Assuntos
Borrelia/isolamento & purificação , Febre Recorrente/diagnóstico , Borrelia/genética , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Líquido Cefalorraquidiano/microbiologia , Confusão/etiologia , Diagnóstico Diferencial , Fadiga/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Febre Recorrente/complicações , Febre Recorrente/microbiologia , Distúrbios da Fala/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: We report a rare case of chronic brucellosis accompanied with myelodysplastic syndrome and neutrophilic dermatosis, which to the best of our knowledge, has never been reported. CASE PRESENTATION: A young man was admitted to our hospital complaining of recurrent fever, arthritis, rashes and anemia. He had been diagnosed with brucellosis 6 years prior and treated with multiple courses of antibiotics. He was diagnosed with myelodysplastic syndrome and neutrophilic dermatosis following bone marrow puncture and skin biopsy. After anti-brucellosis treatment and glucocorticoid therapy, the symptoms improved. CONCLUSIONS: Clinicians should consider noninfectious diseases when a patient who has been diagnosed with an infectious disease exhibits changing symptoms.
Assuntos
Artrite/complicações , Brucelose/complicações , Exantema/complicações , Síndromes Mielodisplásicas/complicações , Febre Recorrente/complicações , Síndrome de Sweet/complicações , Adulto , Biópsia , Brucelose/tratamento farmacológico , Doença Crônica , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pele/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Relapsing fever is an infectious disease caused by Spirochaetes. The presentation is characterised by recurrent episodes of fever. CASE DESCRIPTION: At the end of her trip through South Africa and Botswana, a 54-year-old woman had symptoms of fever and dry cough. Back in the Netherlands, physical examination at the emergency department did not reveal any abnormalities besides fever. Laboratory investigation found thrombocytopenia and elevated infection markers. Thick blood smear revealed the presence of Spirochaetes. Following a working diagnosis of 'relapsing fever', the patient was treated with doxycycline. There was no Jarisch-Herxheimer reaction. At a follow-up outpatient appointment two weeks later, the patient had fully recovered. CONCLUSION: Relapsing fever is a rare disease without specific symptoms. The diagnosis is therefore easily overlooked. Untreated, mortality is high. During episodes of fever, the diagnosis can be established with a thick blood smear.
Assuntos
Febre Recorrente/diagnóstico , Febre Recorrente/tratamento farmacológico , Viagem , Anti-Infecciosos/uso terapêutico , Borrelia/isolamento & purificação , Tosse/etiologia , Doxiciclina/uso terapêutico , Feminino , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Países Baixos , Doenças Raras , Febre Recorrente/complicaçõesRESUMO
BACKGROUND: West African tick-borne relapsing fever (TBRF) due to Borrelia crocidurae and malaria are co-endemics in Senegal. Although expected to be high, co-infections are rarely reported. A case of falciparum malaria and B. crocidurae co-infection in a patient from Velingara (South of Senegal) is discussed. CASE: A 28 year-old-male patient presented to Aristide Le Dantec Hospital for recurrent fever. He initially presented to a local post health of Pikine (sub-urban of Dakar) and was diagnosed for malaria on the basis of positive malaria rapid diagnostic test (RDT) specific to Plamodium falciparum. The patient was treated as uncomplicated falciparum malaria. Four days after admission the patient was referred to Le Dantec Hospital. He presented with fever (39 °C), soreness, headache and vomiting. The blood pressure was 120/80 mmHg. The rest of the examination was normal. A thick film from peripheral blood was performed and addressed to the parasitology laboratory of the hospital. Thick film was stained with 10% Giemsa. Trophozoite of P. falciparum was identified at parasite density of 47 parasites per microlitre. The presence of Borrelia was also observed, concluding to malaria co-infection with borreliosis. CONCLUSIONS: Signs of malaria can overlap with signs of borreliosis leading to the misdiagnosis of the latter. Thick and thin smear or QBC test or molecular method may be helpful to detect both Plamodium species and Borrelia. In addition, there is a real need to consider co-infections with other endemics pathogens when diagnosing malaria.
