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A Case History of Concurrent Rocky Mountain Spotted Fever and Human Monocytic Ehrlichiosis in Florida

Authors
Publisher
Florida Entomologist
Publication Date
Disciplines
  • Biology
  • Medicine

Abstract

2-17520 p457-459 FESdj Scientific Notes 457 A CASE HISTORY OF CONCURRENT ROCKY MOUNTAIN SPOTTED FEVER AND HUMAN MONOCYTIC EHRLICHIOSIS IN FLORIDA P AUL E. K ENDRA 1 AND P. V ÁZQUEZ -K ENDRA 2 1 13601 Old Cutler Road, Miami, FL 33158 2 Henderson Mental Health Center, 2900 West Prospect Road, Fort Lauderdale, FL 33309 On 23 Oct 2009 the first author found 4 small ticks (~2 mm in length) engorged and attached to his left leg after conducting 2 days of field work in Citra (UF-PSREU, Marion County, FL) and Cross Creek (Lochloosa Wildlife Conservation Area, Alachua County, FL). Two of the specimens were preserved in alcohol. Nine days later (1 Nov) he developed a low-grade fever. By 7 Nov he began to experience minor myalgia (muscle pain) and in- tensifying cycles of fever, chills, and sweating, which were no longer controlled with ibuprofen. Assuming it was influenza, because of the recent outbreaks, he delayed seeking medical attention. On 9 Nov his spouse (a physician, the second au- thor) took him to the emergency room of a Bro- ward County FL hospital, where he presented with generalized “flu-like” symptoms—a fever of 38.9°C (102°F), frontal-temporal headaches, backaches, and malaise. A rapid diagnostic test for novel influenza A (H1N1) was negative, and he was admitted to the ICU for a fulminant (sudden and severe) febrile illness of unknown cause. Ini- tial tests indicated severe thrombocytopenia (low platelets), moderate leukocytopenia (low white blood cells), elevated liver enzymes, and dehydra- tion. That evening, the scientist contacted his se- nior technician and requested that the tick speci- mens be photographed and sent to a medical en- tomologist for identification. By the next day, they were identified as nymphs of the lone star tick, Amblyomma americanum L. (Acari: Ixodidae) (Fig. 1). Alerted to the possibility of a tick-borne illness, physicians

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