Case report
First isolation of Borrelia sp. (Borrelia afzelii) from cerebrospinal fluid in a patient with neuroborreliosis in Croatia
Tomislav Maretić
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Branka Benić
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Oktavija Đaković Rode
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Dubravka Beritić
; Klinika za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, Hrvatska
Eva Ružić Sabljić
; Mikrobiološki Inštitut, Ljubljana, Slovenija
Abstract
We describe a patient with lyme borreliosis that manifested with facial erythema migrans one month after tick bite and consequently with peripheral facial paresis with lymphocyte meningitis (127 cells/μL and 78 % lymphocytes). Clinical picture of neuroborreliosis was relatively mild. The patient received ceftriaxone parenterally for three weeks, with beneficial effect of antibiotic therapy and almost complete resolution of facial paresis until discharge from hospital. Reactive IgG antibodies to B. burgdorferi were found in the patient’s serum. A positive index of intrathecal synthesis of IgM and IgG antibodies to borreliae was determined (specific test IDEIA Lyme Neuroborreliosis Oxoid, Great Britain). Immunological examination for detection of tick-borne meningoencephalitis, varicella-zoster virus and herpes simplex proved negative in both serum and cerebrospinal fluid (CSF). B. burgdorferi sensu lato was isolated from CSF using specific culturing techniques at the Institute of Microbiology and Immunology of the Medical Faculty, University of Ljubljana. After cultivation of the pathogen, identification of Borrelia species was performed by using restriction enzyme MluI thus determining the causative agent of neuroborreliosis: Borrelia afzelii. Although neuroborreliosis has been diagnosed and treated for over twenty years in Croatia, so far Borrelia has never been isolated from cerebrospinal fluid in our patients.
Keywords
neuroborreliosis; Borrelia afzelii; cerebrospinal fluid
Hrčak ID:
43785
URI
Publication date:
16.6.2009.
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