Central Nervous System Manifestations of Human Ehrlichiosis

Abstract

Since 1989, we have confirmed the diagnosis of human ehrlichiosis in 57 patients. Although routine radiological studies of the central nervous system (CNS) or analyses of cerebrospinal fluid (CSF) samples were not done for these patients, primary care physicians detected symptoms or signs that prompted them to perform such studies. CSF samples were examined for 15 of the 57 patients. Findings in eight of the 15 CSF samples were abnormal, and the most common abnormalities were lymphocytic pleocytosis and elevated protein levels. A search of the English-language literature revealed 21 additional cases in which CSF examinations were performed; in 13 of these cases, CSF findings were abnormal. The most common clinical finding that predicted CSF abnormalities was a change in mental status. A total of 14 patients underwent computerized tomographic studies, and none of these studies showed abnormalities. Four (19%) of the 21 patients with CNS manifestations of ehrlichiosis and abnormal CSF findings died.

Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States

“…Cough or respiratory symptoms are reported in approximately 28% of patients and are more common among adults (10,51,129). Central nervous system involvement, such as meningitis or meningoencephalitis, is present in approximately 20% of patients (135).…”

“…In this context, a routine blood smear can provide a presumptive clue for early diagnosis; however, the visualization of morulae still requires confirmatory diagnostic testing (see Confirmatory Diagnostic Tests). When CSF is evaluated, a lymphocytic pleocytosis is most commonly observed, although neutrophilic pleocytosis also can occur (128,135). CSF white blood cell counts are typically <250 cells/µL but can be higher in children (128,135,158).…”

“…When CSF is evaluated, a lymphocytic pleocytosis is most commonly observed, although neutrophilic pleocytosis also can occur (128,135). CSF white blood cell counts are typically <250 cells/µL but can be higher in children (128,135,158). Elevated CSF protein levels are common (135).…”

“…CSF white blood cell counts are typically <250 cells/µL but can be higher in children (128,135,158). Elevated CSF protein levels are common (135).…”

“…For example, improved nucleic acid extraction technology has facilitated recovery of rickettsial DNA from some types of formalin-fixed, paraffin-embedded skin biopsies or autopsy tissues to allow species-specific PCR and sequence analysis (292,293). Testing of CSF by PCR assays has successfully identified E. chaffeensis (135,159,294). For eschar-producing tickborne rickettsial diseases, including R. parkeri, Rickettsia species 364D, and R. africae, an eschar biopsy, a swab of eschar exudate, or scab material from the eschar surface can provide suitable specimens for molecular confirmation of SFG rickettsial DNA (41,44,292,295).…”