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BMJ 2011; 343 doi: (Published 10 August 2011) Cite this as: BMJ 2011;343:d5061

New species of Ehrlichia is discovered

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Ehrlichiosis is transmitted by infected ticks, and symptoms usually include fever, myalgia, and headache, sometimes with a rash. In severe cases the gastrointestinal tract, kidneys, respiratory system, and central nervous system can be affected; rarely, the disease causes death. Ehrlichia canis is thought to cause human disease in Venezuela and E muris in Russia. In the US only E chaffeensis and E ewingii have been identified as human pathogens.

Blood samples were taken from all 4247 suspected cases of ehrlichiosis or anaplasmosis, a similar tick borne zoonosis, seen over seven months across 45 US states. Molecular methods showed that four people (three residents of Wisconsin and one of Minnesota) were infected with a new Ehrlichia species, which was named “Wisconsin.”

All four patients had fever, fatigue, and headache, and one patient also reported nausea and vomiting. Laboratory results showed lymphopenia in all patients and thrombocytopenia in three. Two patients were immunocompromised, after lung and kidney transplantation several years earlier, and had more severe disease, but all patients recovered well after treatment with doxycycline.

Ticks were also collected, a total of 697; 16 of 534 Ixodes scapularis ticks from Minnesota and five of 154 from Wisconsin were positive for the new species of Ehrlichia. None of the tested Dermacentor variabilis ticks contained DNA from the new species.

Pneumothorax is a common complication of lung biopsy

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Solitary lung nodules are found in up to a quarter of people who undergo chest computed tomography. The potential for harm should be taken into account when deciding whether to perform a biopsy. But reported complication rates vary greatly—for example, rates of …

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