Removal · field guidance

Ehrlichiosis: morulae on blood smear

Wright- or Giemsa-stained peripheral smear may show intracytoplasmic morulae in monocytes (E. chaffeensis) or granulocytes (Anaplasma).

Steps

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01
Examine peripheral blood smear during the acute febrile phase.
02
Look for morulae — mulberry-like inclusions inside leukocytes.
03
Monocytic morulae suggest E. chaffeensis (HME); granulocytic morulae suggest Anaplasma (HGA).
04
Smear sensitivity is low (1-20% for HME, 20-80% for HGA) — a negative smear does not rule out disease.
05
Confirm with whole-blood PCR and/or paired IFA serology.

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