Assuntos
Coinfecção/diagnóstico , Malária Falciparum/complicações , Malária Falciparum/diagnóstico , Febre Recorrente/complicações , Febre Recorrente/diagnóstico , Doenças Transmitidas por Carrapatos/complicações , Doenças Transmitidas por Carrapatos/diagnóstico , Adulto , Infecções Bacterianas , Borrelia , Infecções por Borrelia , Coinfecção/patologia , Humanos , Malária , Malária Falciparum/patologia , Masculino , Febre Recorrente/patologia , Senegal/epidemiologia , Doenças Transmitidas por Carrapatos/patologiaRESUMO
INTRODUCTION: Tick-borne relapsing fever (TBRF) can cause neurological complications. There are hardly any studies in Spain on this subject. AIM: To study the prevalence and clinical characteristics of neurological complications of patients with TBRF. PATIENTS AND METHODS: We retrospectively reviewed all the patients attended with TBRF over 12 years (2004-2015) in a hospital in a rural area of southern Spain. RESULTS: We included 75 patients, 42 males (56%). Mean age: 33 years (range: 14-72 years). Tick bites were observed in 9 patients (12%). The most common symptoms were: fever in 64 (85.3 %) patients, headache in 41 (54.6%) patients, and vomits in 26 (34.6%) patients. Manifestations suggesting meningeal involvement were noted in 9 (12%) of the patients, and 3 patients (4%) had clear meningeal signs on admission. All these patients underwent lumbar puncture. None of the patients presented facial palsy or other neurologic manifestation. Cerebrospinal fluid abnormalities were found in the three patients with meningismus. In one case Borrelia were found in the cerebrospinal fluid. In those cases with neurologic involvement the treatment used was penicillin G in one case and ceftriaxone in two patients. All patients recovered completely. CONCLUSIONS: TBRF is one of the less severe forms of borreliosis and less than 5% of patients present neurological complications. However, physicians should know that Borrelia can cause meningitis in subjects exposed to ticks in endemic regions of TBRF.
TITLE: Complicaciones neurologicas de la fiebre recurrente transmitida por garrapatas.Introduccion. La fiebre recurrente transmitida por garrapatas (FRTG) puede producir complicaciones neurologicas. No existen apenas estudios en España sobre el tema. Objetivo. Estudiar la prevalencia y las caracteristicas clinicas de las complicaciones neurologicas de los pacientes con FRTG. Pacientes y metodos. Estudio retrospectivo de los pacientes atendidos con FRTG durante 12 años (2004-2015) en un hospital de una zona rural del sur de España. Resultados. Se incluyeron 75 pacientes, 42 varones (56%), con una edad media de 33 años (rango: 14-72 años). Se observaron picaduras de garrapatas en nueve pacientes (12%). Los sintomas mas frecuentes fueron: fiebre en 64 pacientes (85,3%), cefalea en 41 (54,6%) y vomitos en 26 (34,6%). Se sospecho afectacion meningea en nueve pacientes (12%), de los que tres (4%) tenian signos meningeos en el momento del ingreso. A todos ellos se les realizo una puncion lumbar. Ninguno presento paralisis facial ni otra manifestacion neurologica. Se encontraron alteraciones del liquido cefalorraquideo en los tres pacientes con meningismo. En uno de los casos se visualizo Borrelia en el liquido cefalorraquideo. En los pacientes con afectacion neurologica, el tratamiento utilizado fue penicilina G en un caso y ceftriaxona en dos. Todos los pacientes se recuperaron completamente. Conclusiones. La FRTG es una de las formas menos graves de borreliosis, y menos del 5% de los pacientes presenta complicaciones neurologicas. Sin embargo, los medicos deben saber que Borrelia puede causar meningitis en los sujetos expuestos a garrapatas en regiones endemicas de FRTG.
