ro13-9904 and Myalgia

Topics: Anti-Bacterial Agents; Ceftriaxone; Diplopia; Exanthema; Fatigue; Humans; Lyme Disease; Magnetic Resonance Imaging; Male; Middle Aged; Myalgia; Oculomotor Nerve Diseases

Tick-borne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia. The zoonosis is endemic in higher-elevation coniferous forests of the western United States.. We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department. Laboratory studies were notable for bandemia and thrombocytopenia with mild hyperbilirubinemia. Peripheral smear demonstrated multiple Borrelia spirochetes. The patient was treated with parenteral ceftriaxone and discharged with oral doxycycline therapy and recovered uneventfully. We discuss the clinical and epidemiological features of TBRF and the salient points for clinical diagnosis and management of this rare but important disease entity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: TBRF is a rare and potentially life-threatening infectious process, which presents with nonspecific findings and often poses a diagnostic challenge. TBRF should be considered in the differential diagnosis for patients residing or vacationing in high-altitude forested areas in the western United States.

Topics: Adult; Animals; Anti-Bacterial Agents; Borrelia Infections; Ceftriaxone; Colorado; Emergency Service, Hospital; Fever; Humans; Male; Myalgia; Relapsing Fever; Ticks; Vomiting

Undifferentiated febrile illness in a returning soldier is a common problem encountered by serving medical officers. A 32-year-old soldier presented to Birmingham Heartlands Hospital with fever and acute kidney injury after return from Borneo. Leptospirosis was suspected and empirical antibiotics were started before subsequent confirmation by serology and PCR. Leptospirosis is common in South-East Asia, and troops exercising in jungle areas, and in the UK, are at risk. Advice, including inpatient management when appropriate, is available from the UK Role 4 Military Infectious Diseases and Tropical Medicine Service.

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Borneo; Ceftriaxone; Diarrhea; DNA, Bacterial; Doxycycline; Fever; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Male; Military Personnel; Myalgia; Polymerase Chain Reaction; Serologic Tests; Travel; United Kingdom

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Combined Modality Therapy; Dental Prophylaxis; Diagnosis, Differential; Fasciotomy; Fever; Humans; Levofloxacin; Male; Mobility Limitation; Mouth; Muscle, Skeletal; Myalgia; Myositis; Rhabdomyolysis; Running; Streptococcus sanguis