TABLE III. Cases of specified notifiable diseases, United States, weeks ending TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending April 30, 1988 and May 2, 1987 (17th Week) *For measles only, imported cases includes both out-of-state and international importations. N: Not notifiable U: Unavailable *International $Out-of-state TABLE III. (Cont'd.) Cases of specified notifiable diseases, United States, weeks ending April 30, 1988 and May 2, 1987 (17th Week) *Mortality data in this table are voluntarily reported from 121 cities in the United states, most of which have populations of 100,000 or more. A death is reported by the place of its occurrence and by the week that the death certificate was filed. Fetal deaths are not included. **Pneumonia and influenza. † Because of changes in reporting methods in these 3 Pennsylvania cities, these numbers are partial counts for the current week. Complete counts will be available in 4 to 6 weeks. ++Total includes unknown ages. Data not available. Figures are estimates based on average of past available 4 weeks. by disseminated candidiasis, but he was discharged after 12 weeks of hospitalization without residual problems. Serum samples obtained during the late acute and convalescent periods of illness were negative for antibodies against Rickettsia rickettsii and other agents, but there was a 16-fold decrease in antibody titers against E. canis (highest titer, 640) by indirect fluorescent antibody (IFA) test. In addition, examination of inclusions in leukocytes by electron microscopy revealed a structure that was compatible with rickettsia belonging to the genus Ehrlichia. Since this initial case report, 45 additional cases of human ehrlichiosis have been identified by various investigators (2–5; CDC, unpublished data). All but eight of these cases were detected by testing serum samples from patients who had suspected RMSF but who were seronegative for R. rickettsii. = Seventy-four percent of patients were male, and the majority of patients were between 30 and 60 years of age (range 2-68). Patients were exposed to infection in 11 states,* the majority of which are in the southeastern and south central areas of the country. These are the same areas from which the majority of serum specimens tested for E. canis were obtained. Onsets of illness occurred between March and October. Eighty-three percent of patients had a history of tick exposure in the 4-week period before onset of illness; the majority were exposed to ticks 1 to 3 weeks before they became ill. Information on the species of ticks involved was not available. Symptoms reported by patients were nonspecific (Table 1) and similar to those reported by patients with RMSF. However, approximately 20% of patients with ehrlichiosis reported a rash (frequently nonspecific), whereas 88% of those with RMSF reported a rash (6). One patient was asymptomatic. Over half of the patients had hematologic abnormalities such as leukopenia and thrombocytopenia (Table 1) and mildly abnormal liver function tests, especially aspartate aminotransferase and alanine aminotransferase (Table 1). Although 63% of patients were hospitalized, all recovered without residual problems. However, there has been a preliminary report of a human fatality possibly associated with E. canis infection. Reported by: Viral and Rickettsial Zoonoses Br, Div of Viral Diseases, Center for Infectious Diseases, CDC. *Alabama, Arkansas, Georgia, Missouri, New Jersey, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia. The state of residence was used for two persons with no history of tick exposure. TABLE 1. Clinical and laboratory findings for 46 human ehrlichiosis cases* United |