The eye and tick-borne disease in the United States

Sathiamoorthi, Saraniya; Smith, Wendy

doi:10.1097/icu.0000000000000308

Cited by 21 publications

(17 citation statements)

References 58 publications

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“…E. chaffeensis PCR has high specificity (60-85 %) and sensitivity (60-85 %) and is the confirmatory test of choice. Peripheral blood, bone marrow, or CSF smear analysis looking for morulae is the most specific for Ehrlichiosis diagnosis; however, Wright Giemsa stains are relatively insensitive as only 3% of patients have monocytes with morulae [12]. Most cases demonstrate a lymphocytic pleocytosis in CSF; however, one-third of cases can have a neutrophilic predominance [14].…”

Section: Discussionmentioning

confidence: 99%

Ehrlichia Meningoencephalitis: A Case Series

Morena¹,

Antimisiaris²,

Singh³

2021

austinjclincaserep

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Objective: We present the distinct clinical and laboratory findings in two cases of Ehrlichia meningoencephalitis, along with one suspected case. Background: The number of cases of Ehrlichia chaffeensis reported to the CDC has more than doubled from 2007-2017. A PubMed literature search using the words “Ehrlichiosis and meningoencephalitis” revealed five case reports with neurologic manifestations. Design/Methods: This is a retrospective observational study. Two elderly patients presented with encephalopathy, fever, transaminitis, thrombocytopenia, a positive E. chaffeensis Polymerase Chain Reaction (PCR) in Serum, and Cerebrospinal Fluid (CSF) with a lymphocytic or neutrophilic pleocytosis and elevated protein. One patient had similar symptoms and a positive E. chaffeensis PCR, but lumbar puncture was unable to be performed due to severe thrombocytopenia. They presented in May or June. Doxycycline was started within 2-3 days after presentation to the hospital. Follow up five months later revealed all patients were close, or back to baseline. Results and Conclusions: Suspicion of Ehrlichia meningoencephalitis should be raised in elderly patients presenting with fever and encephalopathy in the summer season with history of tick bite or residence in wooded areas. Thrombocytopenia and transaminitis should raise further suspicion. CSF studies typically show a lymphocytic pleocytosis and elevated protein. PCR technique allows for direct detection of pathogen-specific DNA and is the preferred method of detection during the acute phase of illness. Prompt treatment with doxycycline results in good outcomes. Doxycycline is not included in the typical meningitis regimen, therefore, this disease is important to quickly identify as delay in Doxycycline can result in worse outcomes.

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Section: Discussionmentioning

confidence: 99%

Ehrlichia Meningoencephalitis: A Case Series

Morena¹,

Antimisiaris²,

Singh³

2021

austinjclincaserep

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“…2 Cases of pupil abnormalities, facial nerve palsy, ophthalmoplegia, and optic neuritis were all documented in association with anaplasmosis. 3 This case report is an important addition to the study of atypical cases of anaplasmosis. Retinal hemorrhages with other tick-borne infections were associated with retinal vasculitis, coagulopathy, or thrombocytopenia.…”

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confidence: 86%

Retinal Hemorrhage Associated with Human Granulocytic Anaplasmosis

Lynch,

Upadhyaya,

Bhagat

2024

JAMA Neurol

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“…Rocky Mountain spotted fever, caused by Rickettsia rickettsii , can cause encephalitis that typically begins abruptly with fever, severe headache, restlessness, and delirium 54 . Ophthalmologic findings, most commonly retinal vascular changes, are frequent, 55 as is temporary loss of hearing. The distinctive spotted rash develops about 3 to 5 days after fever onset, initially appearing on the wrists and ankles before spreading to involve other areas and developing into petechiae.…”

Section: Encephalitismentioning

confidence: 99%

Encephalitis and Brain Abscess

Venkatesan¹

2021

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: This article reviews infections of the brain parenchyma and includes an overview of the epidemiology, pathogenesis, diagnostic approach, and management of infectious encephalitis and brain abscess.RECENT FINDINGS: The epidemiology of infectious encephalitis and brain abscess has changed in recent years. Vaccination has reduced the incidence of certain viruses associated with encephalitis, while a decrease in fulminant otogenic infections has led to fewer brain abscesses associated with otitis media. However, changes in climate and human population density and distribution have enabled the emergence of newer pathogens and expanded the geographic range of others, and greater adoption of intensive immunosuppressive regimens for autoimmune conditions has increased the risk of opportunistic infections of the brain. The widespread use of early neuroimaging, along with improved diagnostic methodologies for pathogen detection, newer antimicrobial therapies with better brain penetration, and less invasive neurosurgical techniques, has resulted in better outcomes for patients with infectious encephalitis and brain abscess. Novel technologies including metagenomic next-generation sequencing are increasingly being applied to these conditions in an effort to improve diagnosis. Nevertheless, both infectious encephalitis and brain abscess continue to be associated with substantial mortality. SUMMARY: Infectious encephalitis and brain abscess can present as neurologic emergencies and require rapid assessment, thorough and appropriate diagnostic testing, and early initiation of empiric therapies directed against infectious agents. Close clinical follow-up, proper interpretation of diagnostic results, and appropriate tailoring of therapeutic agents are essential to optimizing outcomes. Diagnosis and management of parenchymal brain infections are complex and often best achieved with a multidisciplinary care team involving neurologists, neurosurgeons, neuroradiologists, infectious disease physicians, and pathologists.

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The eye and tick-borne disease in the United States

Abstract: Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases.

Cited by 21 publications

References 58 publications

Ehrlichia Meningoencephalitis: A Case Series

Ehrlichia Meningoencephalitis: A Case Series

Retinal Hemorrhage Associated with Human Granulocytic Anaplasmosis

Encephalitis and Brain Abscess

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