Lee F S, Chu F K, Tackley M, Wu A D, Atri A, Wessels M R
Infectious Disease Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA.
Clin Infect Dis. 2000 Nov;31(5):1288-91. doi: 10.1086/317466.
Neurologic manifestations of human ehrlichiosis are unusual and have been described almost exclusively in human monocytic ehrlichiosis associated with Ehrlichia chaffeensis. We report here a case of a previously healthy 42-year-old woman who developed bilateral facial nerve palsies in association with infection by the agent of human granulocytic ehrlichiosis (aoHGE). The diagnosis was made by specific polymerase chain reaction amplification of aoHGE sequences from samples of the patient's blood and cerebrospinal fluid (CSF), as well as propagation of aoHGE in culture of HL60 cells inoculated with the patient's CSF. To our knowledge, this is the first report directly demonstrating the presence of aoHGE in CSF, and it underscores the importance of considering HGE in patients presenting with a nonspecific febrile illness and unexplained neurologic manifestations. HGE should also be considered in the differential diagnosis of bilateral facial palsy-a rare occurrence.
人类埃立克体病的神经系统表现并不常见，几乎仅在与查菲埃立克体相关的人类单核细胞埃立克体病中有所描述。我们在此报告一例先前健康的42岁女性病例，该患者出现双侧面神经麻痹，与人类粒细胞埃立克体病原体（aoHGE）感染有关。通过对患者血液和脑脊液（CSF）样本中的aoHGE序列进行特异性聚合酶链反应扩增，以及用患者CSF接种的HL60细胞培养物中aoHGE的增殖，做出了诊断。据我们所知，这是首次直接证明CSF中存在aoHGE的报告，它强调了在出现非特异性发热疾病和无法解释的神经系统表现的患者中考虑HGE的重要性。在双侧面神经麻痹（一种罕见情况）的鉴别诊断中也应考虑HGE。
