ro13-9904 and Tick-Bites

The number of new rickettsial species are rapidly increasing, and increasing numbers of Rickettsia raoultii (R. raoultii) infection cases have been detected in humans. However, neurological abnormalities caused by R. raoultii are rarely reported, especially in northwestern China.. This is the first reported case with neurological abnormalities caused by R. raoultii in northwestern China. It is vital to detect rickettsial agents both in blood and CSF for tick bite patients with neurological abnormalities. Public health workers and physicians should pay attention to neurological abnormalities caused by Rickettsia.

Topics: Adenosine Deaminase; Adult; Animals; Antigens, Bacterial; Ceftriaxone; China; DNA, Bacterial; Doxycycline; Humans; Leukocyte Count; Male; Nervous System Diseases; Phylogeny; Rickettsia; Rickettsia Infections; RNA, Ribosomal, 16S; Tick Bites; Ticks

Neonatal tick bites place infants at risk for acquiring infections that have rarely or never been documented in this age group. We describe 2 rare cases of tickborne infection in neonates. The first patient presented with multiple erythema migrans and fever, leading to a diagnosis of early disseminated Lyme disease. The second patient presented with irritability, fever, and worsening anemia due to babesiosis. Both infants had been bitten by arthropods fitting the description of ticks before the onset of symptoms. Our cases demonstrate the clinical course of 2 common tickborne infections occurring at an atypical age, opening the door to new, complex questions for which little guiding data exists. As tickborne infections become more prevalent, we expect other clinicians will be faced with similarly challenging neonatal cases. Providers must use past experience and a keen eye to identify neonates with tickborne infections and sort through their optimal diagnosis and management. In this article, we raise some of the questions we faced and discuss our conclusions.

Topics: Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Atovaquone; Azithromycin; Babesiosis; Ceftriaxone; Erythema Chronicum Migrans; Exanthema; Female; Humans; Infant, Newborn; Parasitemia; Tick Bites

Early neurological Lyme disease (neuroborreliosis) typically presents with well-recognised neurological syndromes. Spinal myoclonus is however a rare manifestation of neuroborreliosis. We present the case of a man who developed spinal myoclonus 3 weeks after returning from the Czech Republic where he developed erythema migrans on his arm following multiple tick exposures. Spinal fluid analysis showed a pleocytosis and MRI showed enhancement at C5-C6. His serology was positive for IgM antibodies to

Topics: Administration, Intravenous; Aged; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Humans; Lyme Disease; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Male; Myoclonus; Spinal Cord Diseases; Spinal Puncture; Tick Bites; Treatment Outcome

Lyme disease is an emerging problem in Poland. Analysis has been undertaken of the medical documentation of 86 patients hospitalized in the Infectious Diseases Department, University Hospital in Cracow in 2013-2016, suspected of Lyme arthritis. It has especially considered medical history including potential exposure to the infection, detailed characteristics of the symptoms, diagnostic challenges and results of the treatment. Only some patients had a history of erythema migrans and not all of them recalled tick-bite. The majority of the patients had affected large joints, especially knee joints, and polyarthritis was rarely observed. Symptoms were resolved completely or partially after antibiotic treatment in most patients. The diagnosis of Lyme arthritis in areas endemic for Lyme disease is still a diagnostic challenge in patients with other rheumatic diseases, including osteoarthritis.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Diagnosis, Differential; Doxycycline; Erythema Chronicum Migrans; Female; Foot Joints; Hand Joints; Hip Joint; Hospitalization; Hospitals, University; Humans; Knee Joint; Lyme Disease; Male; Middle Aged; Osteoarthritis; Poland; Shoulder Joint; Tick Bites; Treatment Outcome

A 56-year-old man was sustained ticks at the left axilla and flank. He did not have a rash. About 3 months after the tick bites, he developed back pain, right leg weakness, right abducens nerve palsy, and left facial palsy. Western blot analysis for serum IgM and IgG antibodies against Borrelia were positive. We diagnosed Lyme borreliosis. The patient was treated with antibiotics and steroids, and the symptoms improved. Our findings demonstrate that, even if erythema migrans is not obvious, neuroborreliosis should be considered when neurological signs, such as multiple cranial nerve palsies, are present.

Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Biomarkers; Borrelia; Ceftriaxone; Erythema Chronicum Migrans; Humans; Immunoglobulin G; Immunoglobulin M; Infusions, Intravenous; Lyme Neuroborreliosis; Male; Methylprednisolone; Middle Aged; Prednisolone; Pulse Therapy, Drug; Tick Bites; Treatment Outcome

Canada has seen a sixfold increase in Lyme disease since being nationally notifiable in 2009. This is the first Canadian series on Lyme carditis manifested as high-degree atrioventricular block. We report 5 recent cases presented over a 2-year period. The variation of nonspecific presentations requires a high index of suspicion for prompt diagnosis and correct management. Recognizing this early would curtail the progression of conduction disorders and potentially avoid permanent pacemaker implantation.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Atrioventricular Block; Canada; Ceftriaxone; Doxycycline; Echocardiography; Electrocardiography; Erythema Chronicum Migrans; Exercise Test; Humans; Lyme Disease; Male; Myocarditis; Severity of Illness Index; Tick Bites; Young Adult

A 53-year-old Japanese female developed a fever about two months after a tick bite. She also exhibited blurred vision, central scotoma in the left eye, left facial paresis and mild ataxia. A fundus examination revealed left disc swelling in the left eye. An ophthalmological examination showed decreased visual acuity with central scotoma in the left eye. We suspected neuroborreliosis because of the presence of pleocytosis and an elevated level of IL-6 in the cerebrospinal fluid (CSF), in addition to the characteristic neurological findings. She was positive for serum IgG antibodies against Borrelia by a Western blot of her serum. Therefore, we diagnosed her to have neuroborreliosis with papillitis. After the combined administration of antibiotics and steroids, her symptoms gradually improved, but not all of her eye manifestations resolved. Although ocular involvement is rare in neuroborreliosis, this case highlights the fact that neuroborreliosis shoud be considered as a differential diagnosis for patients presenting with papillitis. The diagnosis of neuroborreliosis is important since improvement of the visual acuity is possible with specific antibiotheraphy. In cases with papillitis of unknown etiology, it might be better to consider the possibility of neuroborreliosis should be considered when there are signs of Lyme borreliosis, such as facial nerve palsy, arthritis or radiculoneuritis.

Topics: Asian People; Biomarkers; Borrelia burgdorferi; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Female; Humans; Immunoglobulin G; Lyme Neuroborreliosis; Methylprednisolone; Middle Aged; Papilledema; Prednisolone; Pulse Therapy, Drug; Tick Bites; Treatment Outcome

The paper describes a clinical case of South African tick bite fever in a group of Russian tourists. The group of 5 people who had been ill with this disease after a tourist trip to the South African Republic (the Kruger National Park in the north-eastern province of Mpumalanga) were followed up. During their trip, all of them were bitten by different insects many times. The disease exhibited different clinical presentations; however, all the patients were noted to have a fever with slight intoxication and a maculopapular rash at different sites of the body; 3 had lymphadenopathy and one had a primary effect at the site of tick sticking. The diagnosis was verified by indirect immunofluorescence for the detection of high titers to Rickettsia conorii. The course of the disease was favorable in all the patients treated with antibiotics (doxycycline or ceftriaxone).

Topics: Anti-Bacterial Agents; Boutonneuse Fever; Ceftriaxone; Doxycycline; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Humans; Rickettsia conorii; Russia; South Africa; Tick Bites; Tick-Borne Diseases; Travel; Treatment Outcome