- 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)
- 1-4 w after infxn
- Subacute f, c, sweats, HA, muscle aches
- In severe cases hemolytic anemia, kidney, liver injury, respiratory distress
- Low hemoglobin, evidence hemolysis (elevate bilirubin, LDH, reticulocytes)
- If severe: elevated creatinine, transaminases