Since 1989, we have confirmed the diagnosis of human ehrlichiosis in 5
7 patients, Although routine radiological studies of the central nervo
us 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 s
amples were abnormal, and the most common abnormalities were lymphocyt
ic pleocytosis and elevated protein levels, A search of the English-la
nguage literature revealed 21 additional cases in which CSF examinatio
ns were performed; in 13 of these cases, CSF findings were abnormal, T
he most common clinical finding that predicted CSF abnormalities was a
change in mental status. A total of 14 patients underwent computerize
d 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.