Some infections are asymptomatic, most cause abrupt onset of an influenza-like illness with nonspecific symptoms such as fever, chills, myalgias, weakness, nausea, vomiting, cough. headache, and malaise, usually beginning about 12 days after the tick bite. Anaplasmosis may result in disseminated intravascular coagulation, multiorgan failure, seizures, and coma. Diagnostic serologic tests are available, but PCR of blood is more sensitive and specific and can result in an early diagnosis because serologic tests require comparison of serial titers. Cytoplasmic ehrlichial inclusions in monocytes or neutrophils may be detected. Blood and liver functions tests may detect hematologic and hepatic abnormalities, such as leukopenia, thrombocytopenia, and elevated aminotransferase levels.
Primary treatment is doxycycline 200 mg po once followed by 100 mg bid until the patient improves and has been afebrile for 24 to 48 h but is continued for at least 7 days. Chloramphenicol is no longer effective. Some patients continue to experience headache, weakness, and malaise for weeks after adequate treatment. In 2014, 448 confirmed or probable cases of anaplasmosis (8.3 cases per 100,000 population) were reported, down from the 627 cases reported in 2013. Despite these occasional decreases in reported cases, the overall trend is an increase in yearly case totals over time. Two hundred ninety-two (65%) cases reported in 2014 were male