2006: Ehrlichia infection of the central nervous system.

1: Curr Treat Options Neurol. 2006 May;8(3):179-84. Related Articles,
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Ehrlichia infection of the central nervous system.

Hongo I, Bloch KC.

Division of Infectious Diseases, Vanderbilt University School of
Medicine, A-2200 Medical Center North, 1161 21st Avenue South,
Nashville, TN 37232, USA. igen.hongo@xxxxxxxxxxxxxxx

Ehrlichiosis in the United States is caused by three closely related
bacterial species (Ehrlichia chaffeensis, Ehrlichia ewingii, and
Anaplasma phagocytophilum), all transmitted through tick bite. Although
there is variation with respect to geography and tick vector, the
clinical manifestations are similar, and treatment of these infections
is identical. Ehrlichiosis can present with a spectrum of neurologic
manifestations, ranging in severity from headache to
meningoencephalitis. Treatment is straightforward if the diagnosis is
suspected, but antibiotic therapy should not be delayed pending
laboratory confirmation. Doxycycline, the treatment of choice for
adults and children with suspected ehrlichiosis, has high
bioavailability and can be administered orally in most cases. Therapy
is typically continued at least 3 days after the last documented fever.
Although there have been no studies specifically evaluating duration or
dosing of doxycycline for Ehrlichia meningoencephalitis, anecdotal
reports suggest 100 mg doxycycline administered twice daily is
effective, despite limited penetration into the cerebrospinal fluid.
Because doxycycline interacts with CYP3A4 enzymes, there is potential
for drug interactions with a number of medications. In endemic areas,
documentation of coinfection with Borrelia burgdorferi, the etiologic
agent of Lyme disease, may require prolonging the duration of
doxycycline therapy.

PMID: 16569376 [PubMed - in process]

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