Schwartz Thomas, Hoornstra Dieuwertje, Øie Erik, Hovius Joppe, Quarsten Hanne
Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway.
Oslo New University College, Oslo, Norway.
IDCases. 2023 Jul 31;33:e01867. doi: 10.1016/j.idcr.2023.e01867. eCollection 2023.
Tick-borne disease caused by (BMD) usually manifest as a febrile illness in humans. Complications include relapsing fever and in rare occasions involvement of the central nervous system. Only a few cases of meningoencephalitis have been described, mostly in immunosuppressed patients.
A 70-year-old female receiving immunosuppressive rituximab therapy presented with frontal headache, dizziness, nausea, vomiting and chills. Clinical laboratory blood analyses were normal. Cerebrospinal fluid (CSF) was translucent and analysis showed increased leucocyte count (187 10/L) and elevated level of protein (1056 mg/L). Empiric antibiotic treatment was initiated. The patient showed an early symptomatic relief and 24 h after admission she was discharged from the hospital and antibiotic treatment was discontinued. Two weeks after hospitalisation the specific PCR turned out positive in both CSF and serum. At the time, the patient was recovered with mild residual headache. She was treated with high dose doxycycline and her subtle symptoms disappeared.
To our knowledge, we present the first patient with BMD-associated meningitis in Norway, one of eight cases reported worldwide. The patient had mild symptoms and received an early diagnosis. A more severe progression or relapse of disease may have been prevented by antibiotic treatment. BMD should be considered as causes of aseptic meningitis, especially in immunosuppressed patients living in endemic areas.
由[病原体名称未给出]引起的蜱传疾病（BMD）在人类中通常表现为发热性疾病。并发症包括回归热，在极少数情况下会累及中枢神经系统。仅描述了少数几例脑膜脑炎病例，大多发生在免疫抑制患者中。
一名70岁接受免疫抑制利妥昔单抗治疗的女性出现前额头痛、头晕、恶心、呕吐和寒战。临床实验室血液分析正常。脑脊液（CSF）半透明，分析显示白细胞计数增加（187×10⁶/L）和蛋白质水平升高（1056mg/L）。开始经验性抗生素治疗。患者症状早期缓解，入院24小时后出院，抗生素治疗停止。住院两周后，脑脊液和血清中的[病原体名称未给出]特异性PCR均呈阳性。此时，患者已康复，仅遗留轻度头痛。她接受了高剂量强力霉素治疗，轻微症状消失。
据我们所知，我们报告了挪威首例与BMD相关的脑膜炎患者，这是全球报告的八例病例之一。该患者症状轻微且得到了早期诊断。抗生素治疗可能预防了疾病更严重的进展或复发。BMD应被视为无菌性脑膜炎的病因，尤其是在流行地区的免疫抑制患者中。
