Ehrlichia Guillain-Barre Syndrome Following Tick-Borne Infection
Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron.
In this episode, Dr. Cameron discusses Ehrlichia Guillain-Barre syndrome,
a rare neurologic complication in which a tick-borne infection triggered Guillain-Barré
Syndrome in a 71-year-old woman.
The case, published by Malhis and colleagues in the journal IDCases, is entitled
“Case of ehrlichiosis-induced Guillain-Barre Syndrome in a 71-year-old female.”
Ehrlichia Guillain-Barre Syndrome: Initial Presentation
The woman’s symptoms developed over a three-week period and included generalized weakness,
dizziness, visual changes, chills, fever, neck pain, and abdominal pain. After presenting
to the hospital, she was diagnosed with ehrlichiosis based on thrombocytopenia, elevated
liver function tests, a reported insect bite, a positive Ehrlichia PCR test, and the
absence of another identified illness.
She was treated with doxycycline and initially experienced clinical improvement.
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Neurologic Progression and Worsening Symptoms
Approximately one week later, the patient returned with worsening neurologic symptoms,
including numbness and areflexia in the lower extremities, an unsteady gait requiring a
walker, tingling in her feet, and urinary retention requiring catheterization.
Although ehrlichiosis is not a common cause of Guillain-Barré Syndrome, the pathogenesis
may resemble immune-mediated neurologic injury seen in other infections such as
Lyme disease or Campylobacter jejuni.
“This patient had clinical symptoms consistent with tick-borne illness, yet as her disease
progressed, it illustrated the need for an expanded differential diagnosis.”
She was diagnosed with acute inflammatory demyelinating polyneuropathy,
the most common form of Guillain-Barré Syndrome.
There was no evidence of other tick-borne infections including Lyme disease,
Babesia, Heartland virus, or Bourbon virus.
This case of Ehrlichia Guillain-Barre syndrome highlights how
tick-borne infections can trigger immune-mediated neurologic disease.
Treatment and Clinical Outcome
The patient was treated with intravenous immunoglobulin (IVIG) and improved significantly.
She was subsequently discharged to a rehabilitation facility.
The authors emphasized that while ehrlichiosis is not a common trigger for Guillain-Barré
Syndrome, it should not be excluded as a possible cause, particularly in patients with
recent tick exposure or systemic infection.
Guillain-Barré Syndrome and Tick-Borne Triggers
Guillain-Barré Syndrome is an acute autoimmune demyelinating polyradiculoneuropathy
that can progress rapidly and become life-threatening if respiratory muscles are involved.
Known triggers include respiratory and gastrointestinal infections, Lyme disease,
tick paralysis, HIV, West Nile virus, COVID-19, and—rarely—vaccination.
Approximately 85% of patients eventually regain independent ambulation.
The authors conclude:
“It is important to keep a broad differential, as common syndromes do not always arise from
common pathogens.”
Questions Addressed in This Inside Lyme Podcast Episode
- What is Guillain-Barre Syndrome?
- What is the treatment for Guillain-Barre Syndrome?
- What are the Bourbon and Heartland viruses?
- Why are infections such as COVID-19 relevant to immune-mediated neurologic disease?
Thank you for listening to another Inside Lyme Podcast. The information
presented is educational and not intended as individualized medical advice.
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Clinical Perspective
Dr. Daniel Cameron is a board-certified physician with more than 37 years of clinical
experience treating tick-borne illnesses. He is the past president of the
International Lyme and Associated Diseases Society (ILADS)
and the first author of the ILADS Lyme disease treatment guidelines.
Dr. Cameron frequently discusses complex complications of tick-borne infections,
including neurologic syndromes such as
Lyme neuroborreliosis
and other immune-mediated neurologic conditions.
Through the Inside Lyme Podcast, he reviews clinical cases and
research to help clinicians and patients better understand the evolving science
of Lyme disease and tick-borne infections.
References:
-
Malhis JR, Mahmoud A, Belote A, Ebers A.
Case of ehrlichiosis induced Guillain-Barre Syndrome in a 71-year-old female.
IDCases. 2021;26:e01301. -
Kosoy OI, Lambert AJ, Hawkinson DJ, et al.
Novel thogotovirus associated with febrile illness and death, United States, 2014.
Emerg Infect Dis. 2015;21(5):760–764. -
Heartland and Bourbon Virus Disease. CDC.
https://www.cdc.gov/ticks/tickbornediseases/heartland-virus.html
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.