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Thomas R. Eng, VMD, MPH; Joseph E. McDade, PhD; Daniel B. Fishbein, MD
Centers for Disease Control Atlanta

JAMA. 1988;260(20):3007.

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In Reply. —

We appreciate Dr Goddard's thoughts on the causative agent of human ehrlichiosis and its possible relationship to the agent of Bullis fever. Although many similarities exist in the clinical, laboratory, and epidemiologic aspects of human ehrlichiosis and Bullis fever, major differences between these diseases suggest that they are indeed different entities.

The majority of patients with human ehrlichiosis and Bullis fever have similar nonspecific signs and symptoms such as fever, headache, anorexia, and weight loss.^1,2 However, all patients with Bullis fever had lympadenopathy that was often generalized,² and these lymph nodes "were easily palpable and in many instances acutely tender."³ Generalized lymphadenopathy has not been reported in any patient with human ehrlichiosis (Centers for Disease Control, unpublished data).

Absolute leukopenia is a common hematologic finding in both human ehrlichiosis and Bullis fever.^1,2 However, several hematologic parameters are quite different in descriptions of these . . . [Full Text PDF of this Article]

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