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Home > School Health > Manual Contents > Ehrlichiosis


Ehrlichiosis is an infection caused by bacteria in the genus Ehrlichia. These bacteria are transmitted by the bite of an infected lone star tick.

Signs & Symptoms
Symptoms of ehrlichiosis can range from very mild to very severe illness. These symptoms may include fever, headache, chills, malaise, muscle pain, nausea/vomiting/diarrhea, confusion, conjunctival injection, and rash (in up to 60 percent of children).  Severe clinical presentations may include difficulty breathing and bleeding disorders. Ehrlichiosis can be a serious illness that can be fatal if not treated correctly. People who are immunocompromised or elderly are more at risk for severe disease. 

Ehrlichiosis is primarily transmitted to a person through the bite of an infected lone star tick (Amblyomma americanum). This tick is infrequently found in the state of Maine, but is common in the southeastern and south-central United States. Ehrlichiosis can also be transmitted by receiving transfusions from a blood donor who is infected with an Ehrlichia species.

Ehrlichiosis is diagnosed by clinical symptoms and laboratory tests. A blood test is necessary for confirmation. Co-infections with other tick-borne diseases may occur and should be considered. 

Treatment Recommendations for Primary Care

  • If symptoms are noted, the child should be referred to their primary care provider for treatment.
  • Several effective antibiotic treatments are available and are usually prescribed for at least 5-7 days.

Role of the School Nurse


  • Provide education to students and staff regarding prevention efforts including: Wearing protective clothing, using an EPA-approved repellent, using caution in tick infested areas, and performing daily tick checks.
  • School nurse should encourage the use of EPA-approved repellents when outside (following local policy guidelines), and always performing a tick check when returning indoors. 
  • If a tick is found, the school nurse should remove the tick using tweezers or a tick spoon. Identification of the tick may be useful.
  • Tick identification cards are available at: Whole ticks in safe containers may be given to the parents.
  • Testing of the tick is not recommended.


  • There is no need to exclude students from school for ehrlichiosis.
  • Educational modifications may be warranted in children with a positive diagnosis.

            Reporting Requirements

  • Ehrlichiosis is reportable within 48 hours of recognition or strong suspicion of illness. Call the Maine CDC reporting line at 1-800-821-5821.