Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Jun 2025)

Presenting Symptoms and Delayed Diagnosis of Ehrlichiosis

  • Aleksandra Murawska Baptista, MD,
  • Alicja Kaminska, MD,
  • Marko Gorasevic, MD,
  • Salvador Alvarez, MD,
  • Karthik Gnanapandithan, MBBS, MD,
  • Tatjana Gavrancic, MD,
  • Michael Smerina, MD,
  • Adrian G. Dumitrascu, MD,
  • Melissa P. Cortes, MD,
  • Ricardo J. Pagan, MD,
  • Abhinav Singla, MD

DOI
https://doi.org/10.1016/j.mayocpiqo.2025.100608
Journal volume & issue
Vol. 9, no. 3
p. 100608

Abstract

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Objective: To describe the presenting symptoms, outcomes, and time to diagnosis of ehrlichiosis cases treated at Mayo Clinic, Jacksonville, Florida. Patients and Methods: We conducted a retrospective analysis of all patients with ehrlichiosis who were treated at Mayo Clinic in Florida from January 1, 2018, to November 1, 2021. Ehrlichiosis was diagnosed via positive serologic or polymerase chain reaction tests. Abstracted variables included patient demographic characteristics, presenting symptoms, outcomes, and time to diagnosis. Results: Out of 67 patients with ehrlichiosis who were treated at our institution during the study period, 22 were included in our analysis. These patients had diverse presenting symptoms; fever and malaise were common, and severe cases included altered mental status and septic shock. Laboratory test findings included thrombocytopenia, as well as elevated liver enzyme levels and abnormal kidney function. The time to diagnosis varied among the cases studied, with a median time from admission to diagnosis of 4 days. Conclusion: Prompt treatment with doxycycline was effective, but delayed diagnosis remains a challenge. Our findings underscore the importance of considering ehrlichiosis in differential diagnoses, especially in endemic areas, and emphasize the need for early intervention to prevent severe outcomes.