ro13-9904 and Insect-Bites-and-Stings

A 52-year-old male patient presented to the emergency department because of malaise and frequent dizziness. The ECG revealed high-grade atrioventricular block that required placement of a temporary pacemaker. There were no other abnormalities in physical and echocardiographic examination, and coronary angiography excluded the presence of coronary artery disease. IgM and IgG antibodies against Borrelia were positive, and antibiotic therapy with ceftriaxone at the dose of 2 g/die for 15 days resulted in rapid regression of atrioventricular block. Seven-day ECG recording immediately after discharge and 24h ECG monitoring at 40 days confirmed the total disappearance of atrioventricular block. This represents a case of atrioventricular block as the first manifestation of Borrelia infection (Lyme disease). A prompt diagnosis and antibiotic therapy usually result in complete resolution of atrioventricular block without the need for a permanent pacemaker.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Electrocardiography, Ambulatory; Heart Block; Humans; Insect Bites and Stings; Lyme Disease; Male; Middle Aged; Pacemaker, Artificial; Ticks

Scrub typhus usually presents as pyrexia with or without multiple organ involvement. Acute hearing loss occurs in about one third of cases and is a useful clue toward the diagnosis. We present two cases of scrub typhus with acute reversible hearing loss from an endemic area. The diagnosis was confirmed by nested PCR.

Topics: Acute Disease; Adult; Animals; Ceftriaxone; Doxycycline; Female; Hearing Loss; Humans; Insect Bites and Stings; Male; Orientia tsutsugamushi; Risk Factors; Scrub Typhus; Trombiculidae

West Nile Virus (WNV) infection is an important cause of encephalitis. Although the medical literature contains examples of WNV encephalitis in susceptible, mainly elderly, immunocompromised hosts, few case reports have described pediatric cases. The authors describe an adolescent with acute lymphocytic leukemia and WNV encephalitis. Surveillance studies indicate an increase in WNV activity. Physicians need to be aware of WNV activity in their community and consider WNV as a potential source of infection.

Topics: Acyclovir; Adolescent; Animals; Antibodies, Viral; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Brain; Ceftazidime; Ceftriaxone; Culicidae; Diagnosis, Differential; Encephalitis, Viral; Fatal Outcome; Humans; Immunoglobulins, Intravenous; Insect Bites and Stings; Magnetic Resonance Imaging; Male; Mercaptopurine; North Carolina; Persistent Vegetative State; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Vancomycin; Vincristine; Virginia; West Nile Fever; West Nile virus

A 39-year-old HIV positive patient developed myalgia, headache and cough 4 weeks after a tick bite. His temperature was 37.4 degrees C and a circular pale erythema was noted over the left lower leg.. C-reactive protein was raised to 120 mg/l, white blood cell count was 5860/microliter, CD4-lymphocyte count 250/microliter. The chest radiogram showed pneumonitic infiltration in the left lower lobe. There were IgM antibodies against Borrelia burgdorferi.. Left lower lobe pneumonia and chronic erythema migrans were diagnosed and he was given oral azithromycin (500 mg on the first day and 250 mg for 4 days). The pneumonia cleared up, but 2 weeks later he developed symptoms of meningitis (496 cells per microliter, 87% lymphocytes, positive Borrelia burgdorferi antibody titer), which quickly and lastingly responded to ceftriaxon (2 g daily by brief infusion for 14 days).. This immune-compromised HIV-infected patient developed disseminated borreliosis with CNS involvement 2 weeks after the occurrence of chronic erythema migrans. The initial treatment of the latter with azithromycin was unable to prevent the meningitis. It is unlikely that there was a causal connection between the borreliosis and the pneumonia.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; HIV Seropositivity; Humans; Immunocompromised Host; Immunoglobulin M; Insect Bites and Stings; Lyme Disease; Male; Meningitis, Bacterial; Pneumonia; Ticks

Topics: Adolescent; Ceftriaxone; Conjunctivitis; Doxycycline; Drug Therapy, Combination; Fever; Follow-Up Studies; Francisella tularensis; Humans; Insect Bites and Stings; Lymphadenitis; Male; Tularemia