-
Views
-
Cite
Cite
A 20-Year-Old Man with Fever, Headache and Neck Stiffness, Clinical Infectious Diseases, Volume 52, Issue 2, 15 January 2011, Pages 271–272, https://doi.org/10.1093/cid/ciq123
Close - Share Icon Share
Extract
(See page 218 for the Photo Quiz.)
Diagnosis: Neuroborreliosis with tick-borne relapsing fever (TBRF) caused by Borrelia hermsii.
Wright stain of the patient’s peripheral blood smear demonstrated numerous spirochetes (Figure 1). The results of screening tests performed on the patient’s serum sample for Lyme disease antibody, human immunodeficiency virus antibody, and Leptospira antibody and a rapid plasma reagin test were negative. Serum samples were also tested for B. hermsii with an immunoglobulin (Ig) G and IgM immunofluorescence assay (Focus Diagnostics), which revealed borderline high IgG (acute phase, 1:64; convalescent phase, < 1:64; normal value, <1:64) and IgM titer (acute phase, <1:16; convalescent phase, 1:32; normal value, <1:16). Species identification of spirochetes was aided by in-house broad-range bacterial 16S ribosomal RNA polymerase chain reaction and sequencing performed on blood specimens, which established a diagnosis with a 100% sequence match with the B. hermsii 16S ribosomal RNA gene (Genbank reference sequence DQ855530.1). Our patient was treated with intravenous ceftriaxone and oral doxycycline for 14 days and returned to his usual state of health at end of therapy.
