disease (relatively uncommon)
- Low hemoglobin, evidence hemolysis (elevate bilirubin, LDH, reticulocytes; negative direct Coomb's test), thrombocytonpenia
- If severe disease: elevated creatinine, transaminases
- Parasite may be visible on examination of thick and thin peripheral blood smears
- Sometimes neutropenia, thrombocytopenia