6 February 2017 (Monday) - Borellia

This case study appeared in a Facebook group I follow today:

“62 yr old Canadian citizen was admitted to ER in Canada, with fever, and "very sick". His family had an annual family reunion with their US relatives in a summer cabin in the Pacific Northwest in Washington State. He felt unwell and drove himself back to Canada to seek medical treatment. At the mean time, two of his American relatives were also very ill and admitted to ICU with similar symptoms, diagnosis: fever NYD. The night-shift on-call tech reviewed his peripheral blood and immediately alerted the ER doctor of her finding. Because of her quick reaction, the ER doc was able to contact the patient's relatives who were still in the American hospital ICU with an unknown diagnosis.

What did the tech see?”

“Diagnosis: Tick-borne relapsing fever (TBRF) caused by Borellia hemsii. Subsequent serology testing for Borellia hemsii at the BC CDC confirms the diagnosis. Patient recovered with appropriate antibiotic treatment. Other family members in the US hospital also recovered with no ill-effects.

Additional patient history: Patient was in the attic of the family summer cabin cleaning up a day before the arrival of the rest of the family members. He remembered there were rodent droppings on the floor of the attic. Patient had relapsing fever, alternating between fever and chills.

Some of the case discussion participants suggest this is Lyme disease. As one of the participants Mark Hawking pointed out that spirochettes are usually not seen in the blood in Lyme disease.

A couple of case discussion participants correctly observed that this happened in the Pacific Northwest which is the endemic zone of TBRF.

Helpful references:

TBRF:https://www.cdc.gov/relapsing-fever/index.html
Lyme Disease: https://www.cdc.gov/lyme/index.html”

Well…I missed this entirely. I was intrigued with the granules/inclusions in the monocyte. I totally didn’t see the spirochetes. I learned something here…