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Febre Recorrente/complicações , Adolescente , Adulto , Idoso , Animais , Ceftriaxona/uso terapêutico , Feminino , Cefaleia , Humanos , Masculino , Meninges/fisiopatologia , Pessoa de Meia-Idade , Penicilina G/uso terapêutico , Febre Recorrente/líquido cefalorraquidiano , Febre Recorrente/tratamento farmacológico , Espanha , Carrapatos , Vômito , Adulto JovemRESUMO
Tickborne relapsing fever (TBRF) is a bacterial infection characterized by recurring episodes of fever, headache, muscle and joint aches, and nausea. In North America, TBRF primarily is caused by Borrelia hermsii spirochetes transmitted by Ornithodoros hermsii ticks. Once infected, these soft ticks are infectious for life and transmit the spirochete to sleeping humans quickly (possibly within 30 seconds) during short feeds (15-90 minutes). On August 10, 2014, the Coconino County Public Health Services District in Arizona was notified by a local hospital that five high school students who attended the same outdoor education camp had been hospitalized with fever, headache, and myalgias. Hantavirus infection initially was suspected because of reported exposure to rodent droppings, but after detecting spirochetes on peripheral blood smears from all five hospitalized students, TBRF was diagnosed. The camp was instructed to close immediately, and the health department, in collaboration with local university experts, investigated to identify additional cases, determine the cause, and prevent further infections. A total of 11 cases (six confirmed and five probable) were identified.
Assuntos
Borrelia/isolamento & purificação , Surtos de Doenças , Febre Recorrente/diagnóstico , Febre Recorrente/epidemiologia , Adolescente , Adulto , Arizona/epidemiologia , Acampamento , Humanos , Febre Recorrente/complicações , Instituições AcadêmicasRESUMO
AIM: To clarify the clinical, laboratory, and epidemiological characteristics of relapsing Ixodes tick-borne borreliosis (ITB) caused by Borrelia miyamotoi. SUBJECTS AND METHODS: Retrospective clinical observation was made in 79 inpatients of the Republican Infectious Diseases Hospital (Udmurt Republic), who had been diagnosed with B. miyamotoi-caused disease verified by real-time polymerase chain reaction. The latter and enzyme immunoassay ruled out possible vector-borne coinfections (ITB caused by B. burgdorferi sensu lato; tick-borne encephalitis; anaplasmosis; and ehrlichiosis). RESULTS: The recurrent course of the disease was observed in 8 (10%) of the 79 patients. The relapsing fever curve was noted in 6 of the 8 patients; 4 patients had 2 episodes of fever and 2 patients had 3 episodes; the wave-like continuous type of fever cannot enable one to estimate the specific number of episodes in 2 more cases. Relapses occurred in all the 8 patients before antibiotic treatment. Febrile syndrome (weakness, headache, chill, fever, sweating, dizziness, nausea, vomiting, myalgia, and arthralgia) was leading in patients with relapses. These patients were less frequently observed to have signs of organ dysfunctions than those with one episode of fever. The values of clinical and biochemical blood tests and urinalyses were normal and near-normal in the majority of patients on hospital admission. CONCLUSION: Relapsing B. miyamotoi infection cases detected in the directed study proved to be unrecognized by practical health authorities during the first and sometimes second episodes of fever. This indicates that the prevalence of this disease is essentially underestimated and there is a need to increase physicians' alertness and awareness and to introduce adequate diagnostic methods.
Assuntos
Borrelia/patogenicidade , Ixodes/microbiologia , Febre Recorrente/epidemiologia , Infestações por Carrapato/epidemiologia , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Febre Recorrente/complicações , Febre Recorrente/tratamento farmacológico , Federação Russa/epidemiologiaRESUMO
Undifferentiated febrile illnesses (UFIs) present with acute symptoms, objective fever and no specific organ focus on clinical assessment. The term is mostly used in developing and tropical countries where a wide range of infections may be responsible. Laboratory diagnosis often requires specialist microbiology investigations that are not widely available, and serology tests that only become positive during convalescence. Optimal clinical management requires a good travel history, awareness of local endemic diseases, an understanding of the features that may help distinguish different causes and appropriate use of empirical antibiotics. This review describes the most common examples of UFI in military personnel on overseas deployments, and provides a practical approach to their initial management.
