Human ehrlichiosis associated with cerebrospinal fluid pleocytosis: A case report

Dimmitt, Dean C.; Fishbein, Daniel B.; Dawson, Jacqueline E.

doi:10.1016/0002-9343(89)90731-6

Cited by 2 publications

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“…The demographics and CNS symptoms and signs for all 21 patients with abnormal CSF findings are shown in table 1; all of the patients, except patient 5, were infected with E. chaffeensis [8][9][10][11][12][13][14]. Of the 15 patients with normal CSF findings, nine were infected with E. chaffeensis, and six were infected with the agent of HGE [5,8,16,17].…”

Section: Resultsmentioning

confidence: 99%

“…We and other investigators have noted that CNS manifestations occur in --20% of patients infected with E. chaffeensis [6,7]. Seventeen percent of the patients with human granulocytic ehrlichiosis (HGE) were reported to have confusion [5], and evidence of meningitis has been cited in several reports [1,[8][9][10][11][12][13][14]. We describe our experience with patients who had CNS involvement during episodes of ehrlichiosis, and we review the English-language literature on this condition.…”

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confidence: 99%

“…We gathered data from the records for a previously reported series of patients seen by the infectious diseases consultative services at the University of Missouri Hospitals (Columbia, MO) and the Harry S. Truman Veterans Affairs Hospital (Columbia) during the period 1989 through 1993 [5] and for subsequent patients seen through September 1995. We also reviewed previously published cases in which CSF examinations were done [1,5,[8][9][10][11][12][13][14][15][16][17]. CSF was considered to be abnormal when any of the following values were obtained: leukocyte count, >5 X 10 6 fL; protein level, >0.45 g/L; or glucose concentration, <2.5 mmol/L.…”

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Central Nervous System Manifestations of Human Ehrlichiosis

Ratnasamy¹,

Everett²,

Roland³

et al. 1996

Clinical Infectious Diseases

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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.

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confidence: 99%

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confidence: 99%

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Central Nervous System Manifestations of Human Ehrlichiosis

Ratnasamy¹,

Everett²,

Roland³

et al. 1996

Clinical Infectious Diseases

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“…Neurologic changes in infected patients occur relatively frequently. Among patients with central nervous system involvement in whom lumbar punctures have been performed, cerebrospinal fluid (CSF) pleocytosis has been reported for approximately 25% (6,8). However, characteristic Ehrlichia inclusions (morulae) have not previously been reported in CSF cells.…”

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Identification of Ehrlichia chaffeensis morulae in cerebrospinal fluid mononuclear cells

et al. 1992

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We report a case of ehrlichiosis in a 72-year-old man who developed extreme lethargy, acute renal failure requiring hemodialysis, and respiratory insufficiency requiring intubation. Lumbar puncture performed on the second day of hospitalization revealed significant cellular pleocytosis. Ehrlichia morulae were tentatively identified in mononuclear cells in routinely processed Wright-stained cytospin preparations of cerebrospinal fluid (CSF). Identification was confirmed by a specific immunocytochemical staining procedure. Subsequent identification specifically as Ehrlichia chaffeensis morulae was established by polymerase chain reaction analysis, which revealed E. chaffeensis-specific DNA in CSF, bone marrow, and blood samples; by indirect fluorescent-antibody analysis, the patient developed an antibody titer of 32,768 against E. chaffeensis antigen. The patient responded to intravenous therapy with doxycycline and dexamethasone. Subsequently, neurologic, hematologic, renal, and pulmonary status had returned to baseline at follow-up 12 weeks after admission. To our knowledge, this is the first identification of E. chaffeensis morulae in CSF cells in an infected patient.

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Human ehrlichiosis associated with cerebrospinal fluid pleocytosis: A case report

Cited by 2 publications

References 0 publications

Central Nervous System Manifestations of Human Ehrlichiosis

Central Nervous System Manifestations of Human Ehrlichiosis

Identification of Ehrlichia chaffeensis morulae in cerebrospinal fluid mononuclear cells

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