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Volume 6, Number 3—June 2000


Serologic Evidence of Human Monocytic and Granulocytic Ehrlichiosis in Israel

Suggested citation for this article

Letter to the Editor: Our article on ehrlichiosis in Israel is one of several reporting serologic evidence of ehrlichiosis outside North America (1-4). Serologic tests were performed for immunoglobulin (IgG) antibodies to Ehrlichia chaffeensis, E. canis, and human granulocytic ehrlichiosis (HGE) agent to prevent misinterpretation due to cross-reaction. The conclusions meet the criteria published by the American Society for Rickettsiology, in which a confirmed diagnosis of human monocytic ehrlichiosis (HME) is based on a "single serum titer of 256" in a patient with clinically compatible disease (5).

The argument that the same epidemiologic circumstances that exist in the United States have to be prevalent in Israel for the disease to be present is not compelling. Reporting serologic evidence of ehrlichiosis in Israel alerts physicians to the possibility of HME and HGE when they see patients with symptoms compatible with these diseases. We agree that isolation and molecular identification of both agents are essential to confirming the presence of these diseases in Israel.

Read original article: to the Editor regarding Keysary's original article:

Avi Keysary and Trevor Waner

Author affiliations: Israel Institute for Biological Research, Ness Ziona, Israel


  1. Keysary A, Amram L, Keren G, Sthoeger A, Potasman I, Jacob A, Serologic evidence of human monocytic and granulocytic ehrlichiosis in Israel. Emerg Infect Dis. 1999;5:7758. DOIPubMed
  2. Morais JD, Dawson JE, Greene C, Filipe AR, Galhardas LC, Bacellar F. First European case of ehrlichiosis. Lancet. 1991;338:6334.PubMed
  3. Bakken JS, Krueth J, Tilden RL, Dumler JS, Kristiansen BE. Serological evidence of human granulocytic ehrlichiosis in Norway. Eur J Microbiol Infect Dis. 1996;15:82932. DOI
  4. Christova IS, Dumler JS. Human granulocytic ehrlichiosis in Bulgaria. Am J Trop Med Hyg. 1999;60:5861.PubMed
  5. Walker DH. Consensus workshop on diagnosis of human ehrlichiosis. Bulletin of the American Society for Rickettsiology. 1999;2:18.

Suggested citation: Keysary A, Waner T. Serologic Evidence of Human Monocytic and Granulocytic Ehrlichiosis in Israel [letter]. Emerg Infect Dis [serial on the Internet]. 2000, Jun [date cited]. Available from

DOI: 10.3201/eid0603.000317

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Table of Contents – Volume 6, Number 3—June 2000