A 13-year old girl with pancytopenia at the presentation of a Borrelia hispanica infection: a case report and review of the literature.

BACKGROUND: It is not uncommon that a child with a febrile illness of unknown etiology is admitted to the hospital. When the complete blood count reveals a pancytopenia, the diagnostic process can be a real challenge. CASE PRESENTATION: A 13-year girl of Arab-Berber descent presented with abdominal pain and fever after a holiday in northwestern Morocco. A complete blood count revealed a pancytopenia and blood smear test results revealed spirochetes. Borrelia hispanica was identified by sequencing the 16S ribosomal ribonucleic acid gene. Our patient was treated with tetracyclines and during this treatment we saw full clinical and hematological recovery. CONCLUSIONS: Borrelia hispanica is a known cause of tick-borne relapsing fever and is transmitted to humans through the bite of soft ticks of the genus Ornithodoros (Alectorobius). Although the link between tick-borne relapsing fever and thrombocytopenia has been documented, there are only a few case reports of tick-borne relapsing fever presenting with pancytopenia. To the best of our knowledge, there is no previous report of Borrelia hispanica presenting with pancytopenia.

Quantitative real-time PCR on Lightcycler for the detection of human immunodeficiency virus type 2 (HIV-2).

Similar to HIV-1, the viral load in HIV-2 is a marker of the evolution of infection and the success of therapy. No approved or commercially distributed assay exists to determine the plasma viral load of HIV-2. We therefore developed a quantitative real-time PCR to determine the plasma RNA viral load of HIV-2, based on the reference strains ROD and EHO, which represent subtypes A and B of HIV-2, respectively. After testing several pairs of primers, a set was chosen that recognised the 5'-LTR region of a subtypes A and B consensus sequence. The quantification of the PCR reaction was done using SYBR-Green I as the fluorescent dye in a Lightcycler system and relying on an external standard curve. The method was then optimised with reference strains, an validated further using patient samples and an inter-laboratory comparison. Good specificity was obtained for both subtypes of HIV-2, and a linear range between 10 and 10(6) copies of viral RNA. The limit of quantitation was 250 copies per millilitre of plasma. The coefficient of variation ranged from 0.7 to 5.6%, depending on the concentration of the target sequences.