Human ehrlichiosis in Central Europe

Ehrlichioses are tick-transmitted diseases associated with illnesses of ani mals for decades, but recently recognised to be emerging human diseases. In the last ten years increasing number of cases of human infections caused b y Ehrlichia chaffeensis and granulocytic ehrlichia were described in the Un ited States. Several reports also indicate the presence of infection with t he human granulocytic ehrlichiosis (HGE) agent in Europe. The first confirm ed acute human disease caused by HGE agent was reported from Slovenia. Unti l 1997, five patients have been discovered in a prospective study on the et iology of febrile illnesses occurring within six weeks following a tick bit e, conducted at the Department of infectious Diseases, University Medical C entre, Ljubljana, Slovenia. The diagnosis of acute HGE was established by s eroconversion to the HGE agent and/or molecular identification of ehrlichia l organisms. None of the patients had detectable morulae on blood smear exa mination. Clinical characteristics and laboratory findings were similar to those reported from the United States, although the disease course was rela tively mild in the Slovenian cases. All patients recovered rapidly and with out sequelae, although only three patients received antibiotic therapy (of whom only two were treated with doxycycline). Many ehrlichiosis cases could go undetected due to a lack of physician awar eness, lack of public knowledge, or limited investigation. HGE should now b e also included in the differential diagnosis of febrile illnesses occurrin g after a tick bite in Europe.