Diagnosis of Ehrlichia ewingii infection by PCR in a puppy from Ohio.

An 8-week-old, male, German Shepherd-cross puppy found in southeastern Ohio was presented to The Ohio State University Veterinary Teaching Hospital for evaluation of lameness and lethargy. Fever and joint effusion involving multiple joints were identified on physical examination. Results of a CBC included mild anemia, mature neutrophilia, monocytosis, and hyperglobulinemia. Rickettsial morulae were identified within neutrophils in joint fluid and peripheral blood. Both initial and convalescent serum titers were negative for Ehrlichia sp.; however, PCR analysis was strongly positive for Ehrlichia ewingii. The patient's clinical signs resolved within several days of beginning doxycycline treatment. Resolution of infection was confirmed by negative PCR results after 18 days of treatment and again after 3 years. This is the first reported case of E. ewingii in Ohio. More importantly, this case demonstrates the importance of PCR in making a definitive diagnosis of tick-borne disease and the potential pitfalls of relying on serologic testing alone in making a diagnosis.