Geographic distribution of likely county in Minnesota or Wisconsin in which exposure to EML occured/CDC
Ehrlichia ewingii causes canine granulocytotropic erhlichiosis. It can also infect humans, who usually have fever, headache, fatigue, and muscle aches within one to two weeks following a tick bite. The vector is Amblyomma americanum, the lone star tick. Disease is usually seen in immunocompromised patients from Missouri, Oklahoma, and Tennessee.
E. ewingii is antigenically similar to E. chaffeensis and E. canis and can only be distinguished from E. chaffeensis by PCR. 28 cases of E. ewingii were reported to the CDC from 2008 to 2010. Before 2008, E. ewingii cases were included in E. chaffeensis cases because tests did not distinguish them. Morulae are found in granulocytes, not moncytes.
Ehrlichia muris-like is believed to be carried by Ixodes scapularis in Minnesota and Wisconsin. E. muris is found in Japan and Russia. One to two weeks after a tick bite, symptoms of fever, malaise, headache, lymphocytopenia, thrombocytopenia, and increased liver enzymes appear. PCR is the test of choice.