Anaplasmosis Neurologic Symptoms and Brain Involvement
Anaplasmosis can occasionally affect the brain and nervous system.
Symptoms may include confusion, memory loss, headaches, and fatigue.
Neurologic complications may persist even after treatment.
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron discusses a rare case of central nervous system involvement in a woman diagnosed with anaplasmosis.
The case was first described by Mullholand and colleagues in the British Medical Journal in a paper entitled “Central nervous system involvement of anaplasmosis.” [1]
Confusion, Memory Loss, and Tick Exposure
A 64-year-old woman was hospitalized with a 24-hour history of confusion and lethargy.
The following morning, her symptoms worsened and she developed:
- subjective fever
- mild headache
- nausea and vomiting
- increased confusion
- memory difficulties
- aphasia
Physical examination revealed “aphasia and memory lapse of the past 24 hours and an engorged tick behind the knee.” [1]
Brain MRI Findings
MRI imaging demonstrated leptomeningeal enhancement along with bilateral frontal lobe subarachnoid hemorrhage (SAH).
Leptomeningeal enhancement refers to inflammation involving the two innermost tissue layers surrounding the brain and spinal cord.
Possible causes of leptomeningeal enhancement include:
- bacterial meningitis
- viral infections
- fungal infections
- encephalitis
- vasculitis
- sarcoidosis
- metastatic disease
Subarachnoid hemorrhage (SAH) refers to bleeding in the space surrounding the brain.
Anaplasmosis PCR Testing
The patient’s serum PCR test for anaplasmosis was positive.
A spinal tap was not performed.
The authors noted that symptom onset in anaplasmosis can occur within 24 hours after transmission. [1]
They also pointed out that neurologic complications are generally considered more common in Lyme disease and ehrlichiosis than in anaplasmosis.
Tests for Lyme disease and coinfections were negative, although the authors acknowledged that early testing may fail to identify acute infection.
Treatment for Anaplasmosis
The woman was treated with doxycycline and discharged home.
However, six weeks later she required rehospitalization because of:
- persistent headaches
- word-finding difficulties
- memory loss
- generalized fatigue
Repeat MRI and MRA imaging demonstrated worsening abnormalities involving the frontal, parietal, and occipital lobes, along with persistent vasospasm affecting the left middle cerebral artery.
Speech therapy was arranged, and the patient was discharged without additional antibiotic treatment.
According to the authors, the patient eventually demonstrated marked improvement and returned to her cognitive baseline three months later. [1]
Long-Term Effects of Anaplasmosis
Most patients with anaplasmosis recover with treatment. However, this case illustrates that neurologic complications and prolonged recovery may occasionally occur.
Persistent symptoms after acute infection may include:
- fatigue
- headaches
- word-finding difficulties
- memory problems
- cognitive slowing
These neurologic symptoms may continue for weeks or months even after the infection itself has been treated.
Questions Discussed in the Podcast
- What is anaplasmosis?
- What is leptomeningeal enhancement?
- What is subarachnoid hemorrhage (SAH)?
- How quickly can tick-borne infections be transmitted?
- How long does it take for anaplasmosis symptoms to appear?
- What treatments are available for anaplasmosis?
Clinical Perspective
Anaplasmosis is typically recognized as a flu-like tick-borne illness, but rare neurologic complications involving the brain and central nervous system have been reported.
This case highlights that confusion, aphasia, memory loss, persistent headaches, and prolonged cognitive symptoms may occasionally occur in patients with anaplasmosis.
Clinicians should consider tick-borne infections in patients presenting with unexplained neurologic symptoms and recent tick exposure in endemic regions.
Thanks for listening to another Inside Lyme Podcast. Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, please seek that advice from an experienced professional.
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References:
- Mullholand JB, Tolman N, De Obaldia A, et al. Central nervous system involvement of anaplasmosis. BMJ Case Reports CP. 2021;14:e243665.
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
Is there any indication of how long the woman had been on doxy?
The authors did not indicate how long she was treated. They did state that Anaplasmosis is typically treated for 10 days.
Hi Dr Cameron,how do you treat anaplasmosis,and other lyme infections,im in the UK, they are in complete denial of lyme over here.Do you use anti biotics only or a combination of things.thanks
I typically use oral doxycycline. I use Rifampin as a backup. I use other treatments if I suspect other tick borne infections. I have needed to use IV antibiotics on some occasions for tick borne illnesses.
My mother showed signs of rapid deterioration (confusion, disorientation) after she notice a tick attachment on the back of her neck 4 years ago. I got no help locally so I took her to a larger hospital and in the testing an abnormal result in spinal fluid and one Dr. had a suspicion that Lyme disease was the culprit. She was treated with Rocephin For 60 days. She responded immediately to the antibiotics and in 60 days was nearly back to normal. Now, years later I am seeing some confusion and dizziness set in. How can I find out if this is a Lyme relapse or true dementia starting?
I advise my patients to work with a neurologist and a doctor experienced in treating Lyme disease. Keep fighting for your mother.