Clinical Signs and Symptoms

HME and HGE represent two clinically indistinguishable yet epidemiolog-ically and etiologically distinct diseases. Infection generally results in acute, influenza-like illness with fever, headache, malaise and frequently low white blood cell and thrombocyte counts. Nausea, vomiting, and a rash may be present in certain cases. Intracytoplasmic bacterial aggregates (morulae) may be visible in the white blood cells of some patients. Because the symptoms are relatively non-specific, a definitive diagnosis depends on development of a clinically compatible illness in conjunction with supportive laboratory results (87).

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