Human Granulocytic Ehrlichiosis in Estonia

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 9, No. 11, November 2003 1499 R. conorii) (9,10). Higher reciprocal titers were obtained against R. akari antigens than against R. rickettsii and R. conorii antigens (reciprocol titers of 1,024 vs. 512 and 512, respectively). We observed a difference in reduction in antibody titers against R. akari after adsorption with R. akari (Kaplan) (<16), R. rickettsii (256), and R. conorii (256). Antibodies against R. typhi were not detected. The IFA result confirmed the clinical diagnosis of R. akari infection. After 2 days of doxycycline treatment, the patient was afebrile, and the rickettsialpox infection resolved without scars or complications. In summary, we present a case in which the presence of an eschar on the patient’s penis, the failure of lesions to appear in crops, the sparsity of lesions, and mice on the family’s farm led to a diagnosis of rickettsialpox, which was confirmed by crossadsorption serologic findings. This case indicates that rickettsialpox is an emerging infectious disease in Turkey. We recommend further studies to define the prevalence of R. akari and the worldwide distribution of rickettsialpox.