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Volume 19, Number 2—February 2013

Dispatch

Borrelia crocidurae Meningoencephalitis, West Africa

Sandrine Goutier1Comments to Author , Elisabeth Ferquel1, Claudine Pinel, Annick Bosseray, Bruno Hoen, Gérard Couetdic, Amina Bourahoui, Claire Lapostolle, Hervé Pelloux, Martine Garnier, Natacha Sertour, Isabelle Pelloux, Patricia Pavese, and Muriel Cornet
Author affiliations: Author affiliations: Grenoble Teaching Hospital, Grenoble, France (S. Goutier, C. Pinel, A. Bosseray, H. Pelloux, I. Pelloux, P. Pavese, M. Cornet); Pasteur Institute, Paris, France (E. Ferquel, M. Garnier, N. Sertour), Joseph Fourier University, Grenoble (C. Pinel, H. Pelloux, M. Cornet); Besançon Teaching Hospital, Besançon, France (B. Hoen, G. Couetdic); Argenteuil Hospital, Argenteuil, France (A. Bourahoui); Laennec Hospital, Quimper, France (C. Lapostolle)

Main Article

Table

Epidemiologic, clinical, and laboratory findings and treatment for 4 patients with Borrelia crocidurae meningitis, or encephalitis, or both*

Characteristic and treatment Patient 1 Patient 2 Patient 3 Patient 4
Demographic factor
Age, y/sex 36/M 57/M 7/F 26/M
Country of origin/of residence Senegal/France France/France France/France Senegal/France
Travel country Senegal Senegal Senegal Senegal
Travel dates Mar–May 2009 May 2010 Feb–May 2011 Aug–Sep 2011
Travel duration, d 53 15 15 35
Travel accommodation Family house Hotel Hotel Family house
Arthropod or insect bite report No Yes No No
Individual vector protection No No No No
First suspected diagnosis†/presumptive treatment Malaria/quinine Sinusitis Gastroenteritis Malaria/piperaquine
Symptoms
Oral temperature >38.5°C Yes Yes Yes Yes
Chills No No Yes Yes
Total no. febrile episodes/no. before diagnosis 2/1 4/2 6/5 2/1
Length of acute febrile episodes, d 2–8 2–6 2 2 to 6
Afebrile periods between febrile episodes, d 15 2–15 2–13 34
Asthenia/anorexia/weight loss Yes/no/no Yes/yes/yes‡ Yes/no/no Yes/no/no
Headache Yes (severe) Yes Yes (severe) Yes (severe)
Myalgia No No No Yes
Photophobia, phonophobia No Yes No Yes
Neck stiffness No Yes Yes Yes
Cerebellar syndrome No No No Yes
Drowsiness Yes No No Yes
Imaging results
Brain CT scan Normal Normal ND Normal
Brain MRI Normal ND ND Abnormal
Serologic results
Leukocytes, g/L 4.7 15.8 13.0 8.4
Hemoglobin, g/L 134 139 115 131
Platelets, g/L 245 273 295 103
C-reactive protein, mg/L 103 4 57 150
Creatinine, μmol/L 107 76 42 99
Borrelia spp. detection, Giemsa-stained blood smear
Quantitative buffy coat ND ND ND +
ELISA anti–B. murgdorferi (titer)
Enzygnost Lyme IgG link VlsE Siemens# +(11.3) ND ND +(19)
Enzygnost Lyme IgM Siemens# +(3.7) ND ND +(1.21)
Western blot anti–B. burgdorferi
Bioadvance IgG anti VlsE/p41/p83/p21** +/−/–/+ ND ND ND
Euroimmun IgG anti–p17/p19/p21/p25/p30/p31/ p39/p83/VlsE†† ND ND ND −/−/−/−/−/−/– /‡‡ /‡‡
Meridian IgM garinii/afzelii/p41/p39/p17 ND ND ND ND
Bioadvance IgM anti p25/p83** +/+ ND ND ND
16 rRNA PCR Borrelia/identification +/B. crocidurae +/B. crocidurae +/B. crocidurae +/B. crocidurae
CSF test results
Leukocytes, cells/mm3 405 217 258 156
% Lymphocytes 94 80 90 84
Erythrocytes, cells/ mm3 0 7 12 5
Protein, g/L 0.66 1.38 0.39 0.44
Glucose, mmol/L 3.1 2.7 2.69 2.9
Chloride, mmol/L 114 113 117 115
Lactate, mmol/L ND ND 1.5 2.2
Direct examination (Gram stain)
Conventional bacterial culture
16 rRNA PCR Borrelia/Identification +/B. crocidurae +/B. crocidurae +/B. crocidurae
ELISA anti-B. burgdorferi
IgG enzygnost lyme IgG link VlsE Siemens ND ND ND +¶¶
IgM enzygnost lyme IgM Siemens ND ND ND
Treatment (daily dose/total d) Ceftriaxone
(2 g/21) Doxycycline (100 mg 2×d/10) Ceftriaxone (2 g/14) Doxycycline (100 mg 2×d/21), ceftriaxone (2 g/15)

*CT, computed tomography; MRI, magnetic resonance imaging; ND, not done; +, positive; –, negative; CSF, cerebrospinal fluid.
†First suspected diagnosis was not biologically confirmed.
‡7 kg in 3 wk.
§Second sample was positive.
¶First sample was positive after review prompted by the quantitative buffy coat result.
#Siemens, Erlangen, Germany.
**Bio-Advance, Bussy Saint Martin, France.
††Euroimmun Medizinische Labordiagnostika AG, Lübeck, Germany.
‡‡Ambiguous.
§§Meridian Bioscience, Paris, France.
¶¶At 12-fold dilution (low level).

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1These authors contributed equally to this work.

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