Introduction. Ehrlichia are obligate intracellular pathogens transmitted to vertebrates by ticks.

Case presentation. We report the case of a 59-year-old man who presented to the University of Kentucky Albert B. Chandler Medical Center (Lexington, KY, USA) after being found fallen down in the woods. A lumbar puncture revealed what appeared to be bacterial meningitis, yet cerebrospinal fluid cultures, Gram stains and a meningitis/encephalitis panel were inconclusive. However, an Ehrlichia DNA PCR of the blood resulted as being positive for Ehrlichia chaffeensis antibodies. The patient received a 14 day course of doxycycline, and recovered from his multiple organ failure. The aetiology of the ehrlichial meningoencephalitis was likely transmission through a tick-bite, due to the patient’s outdoor exposure.

Conclusion. While it is rare to see Ehrlichia as a cause of meningitis, this illness can progress to severe multisystem disease with septic shock, meningoencephalitis or acute respiratory distress syndrome (ARDS). Those with compromised immunity are at a higher risk of developing the more severe form of the disease and have higher case fatality rates.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article metrics loading...

Loading full text...

Full text loading...



  1. Centers for Disease Control and Prevention 2016; Ehrlichiosis. www.cdc.gov/Ehrlichiosis/ [accessed on 16 March 2018]
  2. Walker DH, Ismail N, Olano JP, McBride JW, Yu XJ et al. Ehrlichia chaffeensis: a prevalent, life-threatening, emerging pathogen. Trans Am Clin Climatol Assoc 2004; 115:375–382[PubMed]
    [Google Scholar]
  3. Bogovic P, Strle F. Tick-borne encephalitis: a review of epidemiology, clinical characteristics, and management. World J Clin Cases 2015; 3:430–441 [View Article][PubMed]
    [Google Scholar]
  4. Baker P. 2015; Ehrlichiosis. American Lyme Disease Foundation www.aldf.com/ [accessed 16 March 2018]
  5. Walker DH, Dumler JS. The role of CD8 T lymphocytes in rickettsial infections. Semin Immunopathol 2015; 37:289–299 [View Article]
    [Google Scholar]
  6. Ismail N, Soong L, McBride JW, Valbuena G, Olano JP et al. Overproduction of TNF-alpha by CD8+ type 1 cells and down-regulation of IFN-gamma production by CD4+ Th1 cells contribute to toxic shock-like syndrome in an animal model of fatal monocytotropic ehrlichiosis. J Immunol 2004; 172:1786–1800 [View Article][PubMed]
    [Google Scholar]
  7. Beavers C, Rickard K, Hollensead SC, Snyder JW. Two fatal Ehrlichia cases with complete autopsies. JMM Case Rep 2014; 1:000349 [View Article]
    [Google Scholar]
  8. Dredla B, Freeman WD. Ehrlichia meningitis mimicking aneurysmal subarachnoid hemorrhage. Neurohospitalist 2016; 6:76–79 [View Article]
    [Google Scholar]
  9. Ugbarugba E. Aseptic meningitis secondary to Ehrlichia chaffeensis. J Hosp Med 2015; 10: www.shmabstracts.com/abstract/aseptic-meningitis-secondary-to-ehrlichia-chaffeensis/
    [Google Scholar]
  10. Ahkee S, Ramirez J. A case of concurrent Lyme meningitis with ehrlichiosis. Scand J Infect Dis 1996; 28:527–528 [View Article][PubMed]
    [Google Scholar]
  11. Hamburg BJ, Storch GA, Micek ST, Kollef MH. The importance of early treatment with doxycycline in human ehrlichiosis. Medicine 2008; 87:53–60 [View Article][PubMed]
    [Google Scholar]

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error