Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 22, Number 9—September 2016

Borrelia miyamotoi–Associated Neuroborreliosis in Immunocompromised Person

Katharina BodenComments to Author , Sabine Lobenstein, Beate Hermann, Gabriele Margos, and Volker Fingerle
Author affiliations: University Hospital Jena, Jena, Germany (K. Boden, B. Hermann); Burgenlandkreis Hospital Naumburg, Naumburg, Germany (S. Lobenstein); Bavarian Health and Food Safety Authority, Oberschleissheim, Germany (G. Margos, V. Fingerie)

Main Article


CSF findings of Borrelia miyamotoi meningitis cases and patients with Lyme neuroborrelioses*

Finding (reference) Case (reference)
New Jersey, USA (4) Netherlands (5) Germany (this study) Lyme neuroborreliosis(6)†
Leukocytes/μL (0–5 cells/μL) 65 388 70 170.5 [57.0–369]
Differential count 23% PMNC, 70% lymphocytes, 6% monocytes, 1% diverse 60% mononuclear cells 32% PMNC, 61% lymphocytes, 7% monocytes
Protein level, mg/dL (150–400 mg/dL) >300 486 1718 1,232 [697–1,926]
Qalb, × 103 (<9) 34.8 17.2 [9.7–28.4]
Quantitative IgM, × 103 18.1 Elevated in 70%
Glucose, mmol/L (2.2–4.2 mmol/L) 1.8 1.6 2.41
Glucose ratio (>0.5) 0.45
Lactate, mmol/L (1.2–2.1 mmol/L) 5.58 >3.5 in 4%‡
Routine microscopy Cellular CSF with high nos. of granulocytes and plasma cells Cellular CSF with heterogeneous morphology
CXCL13, pg/mL (100 to <250 pg/mL, borderline) 1,150; 8 d after start of therapy: 186 >415 (7)
Spirochetes visible in CSF by Gram staining, Giemsa staining Darkfield microscopy Acridinorange staining, not definable at Pappenheim cytospin Typically negative

*Blank cells indicate value not determined or was within reference range. CSF, cerebrospinal fluid; PMNC, polymorphonuclear leukocytes; Qalb, albumin quotient.
†n = 118 patients. Values are median [interquartile range].
‡Associated with headache.

Main Article

  1. Platonov  AE, Karan  LS, Kolyasnikova  NM, Makhneva  NA, Toporkova  MG, Maleev  VV, Humans infected with relapsing fever spirochete Borrelia miyamotoi, Russia. Emerg Infect Dis. 2011;17:181623. DOIPubMedGoogle Scholar
  2. Krause  PJ, Fish  D, Narasimhan  S, Barbour  AG. Borrelia miyamotoi infection in nature and in humans. Clin Microbiol Infect. 2015;21:6319. DOIPubMedGoogle Scholar
  3. Telford  SR III, Goethert  HK, Molloy  PJ, Berardi  VP, Chowdri  HR, Gugliotta  JL, Borrelia miyamotoi disease: neither Lyme disease nor relapsing fever. Clin Lab Med. 2015;35:86782. DOIPubMedGoogle Scholar
  4. Gugliotta  JL, Goethert  HK, Berardi  VP, Telford  SR III. Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. N Engl J Med. 2013;368:2405. DOIPubMedGoogle Scholar
  5. Hovius  JW, de Wever  B, Sohne  M, Brouwer  MC, Coumou  J, Wagemakers  A, A case of meningoencephalitis by the relapsing fever spirochaete Borrelia miyamotoi in Europe. Lancet. 2013;382:658. DOIPubMedGoogle Scholar
  6. Djukic  M, Schmidt-Samoa  C, Lange  P, Spreer  A, Neubieser  K, Eiffert  H, Cerebrospinal fluid findings in adults with acute Lyme neuroborreliosis. J Neurol. 2012;259:6306. DOIPubMedGoogle Scholar
  7. Hytönen  J, Kortela  E, Waris  M, Puustinen  J, Salo  J, Oksi  J. CXCL13 and neopterin concentrations in cerebrospinal fluid of patients with Lyme neuroborreliosis and other diseases that cause neuroinflammation. J Neuroinflammation. 2014;11:103. DOIPubMedGoogle Scholar
  8. Tsutsumi  Y, Yamamoto  Y, Ito  S, Ohigashi  H, Shiratori  S, Naruse  H, Hepatitis B virus reactivation with a rituximab-containing regimen. World J Hepatol. 2015;7:234451. DOIPubMedGoogle Scholar
  9. Nei  M, Kumar  S. Molecular evolution and phylogenetics. New York: Oxford University Press; 2000.
  10. Tamura  K, Peterson  D, Peterson  N, Stecher  G, Nei  M, Kumar  S. MEGA5: Molecular Evolutionary Genetics Analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011;28:27319. DOIPubMedGoogle Scholar

Main Article

Page created: August 16, 2016
Page updated: August 16, 2016
Page reviewed: August 16, 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.