Naslov
Meningitis in a patient with anaplasmosis

Autori
Lukić, Ljiljana ; Balen Topić, Mirjana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
1st South-East European Conference on Travel, Tropical, Migration Medicine and HIV & 2nd Croatian Congress on Travel, Tropical, Migration Medicine & HIV - Abstract Book / - , 2017

Skup
1st South-East European Conference on Travel, Tropical, Migration Medicine and HIV & 2nd Croatian Congress on Travel, Tropical, Migration Medicine & HIV

Mjesto i datum
Dubrovnik, Hrvatska, 28.09.2017. - 01.10.2017

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
Meningitis ; anaplasmosis

Sažetak
Introduction: We are going to present you a case of a patient with meningitis and serologically proven anaplasmosis. Case presentation: Previously healthy 27 years old female patient was admitted to the Hospital with a history of 7 day continuously high fever, accompanied by respiratory symptoms (dry caught, rhinorrhea) and frontal headache, without clinical improvement after empirical treatment with oral azithromycin, despite normal chest X-ray and abdominal ultrasound finding. The disease was sporadic and no tick-bite was recorded. Case management: On admission, physical examination showed no aberrations with negative meningeal signs. ESR was 59, CRP was 88.5, complete blood count and routine biochemical and bacteriological laboratory findings were normal. Symptomatic therapy and empirical treatment with parenteral ceftriaxone had been initiated. Respiratory symptoms slowly resolved with persistence of fever, severe headache and development of sporadic vomiting. Lumbar punction was performed on the 3rd in-hospital day and cerebrospinal (CSF) fluid analyses confirmed aseptic meningitis (95% mononuclear pleocytosis of 60 white blood cells in mm 3, haematoencephalic barrier was mildly dysfunctional ; other finding of CSF were normal). Head and abdominal CT, MRI scan and electroencephalography showed no pathology. The patient developed mild thrombocytopenia (167) and normocytic anemia in peripheral blood with mild hepatic lesion and CRP of 80. The possibility of zoonotic pathogen or immune-triggered meningitis was suspected. After 6 days ineffective ceftriaxone therapy was discontinued and the treatment with doxycycline 2x100 mg orally for 14 days and dexamethasone 4x8 mg intravenously was initiated. This resulted in prompt resolution of fever and all symptoms. The patient was discharged in good condition 15 days after admission. Results: All etiological diagnostic tests: PCR on HSV1/2, Enteroviruses ; serology for Puumala virus, EBV, CMV, Rubella virus, VZV, B.burgdorferi, M.pneumoniae, K.pneumoniae, Morbilli, Coxiella burnetii, Brucellae, antiHIV/HIVAg, WNV), flow cytometry, and markers of autoimmune diseases (ANA, ANCA, CCP, anti-dsDNA, PR3 remained negative, except positivity of first and second serum on Anaplasma phagocytophilum using indirect flourescent antibody test (IFA). Conclusion: we have proven an infection with Anaplasma phagocytophilum in a patient with aseptic meningitis. Though more common in North and South America, Anaplasma phagocytophilum and its vector, Exodes ricinus, is present in Europe as well. Neurologic symptoms and aseptic meningitis are less common, but all have been previously described in infection with Anaplasma phagocytophilum. We find that it is important to have this in mind in patients with protracted aseptic meningitis who might be travelling.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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