Ehrlichia and Guillain-Barré Syndrome: A Tick-Borne Case
Tick-borne illness can evolve
Symptoms may initially improve
Neurologic complications can follow
Diagnosis may need reassessment
Tick-borne infections such as Ehrlichia can lead to unexpected neurologic complications, including Guillain-Barré syndrome (GBS).
This case, discussed in an Inside Lyme Podcast, highlights how symptoms may evolve even after appropriate initial treatment. :contentReference[oaicite:0]{index=0}
A study by Malhis and colleagues describes a 71-year-old woman who developed Guillain-Barré syndrome after being treated for Ehrlichia.
Initial Presentation and Diagnosis
The patient developed symptoms over three weeks, including:
- Generalized weakness
- Dizziness and visual changes
- Fever and chills
- Neck and abdominal pain
She was diagnosed with Ehrlichia based on:
- Low platelet count
- Elevated liver enzymes
- History of insect bite
- Positive PCR test
Treatment with doxycycline led to initial improvement.
Neurologic Symptoms Develop
Approximately one week later, the patient returned with worsening symptoms:
- Numbness in the lower extremities
- Loss of reflexes
- Unsteady gait requiring a walker
- Tingling in the feet
- Difficulty urinating
These findings led to a diagnosis of Guillain-Barré syndrome, an acute inflammatory demyelinating neuropathy.
For related neurologic complications, see neurologic Lyme disease.
Understanding Guillain-Barré Syndrome
Guillain-Barré syndrome (GBS) is an autoimmune condition in which the immune system attacks peripheral nerves.
It can lead to:
- Rapidly progressive weakness
- Loss of reflexes
- Difficulty walking
- In severe cases, respiratory failure
GBS has been associated with several infections, including:
- Lyme disease
- Campylobacter jejuni
- Viral infections such as COVID-19
This case suggests Ehrlichia may also trigger a similar immune response.
Response to Treatment
The patient was treated with intravenous immunoglobulin (IVIG), a standard therapy for GBS.
She improved significantly and was discharged to a rehabilitation facility.
Approximately 85% of patients with GBS recover independent ambulation, though recovery timelines vary.
Broader Tick-Borne Considerations
This case highlights the importance of maintaining a broad differential diagnosis when symptoms evolve.
Not all tick-borne illnesses respond predictably to treatment.
For example, Kosoy and colleagues reported a fatal case later attributed to Bourbon virus, a newly recognized tick-borne infection.
For coinfections, see tick-borne coinfections.
Clinical Insight
Initial improvement does not exclude later complications.
When neurologic symptoms emerge or worsen, clinicians should reassess the diagnosis and consider immune-mediated conditions such as GBS.
A broad differential diagnosis is essential in tick-borne illness.
Clinical Takeaway
Tick-borne infections such as Ehrlichia may trigger Guillain-Barré syndrome in rare cases.
Worsening neurologic symptoms after treatment should prompt immediate evaluation and reconsideration of the diagnosis.
Frequently Asked Questions
Can Ehrlichia cause Guillain-Barré syndrome?
Rarely, but case reports suggest it may trigger immune-mediated nerve injury.
What are early signs of GBS?
Weakness, numbness, loss of reflexes, and difficulty walking.
Is GBS treatable?
Yes. IVIG or plasma exchange are effective treatments.
Should symptoms after treatment be ignored?
No. New or worsening symptoms require reassessment.
Related Reading
References
- Malhis JR et al. 2021
- Kosoy OI et al. Emerg Infect Dis, 2015.
- CDC Tick-borne Diseases
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
I have personally seen this in someone post-vaccine.
It seems as though many are experiencing extremely similar symptoms after having Lyme, Covid and post vaccine. Long Covid, Chronic Lyme and Post vaccine injury are almost symptomatically identical.
What is the common denominator here?
In the mid-70s, I had a neighbor contract GBS associated with a viral infection. In the early 80s, as my undiagnosed condition spread throughout my body, I noted how similar it was to her description of the GBS onset…moving from extremities towards the trunk. It took 37 years to diagnose Lyme/Bartonella with multi-viral reactivation. I still remember how each new flare-up would introduce “whatever it was” to a new muscle/joint complex, then die down to embers until new stress or source of fatigue would start the process in a new area. It took 8 years to fully envelop the musculoskeletal system, then was present but subdued until 2017 when multi stressors led to an immune collapse. Multiantibiotic treatment plus several herbals are showing progress, but this latest flare damaged brain function more noticeably. Someday someone will find the common links.
