Volume 19, Number 2—February 2013
Dispatch
Borrelia crocidurae Meningoencephalitis, West Africa
Sandrine Goutier1
, 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
, 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 CornetTable
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).
1These authors contributed equally to this work.
