TY - JOUR
T1 - Case report
T2 - First case of Borrelia miyamotoi meningitis in an immunocompromised patient in Norway
AU - Schwartz, Thomas
AU - Hoornstra, Dieuwertje
AU - Øie, Erik
AU - Hovius, Joppe
AU - Quarsten, Hanne
N1 - Funding Information: This work was supported by ZonMW as part of the project “Ticking on Pandora’s Box, a study into tick-borne pathogens in Europe” (Project no. 52200-30-07 ), and through the European Regional Development Fund and the Interreg North Sea Region Programme 2014–2020 as part of the NorthTick Project (Reference no. J-No.: 38-2-7-19 ). Publisher Copyright: © 2023 The Authors
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Tick-borne disease caused by B. miyamotoi (BMD) usually manifest as a febrile illness in humans. Complications include relapsing fever and in rare occasions involvement of the central nervous system. Only a few cases of meningoencephalitis have been described, mostly in immunosuppressed patients. Case presentation: A 70-year-old female receiving immunosuppressive rituximab therapy presented with frontal headache, dizziness, nausea, vomiting and chills. Clinical laboratory blood analyses were normal. Cerebrospinal fluid (CSF) was translucent and analysis showed increased leucocyte count (187 106/L) and elevated level of protein (1056 mg/L). Empiric antibiotic treatment was initiated. The patient showed an early symptomatic relief and 24 h after admission she was discharged from the hospital and antibiotic treatment was discontinued. Two weeks after hospitalisation the B. miyamotoi specific PCR turned out positive in both CSF and serum. At the time, the patient was recovered with mild residual headache. She was treated with high dose doxycycline and her subtle symptoms disappeared. Conclusions: To our knowledge, we present the first patient with BMD-associated meningitis in Norway, one of eight cases reported worldwide. The patient had mild symptoms and received an early diagnosis. A more severe progression or relapse of disease may have been prevented by antibiotic treatment. BMD should be considered as causes of aseptic meningitis, especially in immunosuppressed patients living in endemic areas.
AB - Background: Tick-borne disease caused by B. miyamotoi (BMD) usually manifest as a febrile illness in humans. Complications include relapsing fever and in rare occasions involvement of the central nervous system. Only a few cases of meningoencephalitis have been described, mostly in immunosuppressed patients. Case presentation: A 70-year-old female receiving immunosuppressive rituximab therapy presented with frontal headache, dizziness, nausea, vomiting and chills. Clinical laboratory blood analyses were normal. Cerebrospinal fluid (CSF) was translucent and analysis showed increased leucocyte count (187 106/L) and elevated level of protein (1056 mg/L). Empiric antibiotic treatment was initiated. The patient showed an early symptomatic relief and 24 h after admission she was discharged from the hospital and antibiotic treatment was discontinued. Two weeks after hospitalisation the B. miyamotoi specific PCR turned out positive in both CSF and serum. At the time, the patient was recovered with mild residual headache. She was treated with high dose doxycycline and her subtle symptoms disappeared. Conclusions: To our knowledge, we present the first patient with BMD-associated meningitis in Norway, one of eight cases reported worldwide. The patient had mild symptoms and received an early diagnosis. A more severe progression or relapse of disease may have been prevented by antibiotic treatment. BMD should be considered as causes of aseptic meningitis, especially in immunosuppressed patients living in endemic areas.
KW - Aseptic meningitis
KW - Borrelia miyamotoi
KW - Opportunistic infections
KW - Rituximab
KW - Tick-borne disease
UR - http://www.scopus.com/inward/record.url?scp=85169812659&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.idcr.2023.e01867
DO - https://doi.org/10.1016/j.idcr.2023.e01867
M3 - Article
C2 - 37577049
SN - 2214-2509
VL - 33
JO - IDCases
JF - IDCases
M1 - e01867
ER -