A man with recurrent fever, arthritis, and rashes-brucellosis? A case report.

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.

[Relapsing fever after travelling in the tropics; a story with a twist]. / Terugkerende koorts na een reis in de tropen.

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.

Síndrome PFAPA: Causa de fiebre recurrente también en adultos / PFAPA síndrome: a cayse of recurrent fever also in adults

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Plasmodium falciparum malaria co-infection with tick-borne relapsing fever in Dakar.

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.

[Neurological complications of tick-borne relapsing fever]. / Complicaciones neurologicas de la fiebre recurrente transmitida por garrapatas.

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.

Complicaciones neurológicas de la fiebre recurrente transmitida por garrapatas / Neurological complications of tick-borne relapsing fever

Introducción. La fiebre recurrente transmitida por garrapatas (FRTG) puede producir complicaciones neurológicas. No existen apenas estudios en España sobre el tema. Objetivo. Estudiar la prevalencia y las características clínicas de las complicaciones neurológicas de los pacientes con FRTG. Pacientes y métodos. 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 síntomas más frecuentes fueron: fiebre en 64 pacientes (85,3%), cefalea en 41 (54,6%) y vómitos en 26 (34,6%). Se sospechó afectación meníngea en nueve pacientes (12%), de los que tres (4%) tenían signos meníngeos en el momento del ingreso. A todos ellos se les realizó una punción lumbar. Ninguno presentó parálisis facial ni otra manifestación neurológica. Se encontraron alteraciones del líquido cefalorraquí- deo en los tres pacientes con meningismo. En uno de los casos se visualizó Borrelia en el líquido cefalorraquídeo. En los pacientes con afectación neurológica, 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 neurológicas. Sin embargo, los médicos deben saber que Borrelia puede causar meningitis en los sujetos expuestos a garrapatas en regiones endémicas de FRTG (AU)

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 (AU)

Fiebre recurrente transmitida por garrapatas: una causa infrecuente de meningitis / Tick-borne relapsing fever: an infrequent cause of meningitis

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Notes from the Field: Tickborne Relapsing Fever Outbreak at an Outdoor Education Camp - Arizona, 2014.

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.

[Relapsing (recurrent) disease caused by Borrelia miyamotoi].

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.

Undifferentiated febrile illnesses in military personnel.

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.

Tick-borne relapsing fever with cutaneous eschar and radiculopathy, Ethiopia.

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.

Tickborne relapsing fever in a mother and newborn child--Colorado, 2011.

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.

Faringoamigdalitis de repetición sin causa infecciosa: síndrome PFAPA. A propósito de un caso / Recurrent cases of pharyngoamygdalitis without an infectious cause: PFAPA syndrome. A case report

La faringoamigdalitis aguda es un proceso frecuente en pediatría, de fácil diagnóstico y tratamiento en general, pero en casos recurrentes o atípicos se deben descartar otras patologías. Presentamos el caso de una niña de 6 años de edad, que sufre desde hace 2 años episodios recurrentes de faringoamigdalitis aguda, y fue diagnosticada y tratada de síndrome PFAPA en la consulta de atención primaria. Se presenta la base teórica de este síndrome, así como una pequeña reflexión acerca de su etiología, diagnóstico diferencial y tratamiento (AU)

Acute pharyngoamygdalitis is a frequent process in pediatrics, which is of easy diagnosis and general treatment, but in atypical or recurrent cases other pathologies should be ruled out. The clinical case described here is that of a six-year-old girl who, for the last two years, has been suffering from recurrent episodes of acute pharyngoamygdalitis diagnosed and treated as PFAPA syndrome in the primary care office. In this article the theoretical basis of the syndrome is shown, as well as some thoughts about its etiology, differential diagnosis and treatment (AU)