Volume 25, Number 10—October 2019
Dispatch
Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018
, Hilmir Asgeirsson, Berit Hammas, Elias Karlsson, Åsa Parke, Dieuwertje Hoornstra, Peter Wilhelmsson, and Joppe W. Hovius
Table
Confirmatory analyses performed on cerebrospinal fluid and serum/plasma samples from 2 patients with diagnoses of meningitis caused by Borrelia miyamotoi, Sweden, 2018*
| Analysis |
Patient A, dates samples collected |
Patient B, dates samples collected |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jul 30 |
Aug 6 |
Aug 24 |
Aug 9 |
Oct 31 |
|||||||||
| Sample | Serum | CSF | Serum | CSF | Serum | Serum | Plasma | CSF | Serum | ||||
| BM-specific PCR |
– |
+ |
+ |
+ |
NA |
NA |
+ |
+ |
NA |
||||
| BM-specific serologic testing |
IgM+ (GlpQ, Vlp5), IgG– |
NA |
IgM+ (GlpQ, Vlp5), IgG+ (GlpQ) |
NA |
IgM+ (GlpQ, Vsp1), IgG+ (GlpQ, Vlp15/16) |
IgM+ (GlpQ), IgG– |
NA |
NA |
IgM+ (GlpQ), IgG– |
||||
| LB serology† |
– |
– |
– |
IgM AI+ |
–‡ |
– |
NA |
IgM detectable, but AI– |
–‡ |
||||
| Culture attempts | – | – | – | – | NA | NA | – | NA | NA | ||||
*Patient A: a 53-year-old immunocompetent woman; patient B: a 66-year-old immunocompromised woman. AI, antibody index; BM, Borrelia miyamotoi; CSF, cerebrospinal fluid; GlpQ, glycerophosphodiester-phosphodiesterase; LB, Lyme borreliosis; NA, not analyzed; Vlp, variable large protein; Vsp, variable small protein; +, positive; –, negative.
†LIAISON Borrelia burgdorferi (DiaSorin, https://www.diasorin.com).
‡In addition to LIAISON, the sample was analyzed by Enzygnost Lyme link VlsE IgG and Enzygnost Borreliosis IgM (DADE Behring, https://www.siemens.com), recomBead Borrelia IgM and IgG (Mikrogen GmbH, https://www.mikrogen.de), C6 Lyme ELISA Kit (Immunetics, https://immunetics.com), and Anti-Borrelia EUROLINE-RN-AT IgG and IgM (EUROIMMUN, http://www.euroimmun.com). All test results were negative.