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