Symptoms
The most common symptoms include headache, muscle aches, and fatigue. A rash may occur, but is uncommon. Ehrlichiosis can also blunt the immune system, which may lead to opportunistic infections such as candidiasis.
Most of the symptoms of ehrlichiosis can likely be ascribed to the immune dysregulation that it causes.
Early in infection, production of TNF-alpha, a cellular product that promotes inflammation and immune response, is suppressed.
Late in infection, however, production of this substance can be upregulated by 30 fold, which is likely responsible for the "toxic shock-like" syndrome seen in some severe cases of ehrlichiosis. Some cases can present with purpura and in one such case the organisms were present in such overwhelming numbers that in 1991 Dr. Aileen Marty of the AFIP was able to demonstrate the bacteria in human tissues using standard stains, and later proved that the organisms were indeed Ehrlichia using immunoperoxidase stains.
Experiments in mouse models further supports this hypothesis, as mice lacking TNF-alpha I/II receptors are resistant to liver injury caused by ehrlichia infection.
3% of human monocytic ehrlichiosis cases result in death, however these deaths occur "most commonly in immunosuppressed individuals who develop respiratory distress syndrome, hepatitis, or opportunistic nosocomial infections."
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