I was Lymes- sick in June of 2020 while in Maine for the summer. I developed big circular rashes all over my body not bull-eyes. I had a fever as high as 103 up and down. This lasted about a week, my head ached, I vomited when my fever was the highest. I had body violently shaking with chills. When the rash hadn’t gone away after 2 weeks I went to a walk-in. Covid was new then and we tried to stay away from places like that. I’d had a test while I was sick which was negative for Cobid. The PA at the clinic took a look at my rashes asked me where I hurt that was new, I told her my knees, my neck. She diagnosed me with Lymes sickness and prescribed 3 weeks of Doxycycline. By late July early August I was still feeling fatigued more than my normal and just ached all over. We found a NP who was very LL because she’d had it herself. She became our most caring practitioner. Without all the details in between, I was getting worse we had headed back to Florida for the winter. I’m getting more fatigued and had very little energy to walk and it was becoming more difficult. I had some very bad falls. I saw a quack in Florida stating he was LL but to a Lymie it doesn’t take long to realize when someone doesn’t understand Lymes and co-infection. My practioner in Maine had ordered Igenix Lymes testing in August and my results were: Positive for Borreliosis, Burgdorferi, Babesiosis and Mycoplasma. I gradually lost feeling in my hands and feet and my arms and legs. By January 2021 I was in bed. In April I made contact with the practitioner in Maine and begged her to please help me long distance. Seeing the lyme specialist in Florida had been a total waste of time . With her help and the supplements and tinctures made by an herbalist in Maine and a Compounding Pharmacy here in Florida for LDN, I had neck surgery on September 29th to fuse C-5 & 6, with a basket and screws around it. I have been in-patient re-hab following my surgery for 6weeks. Now I’m home I’ve regained feeling in my limbs and walking with help for short distances. I’m actually going to walk again.
Ik hoop dat dit vertaald kan worden. Ik vertelde het eerder. In 2016 had ik GBS, alle ledematen verlamd, inclusief nek en de ademhaling. Grove tremor/uitschieters aan armen en fijne over het hele lichaam. De volgende dag had ik een klauwhand en een slappe arm, 2 klapvoeten, heel zwakke benen, romp, armen, nek en slikstoornissen. Ademhaling was nog steeds slecht en daarbij witte tenen en vingers. Die avond ervoor, acuut verlamming, waren mijn vingers halfblauw en kon bijna niet meer praten. Dr. Daniël heeft gelijk, het is een gevolg van diverse oorzaken en geen auto immuunziekte. Het kan net als bij Covid, auto immuun reageren, net als bij long Covid. Ik ben na 4 maanden langzaam hersteld.
I told you before. In 2016 I had GBS, paralyzed all limbs, including neck and breathing. Coarse tremor/outliers on arms and fine all over body. The next day I had a claw hand and a limp arm, 2 foot drop, very weak legs, trunk, arms, neck and swallowing difficulties. Breathing was still bad with white toes and fingers. That night before, acutely paralyzed, my fingers were half blue and could barely speak. dr. Daniel is right, it is a result of various causes and not an autoimmune disease. It can react autoimmune, just like with Covid, just like with lung Covid. I have slowly recovered after 4 months. [translated with google]
BTDT. Tick exposure in New York, Vermont in 1995. Lyme and associated TBDs followed, misdiagnosed GBS, CIDP.
My insurer’s PCP, ID and Neuro gatekeepers followed IDSA Lyme Dx and TMT guidelines. I almost died. Had to self pay for IGENIX tests, IV antibiotics. Much improved now but still disabled, and battling multiple NHL cancers, jaw pain. I asked two insurers to reimburse my out of pocket costs. Won two court cases, lost 2 — the last in 9th Circ Appeals court. Some hate light and love darkness.
I was diagnosed with Guillain-Barre syndrome in March of 2023 with paralysis from waste down. Months later and 3 hospitals later my neurologist tested me foe epison barr and lyme both positive.
It’s been a horrible experience and I’m still recovering. It’s hard to work. Walk my dogs. Daily tasks. Plus I went through both hurricanes in florida and suffered through this living in my truck w my 2 dogs.
I have patients with more than one condition. I have patients who are still ill after a neurologic condition who also have Lyme symptoms. Here is a published article where they treated both. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249767/
Diagnosis lyme disease after having been found unresponsive in hotel and woke out of 5 day coma only to become paralyzed 7 days later. It has not even been a year yet.