Borrelia miyamotoi Disease in an Immunocompetent Patient, Western Europe
Hoornstra D, Koetsveld J, Sprong H, et al. Borrelia miyamotoi Disease in an Immunocompetent Patient, Western Europe. Emerging Infectious Diseases. 2018;24(9):1770-1772. doi:10.3201/eid2409.180806.
Borrelia miyamotoi disease is a hard tick–borne relapsing fever illness that occurs across the temperate climate zone. Human B. miyamotoi disease in immunocompetent patients has been described in Russia, North America, and Japan. We describe a case of B. miyamotoi disease in an immunocompetent patient in western Europe.
“Molecular tests of blood and skin biopsy and serologic testing for Borrelia burgdorferi sensu lato and syphilis were repeatedly negative, except for a C6 EIA IgM/IgG seroconversion (Immunetics, Boston, MA, USA) in convalescent-phase serum samples that was positive but could not be confirmed by either IgM or IgG immunoblot (Mikrogen, Neuried, Germany) (Technical Appendix Table 2). We did not admit the patient to the hospital, and we did not initiate antimicrobial drug treatment because her symptoms had largely resolved. At a 2-month follow-up visit, the patient had fully recovered, and laboratory test results were normal.
In a well-described cohort of PCR-positive patients in Russia, characteristic clinical symptoms were fever, myalgia, nausea, and headaches; laboratory findings showed thrombocytopenia and diffuse organ damage (3).
That the patient recovered even without antimicrobial treatment is consistent with a recent BMD case described in the United States (9). Because of the initial skin rash, we did not completely rule out B. burgdorferi s.l. co-infection; however, prior evaluation by an independent dermatologist, a negative B. burgdorferi s.l. immunoblot despite high C6 reactivity, and a negative PCR on DNA obtained from the skin biopsy argue against co-infection. Regardless, the clinical picture of fever and mild leukopenia and thrombocytopenia is compatible with BMD and not with Lyme borreliosis. Of interest, C6 reactivity in combination with a negative B. burgdorferi s.l. immunoblot has been described in BMD patients in the United States (10).”
Three weeks after a tick bite, a 72 year old Dutch woman reported a bullseye rash several days later with a fever. This was followed by headache, weight loss, and muscle & joint pain.
Notice the repeatedly negative test results.
The denial of antimicrobial treatment is pretty amazing considering the admission of the “well-described cohort of PCR-positive patients in Russia, characteristic clinical symptoms were fever, myalgia, nausea, and headaches; laboratory findings showed thrombocytopenia and diffuse organ damage.”
Are they really going to deny an elderly woman antimicrobial treatment even when diffuse organ damage is on the record?
Medical professionals continue to baffle me.
Dr. Cameron states: “Until now, there have been no treatment guidelines for B. miyamotoi and regimes have been empirically based on the treatment for Lyme disease. ‘The antimicrobial susceptibility of B. miyamotoi has not yet been elucidated, due to difficulties with cultivation of B. miyamotoi spirochetes in vitro,’ according to Koetsveld. http://danielcameronmd.com/best-antibiotics-treat-borrelia-miyamotoi/ The study authors demonstrated that B. miyamotoi is susceptible to doxycycline, azithromycin, and ceftriaxone but resistant to amoxicillin in vitro. The next step would be to show whether these drugs work in patients.”
The denial of this plague where so much is unknown is an ever cause for concern. People are dying out here and all they can do is smugly state that her symptoms had largely resolved. I will add to this very troubling statement, and will very probably come raging back at an undetermined date in the future!
http://danielcameronmd.com/dont-count-on-a-relapsing-fever-to-diagnose-borrelia-miyamotoi/ “You might assume a patient infected with Borrelia miyamotoi, a relapsing fever spirochete, to present with a relapsing fever. However, your assumption would be wrong 48 out of 50 times, according to a case series published in the Annals of Internal Medicine.  The authors found that only 2 out of 50 patients infected with the relapsing spirochete B. miyamotoi actually presented with a relapsing fever. ….The individuals exhibited symptoms similar to those found in other tick-borne illnesses. The majority presented with headaches, myalgias, arthralgias, and malaise/fatigue. ‘More than 50% were suspected of having sepsis, and 24% required hospitalization,’ states Molloy. …..’Serologic testing using the rGlpQ EIA seems insensitive in diagnosing acute BMD infection given that it was positive for IgG or IgM in only 16% of the case patient samples at the time of clinical presentation,’ states Molloy. The rGlpQ was positive after the fact in 86% of the patients during convalescence. ….Elevated liver enzyme levels, neutropenia, and thrombocytopenia were common in 75%, 60% and 51% respectively. ‘Borrelia miyamotoi disease may be clinically similar to or be confused with human anaplasmosis,’ according to Molloy….B. miyamotoi has emerged as a leading cause of hard tick-transmitted infections but lacks a clear diagnostic criteria. According to Molloy, “Infection with B. miyamotoi is the fifth recognized Ixodes-transmitted infection in the northeastern United States and should be part of the differential diagnosis of febrile patients from areas where deer tick–transmitted infections are endemic.'”