Borrelia miyamotoi Meningoencephalitis in an Immunocompetent Patient

Abstract

Borrelia miyamotoi is an underdiagnosed cause of tick-borne illness in endemic regions and, in rare cases, causes neurological disease in immunocompetent patients. Here, we present a case of serologically confirmed Borrelia miyamotoi meningoencephalitis in an otherwise healthy patient who rapidly improved following initiation of antibiotic therapy.

Keywords: Borrelia; meningoencephalitis; miyamotoi.

Figure 1.

Case timeline and serum antibody testing. A, Clinical course of a 73-year-old man with Borrelia miyamotoi encephalitis. The timeline below begins with the onset of symptoms, through hospital admission, antibiotic treatment, and recovery. Facial numbness was the only symptom that persisted at the 6-month follow-up visit (not shown). Test results for Borrelia burgdorferi EIAs and WB are shown. The antigen used in the B. burgdorferi EIA was B. burgdorferi WCS. B, EIA testing for antibodies against recombinant GlpQ in serum from the patient at day 50 (black bars) and day 90 (gray bars) after symptom onset is compared with an age-matched healthy control (orange bars) and an age-matched patient control who had recent B. burgdorferi meningoencephalitis. Abbreviations: EIA, enzyme-linked immunoassay; WB, Western blot; WCS, whole-cell sonicate.