Human granulocytic ehrlichiosis (HGE) is an emerging tick-borne infectious disease found in Europe, the United States, and other regions where Ixodes ticks and Lyme disease are endemic. HGE typically presents with myalgia, fever and nausea. Only a few single cases of HGE predominantly manifesting with neurological symptoms and signs have been described to date. The prevalence of this „neuro-ehrlichiosis“ (NE) is not known and a systematic search for NE in patients with neurological deficits has not yet been performed. As both mode of transmission and clinical neurological presentations of HGE are similar to those of neuroborreliosis (NB) we analyzed 47 inpatients of a neurological tertiary care facility in South-eastern Austria in which NB was suspected but not confirmed by stringent diagnostic criteria. In five patients – two patients with radiculoneuritis, two with polyradiculoneuritis (one of which with Guillain Barré syndrome) and one with peripheral facial nerve palsy – antibodies to Ehrlichia equi related agents (HGE-agents) were detected by means of indirect immunofluorescent antibody assay and in four this was confirmed by Western blot. We suspect that in tick endemic areas of Central Europe HGE may be responsible for neurological deficits but further large scale prospective studies of seroprevalence in neurological patients are needed to make it an established differential diagnosis of NB.

        Key words: ehrlichiosis, lyme disease, antibodies, neuroinfection, borreliosis