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Febre/microbiologia , Febre/parasitologia , Militares , Infecções por Arbovirus/complicações , Brucelose/complicações , Febres Hemorrágicas Virais/complicações , Humanos , Leishmaniose/complicações , Leptospirose/complicações , Malária/complicações , Febre Q/complicações , Febre Recorrente/complicações , Infecções por Rickettsia/complicações , Febre Tifoide/complicações , Reino UnidoRESUMO
We report the first confirmed case of tick-borne borreliosis by molecular tools in a French traveler returning from Ethiopia with unusual presentation: the presence of cutaneous eschar after a hard tick-bite suggesting firstly to clinicians a diagnosis of tick-borne rickettsiosis.
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Borrelia burgdorferi , Febre Recorrente/diagnóstico , Idoso , Borrelia burgdorferi/genética , Borrelia burgdorferi/isolamento & purificação , Diagnóstico Diferencial , Etiópia , Feminino , França , Humanos , Radiculopatia/etiologia , Febre Recorrente/complicações , Febre Recorrente/microbiologia , Pele/patologia , ViagemAssuntos
Borrelia/genética , Meningoencefalite/diagnóstico , Febre Recorrente/diagnóstico , Adulto , DNA Bacteriano/líquido cefalorraquidiano , DNA Bacteriano/genética , Feminino , Flagelina/genética , Humanos , Meningoencefalite/líquido cefalorraquidiano , Meningoencefalite/complicações , Técnicas de Diagnóstico Molecular , Dados de Sequência Molecular , Tipagem Molecular , Febre Recorrente/complicações , Senegal , Análise de Sequência de DNA , ViagemRESUMO
Tickborne relapsing fever (TBRF) is a bacterial infection caused by certain species of Borrelia spirochetes and transmitted through the bite of Ornithodoros ticks. Clinical illness is characterized by relapsing fever, myalgias, and malaise. On May 10, 2011, CDC and the Colorado Department of Public Health and Environment were notified of two patients with TBRF: a young woman and her newborn child. This report summarizes the clinical course of these patients and emphasizes the importance of considering a diagnosis of TBRF among patients with compatible clinical symptoms and residence or travel in a TBRF-endemic area. Pregnant women and neonates are at increased risk for TBRF-associated complications and require prompt diagnosis and treatment for optimal clinical outcomes. Public health follow-up of reported TBRF cases should include a search for persons sharing an exposure with the patient and environmental investigation with remediation measures to prevent additional infections.
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Borrelia/isolamento & purificação , Ornithodoros , Complicações Infecciosas na Gravidez/diagnóstico , Febre Recorrente/diagnóstico , Animais , Antibacterianos/administração & dosagem , Anticorpos Antibacterianos/análise , Borrelia/genética , Borrelia/imunologia , Colorado , Feminino , Humanos , Recém-Nascido , Penicilina G/administração & dosagem , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Febre Recorrente/complicações , Febre Recorrente/tratamento farmacológico , Febre Recorrente/transmissão , Adulto JovemAssuntos
Antibacterianos/efeitos adversos , Borrelia/isolamento & purificação , Doxiciclina/efeitos adversos , Febre Recorrente/complicações , Choque Cardiogênico/induzido quimicamente , Inconsciência/induzido quimicamente , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Reanimação Cardiopulmonar , Fármacos Cardiovasculares/uso terapêutico , Ceftriaxona/uso terapêutico , Criança , Terapia Combinada , Citocinas/metabolismo , Doxiciclina/uso terapêutico , Endotoxinas/metabolismo , Feminino , Humanos , Hipotensão/induzido quimicamente , Respiração com Pressão Positiva , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Febre Recorrente/diagnóstico , Febre Recorrente/tratamento farmacológico , Febre Recorrente/microbiologia , Choque Cardiogênico/terapia , Taquicardia/induzido quimicamenteRESUMO
About 500 million cases of malaria occur annually. However, a substantial number of patients who actually have relapsing fever (RF) Borrelia infection can be misdiagnosed with malaria due to similar manifestations and geographic distributions of the two diseases. More alarmingly, a high prevalence of concomitant infections with malaria and RF Borrelia has been reported. Therefore, we used a mouse model to study the effects of such mixed infection. We observed a 21-fold increase in spirochete titers, whereas the numbers of parasitized erythrocytes were reduced 15-fold. This may be explained by polarization of the host immune response toward the intracellular malaria parasite, resulting in unaffected extracellular spirochetes and hosts that succumb to sepsis. Mixed infection also resulted in severe malaria anemia with low hemoglobin levels, even though the parasite counts were low. Overall, coinfected animals had a higher fatality rate and shorter time to death than those with either malaria or RF single infection. Furthermore, secondary malaria infection reactivated a quiescent RF brain infection, which is the first evidence of a clinically and biologically relevant cue for reactivation of RF Borrelia infection. Our study highlights the importance of investigating concomitant infections in vivo to elucidate the immune responses that are involved in the clinical outcome.
