Coinfection withBorrelia burgdorferiand the Agent of Human Granulocytic Ehrlichiosis

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Abstract
Lyme disease and human granulocyte ehrlichiosis are infections carried by the deer tick, Ixodes scapularis. Ticks may harbor both Borrelia burgdorferi and the human granulocytic ehrlichiosis bacterium, the causative agents of these diseases, and dual infections can occur.1 We assessed the risk of exposure to human granulocytic ehrlichiosis among 86 persons with serologic evidence of Lyme disease living in southern Connecticut and Rhode Island — areas in which Lyme disease and human granulocytic ehrlichiosis are relatively common. We used an enzyme-linked immunosorbent assay (ELISA) and immunoblotting (for IgM and IgG antibodies) with B. burgdorferi as the substrate for the serologic diagnosis of Lyme disease according to the criteria defined by the Centers for Disease Control and Prevention.2 An ELISA using recombinant HGE-44 (also known as P44), an immunodominant antigen of the human granulocytic ehrlichiosis bacterium, was performed to document exposure to the bacterium.3