Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Lyme Disease Testing Algorithm
Clinical Background
Tick-borne diseases in the United States include Lyme disease, human ehrlichiosis (human monocytic ehrlichiosis [HME] and human granulocytic anaplasmosis [HGA]), Rocky Mountain spotted fever, babesiosis and Colorado tick fever. (See separate topics for Borrelia burgdorferi [Lyme disease], Babesia microti [Babesiosis] and Rickettsia rickettsii [Rocky Mountain Spotted Fever].)
Ehrlichiosis
- Epidemiology
- Transmission
- HGA - tick: Ixodes scapular; species: white-footed mouse and white-tailed deer
- HME - tick: Amblyomma americanum and Dermatocentor variabilis; species: white-tailed deer
- Organism
- HGA - Anaplasma phagocytophilum
- HME - Ehrlichia chaffeensis
- Risk Factors
- Exposure in regions where tick is endemic
- HGA - upper Midwest and northeast U.S.; May through August
- HME - south central and southeast U.S.; May through August
- Clinical Presentation
- Influenza-like - headache, myalgias, fever, chills, malaise, cough
- Rash - macular, maculopapular or petechial
- Treatment
Colorado Tick Fever
- Epidemiology
- Incidence - Rocky Mountains
- Transmission - tick: Dermatocentor andersoni; species: small rodents
- Organism
- Double-stranded DNA arbovirus
- Clinical Presentation
- Identical to Ehrlichiosis, no rash
- Treatment
See Also
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Lyme Disease Testing Algorithm
Diagnosis
Ehrlichiosis
- Diagnosis
- Wright stained smear - presence of morulae
- Culture
- Seroconversion by IFA
Colorado Tick Fever
- Diagnosis
- Blood smears (stained with immunofluorescence)
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Lyme Disease Testing Algorithm
Tests generally appear in the order most useful for common clinical situations
| Test name: Colorado Tick Fever Antibodies, IgG & IgM, IFA
|
| ARUP #: 0093167 |
| Methodology: Immunofluorescence Assay
|
| Use: Diagnose infection with Colorado tick fever |
| Limitations: IgM titers alone may not be confirmatory of disease |
| Follow-up: May require acute and convalescent samples to determine presence of disease |
| Test name: Ehrlichia chaffeensis Antibodies, IgG & IgM by IFA
|
| ARUP #: 0051002 |
| Methodology: Indirect Fluorescent Antibody
|
| Use: Diagnose infection with Ehrlichia chaffeensis |
| Limitations: IgM titers alone may not be confirmatory of disease |
| Follow-up: May require acute and convalescent samples to determine presence of disease |
| Test name: Anaplasma Phagocytophilum (HGA) Antibodies, IgG & IgM
|
| ARUP #: 0097303 |
| Methodology: Indirect Fluorescent Antibody
|
| Use: Diagnose infection with Anaplasma phagocytophilum |
| Limitations: IgM titers alone may not be confirmatory of disease |
| Follow-up: May require acute and convalescent samples to determine presence of disease |
Additional Tests Available
| Test name: Wright's Stain 0041976 |
| ARUP #: |
| Methodology: |
| Comments: |
| Test name: Ehrlichia chaffeensis Antibody, IgM by IFA
|
| ARUP #: 0051003 |
| Methodology: Indirect Fluorescent Antibody
|
| Comments: |
| Test name: Ehrlichia chaffeensis Antibody, IgG by IFA
|
| ARUP #: 0051004 |
| Methodology: Indirect Fluorescent Antibody
|
| Comments: |
| Test name: Anaplasma phagocytophilum (HGA) Antibody, IgG
|
| ARUP #: 0097317 |
| Methodology: Indirect Fluorescent Antibody
|
| Comments: |
| Test name: Anaplasma phagocytophilum (HGA) Antibody, IgM
|
| ARUP #: 0097318 |
| Methodology: Indirect Fluorescent Antibody
|
| Comments: |
References
Guidelines
Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, Sexton DJ, Buckingham SC, Marshall GS, Storch GA, Dasch GA, McQuiston JH, Swerdlow DL, Dumler SJ, Nicholson WL, Walker DH, Eremeeva ME, Ohl CA. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis--United States: a practical guide for physicians and other health-care and public health professionals. MMWR Recomm Rep.
2006;
55(
RR-4):
1-27.
General References
Bakken JS, Dumler JS. Clinical diagnosis and treatment of human granulocytotropic anaplasmosis. Ann N Y Acad Sci.
2006;
1078:
236-247.
Bakken JS, Dumler JS. Human granulocytic ehrlichiosis. Clin Infect Dis.
2000;
31(
2):
554-560.
Bratton RL, Corey R. Tick-borne disease. Am Fam Physician.
2005;
71(
12):
2323-2330.
Chapman AS, Murphy SM, Demma LJ, Holman RC, Curns AT, McQuiston JH, Krebs JW, Swerdlow DL. Rocky mountain spotted fever in
the United States, 1997-2002. Ann N Y Acad Sci.
2006;
1078:
154-155.
Demma LJ, Holman RC, McQuiston JH, Krebs JW, Swerdlow DL. Human monocytic ehrlichiosis and human granulocytic anaplasmosis in the United States, 2001-2002. Ann N Y Acad Sci.
2006;
1078:
118-119.
Dumler JS, Madigan JE, Pusterla N, Bakken JS. Ehrlichioses in humans: epidemiology, clinical presentation, diagnosis, and treatment. Clin Infect Dis.
2007;
45 Suppl 1:
S45-S51.
guero-Rosenfeld ME. Laboratory aspects of tick-borne diseases: lyme, human granulocytic ehrlichiosis and babesiosis. Mt Sinai J Med.
2003;
70(
3):
197-206.
Klasco R. Colorado tick fever. Med Clin North Am.
2002;
86(
2):
435-40, ix.
McQuiston JH, McCall CL, Nicholson WL. Ehrlichiosis and related infections. J Am Vet Med Assoc.
2003;
223(
12):
1750-1756.
McQuiston JH, Paddock CD, Holman RC, Childs JE. The human ehrlichioses in the United States. Emerg Infect Dis.
1999;
5(
5):
635-642.
Medical Reviewers
Litwin, Christine, M.D. Medical Director, Immunology at ARUP Laboratories; Professor, Clinical Pathology, University of Utah
Comprehensive Review: March 2008
Last Update: March 2008
