- Obligate intracellular bacteria
- Tick (lone star) borne
- Endemic South Eastern, South Central and Eastern US
- More severe if immunocompromised by meds, disease (eg. HIV), or s/p splenectomy
- Often causes BM suppression
- Occasional rash (< 30% adults; 60% kids)
- Often severe illness
- Conjunctival injection
- Sometimes maculopapular and/or petechial skin eruption
- Often leukopenia, thrombocytopenia, and elevated transaminases
- Evidence of infection by PCR and antibody testing