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Volume 22, Number 2—February 2016
Dispatch

Louseborne Relapsing Fever among East African Refugees, Italy, 2015

Anna LucchiniComments to Author , Filippo Lipani, Cecilia Costa, Mariaelisabetta Scarvaglieri, Rosanna Balbiano, Sinibaldo Carosella, Andrea Calcagno, Sabrina Audagnotto, Anna Maria Barbui, Silvia Brossa, Valeria Ghisetti, Ivano Dal Conte, Pietro Caramello, and Giovanni Di Perri
Author affiliations: Ospedale Amedeo di Savoia, Turin, Italy (A. Lucchini, F. Lipani, R. Balbiano, S. Carosella, S. Audagnotto, V. Ghisetti, I. Dal Conte, P. Caramello); Università degli Studi di Torino, Turin (C. Costa, M. Scaravaglieri, A. Calcagno, S. Brossa, G. Di Perri); Città della Salute, Turin (A.M. Barbui)

Main Article

Table

Characteristics of louseborne relapsing fever among East African refugees, Italy, 2015*

Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Time from arrival in Italy 3 d 4 y 3 y 10 d 10 d
Age, y 20 27 31 20 26
Date of admission Jun 9 Jul 28 Sept 5 Oct 1 Sept 29
Date of symptom onset
 Jun 7
 Jul 24
 Sept 1
 Sept 27
 Sept 26
Symptom
Fever Yes Yes Yes Yes Yes
Abdominal pain No No Yes Yes No
Vomiting Yes Yes Yes Yes No
Diarrhea No No Yes No No
Headache Yes Yes Yes Yes Yes
Myalgia No Yes No No Yes
Other
 None
 Lumbar pain
 None
 Cough
 Chest pain, itching
Laboratory test (reference)
Platelets (>150,000/μL) 32,000 47,000 22,000 41,000 2,9000
Bilirubin (<1.2 mg/dL) 2.3 1.8 3.9 4.2 1.8
Liver function† Normal Normal AST ×4; ALT ×3 AST ×3; ALT normal Normal
Prothrombin time (>70%) 78% 66% 68% 100% 70%
CRP† ×16 ×56 ×95 ×115 ×59
Procalcitonin (<0.5) 11.36 NA 21 11.9 NA
QTc (<440 msec) 428 361 423 391 414
PCR for Borrelia recurrentis
 Positive
 Positive
 Positive
 Positive
 Positive
Treatment Doxycicline Doxycicline Doxycicline Doxicicline + ceftriaxone Doxycicline, switched to ceftriaxone
Jarisch-Herxheimer reaction Yes, mild Not observed Not observed Not observed Yes, moderate

*ALT, alanine aminotransferase; AST, aspartate aminotransferase; CRP, C-reactive protein; NA, not available; QTc, corrected QT interval.
†Indicated as normal (within reference value) or × upper reference value.

Main Article

Page created: January 15, 2016
Page updated: January 15, 2016
Page reviewed: January 15, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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