Initial symptoms are followed several days later by fever, myalgia, headache, and drenching sweats. Illness can range from a mild self-limited infection to severe hemolytic anemia, renal failure, and severe hypertension. Decreased levels of blood platelets may necessitate exchange blood transfusions. Most patients have thrombocytopenia. Wright's or Giemsa-stained blood smears may reveal babesia organisms.
Elevated titers can persist for months after acute infection.
Most patients have a mild illness and recover without specific treatment. A 7-day regimen of oral quinine plus oral or intravenous clindamycin is recommended. Blood transfusions are given in severe cases. Fatigue and low-grade fever may persist for weeks or months after treatment. The latest tick-borne disease to emerge in the U.S., ehrlichiosis was first described in 1987.