Internal Medicine Case Challenge: A Highly Active 80-Year-Old Woman With Sudden Illness

Zafar Jamkhana, MD, MPH; Nirav Patel, MD


April 03, 2023

Because diagnosis of ehrlichiosis requires a high index of suspicion and is frequently delayed because of the prolonged testing time, empiric therapy is frequently used. Furthermore, delay in appropriate antibiotic therapy is a risk factor for increased morbidity.

The drug of choice for E chaffeensis infection, A phagocytophilum infection, and Rocky Mountain spotted fever is doxycycline. Rifampin is considered an alternative, but has substantially less supportive evidence, and doxycycline is suggested even in children and during pregnancy if the clinical concern is great for these infections.[2] Chloramphenicol, ciprofloxacin, erythromycin, trimethoprim-sulfamethoxazole, penicillin, and gentamicin were found not to be active against E chaffeensis in an in vitro model.[6]


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