Monday, July 16, 2018

Case of the Week 502

This week's case is of a patient with recurrent fevers. No further history is available, but the following were noted on Giemsa-stained thin blood films:

Identification? What additional test would be helpful for confirming your diagnosis?


Kamran Kadkhoda said...

B. mayonii
RF Borreliae including: B. miyamotoi

Blaine A. Mathison said...

One of the borreliae, either B. recurrentis (louse-borne) or one of the TBRF spirochetes transmitted by argasid ticks. I am not sure if they can be separated from light microscopy.

Blaine A. Mathison said...

...I meant to add, this is not one of the Lyme borreliae (B. burgorferi or B. mayonii)

Idzi P. said...

Borrelia sp. (but not B. burgdorferi that causes Lyme).
Can be either B. recurrentis (transmitted by body lice) or one of the tick-transmitted borrelias causing recurrent fever.

Idzi P. said...

B.burgdorferi never reaches high enough concentrations in the blood to find it in thin or thick blood films. To detect the recurrent fever borreliae, best to take blood ON the peak of fever.

Anonymous said...

My answer favors B. recurrentis. My former and late co-worker contracted Lyme disease. We never had a positive blood smear with the spirochete.
Thank you Idzi and Blaine for your comments.
Florida Fan

William Sears said...

spirillum bacteria: differential includes campylobacter, helicobacter, vibrio, suterella, anaerobospirillum, desulfurovibrio, borellia, treponema.

For recurrent fevers the most likely would be borellia recurrentis, hermsii, turicatae, parkerii causing relapsing fevers. However, I also would be curious to see if it were b mayonii as described in this paper:.... "Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study" which Dr. Pritt may be aware of......:)
Or also possibly candidatus borellia johnsonii

Additional testing would be pcr and sequencing such as in the following paper..."Surveillance for and Discovery of Borrelia Species in US Patients Suspected of Tickborne Illness.
Kingry LC1, Anacker M2, Pritt B3, Bjork J2, Respicio-Kingry L1, Liu G2, Sheldon S1, Boxrud D2, Strain A2, Oatman S1, Berry J3, Sloan L3, Mead P1, Neitzel D2, Kugeler KJ1, Petersen JM1."

could also use serology taken around day 7 and repeated on day 21 although PCR is largely taking over.
The good part is that regardless of the identification, doxy now please.

Herr Rust said...

Leptospira interrogans

Anonymous said...

After further research, I believe that the spirochete may belong to a new species B. mayonii. There is an article published:
Just like Blaine has said, how could we identify the spirochete with only the smears?
Thank you Dr. Pritt for this educational case.
Florida Fan

sylvie g said...

Borrelia causing relapsing fever, not a Borrelia causing Lyme disease (we never see the Borrelia burgdorferi under giemsa stain as far as I know). We will know the species when a PCR is done.

Ncbaldeo said...

Borrelia hermsii or the 2 other Borrelia species that cause tick-born relapsing fever.