We present the distinct clinical and laboratory findings in three cases of Ehrlichia meningoencephalitis. 

The number of cases of Ehrlichia chaffeensis reported to the CDC has more than doubled from 2007-2017. The last reported prevalence of E. chaffeensis cases in Ohio was in 2017 and was 0.7 cases per million people. Neurological manifestations occur in approximately 20% of cases.

This is a retrospective observational study. We identified three cases of Ehrlichia meningoencephalitis seen by the neurology consult team at our institution over a period of 2 months (5/2019-6/2019). All patients were age 67-71 and presented with fever and encephalopathy. Two patients had headache. One patient had an event concerning for seizure. All of the patients were from Southeast Ohio with exposure to wooded areas and ticks within the month leading up to presentation. All of the patients had mild trans-aminitis and thrombocytopenia. Two cases underwent lumbar puncture, which revealed a lymphocytic pleocytosis with elevated protein. All three patients had positive E. chaffeensis polymerase chain reaction (PCR) in serum. All patients completed at least a 10 day course of Doxycycline. All patients are close, or back to baseline five months later.

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Suspicion of Ehrlichia meningoencephalitis should be raised in elderly patients presenting with fever and encephalopathy in the summer season with history of a tick bite or residence in wooded areas. Thrombocytopenia and transaminits should raise further suspicion. Neuroimaging findings are non-specific. Cerebrospinal fluid studies are abnormal with lymphocytic pleocytosis and mild elevation of 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.