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Malária/complicações , Malária/patologia , Febre Recorrente/complicações , Febre Recorrente/patologia , Anemia , Animais , Borrelia/isolamento & purificação , Contagem de Colônia Microbiana , Eritrócitos/parasitologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Parasitemia , Plasmodium berghei/isolamento & purificação , Sepse , Análise de SobrevidaRESUMO
Borrelia hermsii causes tick-borne relapsing fever (TBRF) in the Pacific Northwest. There are few reports of TBRF-associated acute respiratory distress syndrome. One such unusually severe case is described. Literature is reviewed including diagnosis, treatment, and prevention.
Assuntos
Antibacterianos/uso terapêutico , Febre Recorrente/diagnóstico , Síndrome do Desconforto Respiratório/diagnóstico , Carrapatos/microbiologia , Animais , Mordeduras e Picadas , Feminino , Humanos , Pessoa de Meia-Idade , Febre Recorrente/complicações , Febre Recorrente/tratamento farmacológico , Febre Recorrente/prevenção & controle , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/prevenção & controle , Washington/epidemiologiaRESUMO
Tickborne relapsing fever (TBRF) is a bacterial illness caused by certain species of Borrelia and transmitted through brief and painless bites from Ornithodoros ticks. Illness usually is characterized by intermittent periods of fever, fatigue, and muscle aches. In April 2005, CDC received reports of two cases of severe TBRF associated with acute respiratory distress syndrome (ARDS) in residents of California and Nevada. After a report describing these cases was posted on CDC's Epidemic Information Exchange (Epi-X), health officials in Washington reported a third severe case associated with ARDS. This report summarizes these three cases and the results of the subsequent epidemiologic investigations. The findings indicate that ARDS might occur more frequently in patients with TBRF than previously recognized. Optimal management of TBRF requires both prompt diagnosis and careful observation during the initial phases of treatment.
Assuntos
Febre Recorrente/complicações , Febre Recorrente/epidemiologia , Síndrome do Desconforto Respiratório/etiologia , Adulto , California/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nevada/epidemiologia , Síndrome do Desconforto Respiratório/epidemiologia , Washington/epidemiologiaRESUMO
Given the prevalence of relapsing fever (RF) in Senegal, this disease may cause illness and death in other areas of West Africa. We performed a cross-sectional, clinic-based study to investigate the presence of RF in Togo during 2002-2004. Blood samples from patients with fever were examined for RF spirochetes by microscopy, PCR, and DNA sequencing of amplicons and for antibodies to the glycerophosphodiester phosphodiesterase antigen. Although no spirochetes were seen in blood smears, approximately 10% of the patients were positive by PCR and approximately 13% were seropositive for spirochetes. DNA sequencing demonstrated that Borrelia crocidurae and B. duttonii were present. Most patients were treated for malaria whether or not plasmodia were observed. Thus, many RF patients originally had a misdiagnosis of malaria, which resulted in ineffective treatment. The inability of microscopic analysis to detect spirochetes compared with PCR demonstrates the need for tests with greater sensitivity.