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Borrelia mayonii – A cause of Lyme borreliosis that can be visualized by microscopy of thin blood films

      Keywords

      A previously healthy 42-year-old man from the upper midwestern USA presented with a 1-day history of fever, fatigue, headache, myalgias and arthralgias. He reported removing a ‘wood tick’ the day of admission. His temperature was 38.4 °C. No swollen joints, rash or neurological abnormalities were noted on physical examination.
      Testing revealed lymphopenia (0.24 × 109/L; reference range 0.95 × 109/L to 3.07 × 109/L) and slightly elevated alanine transaminase (59 U/L; reference range 7–55 U/L). Tick-borne pathogen PCR on blood for Borrelia burgdorferi sensu lato [
      • Pritt B.S.
      • Mead P.S.
      • Hoang Johnson D.K.
      • Neitzel D.F.
      • Respicio-Kingry L.B.
      • Davis J.P.
      • et al.
      Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study.
      ], Anaplasma phagocytophilum, Borrelia miyamotoi, Ehrlichia and Babesia species was positive only for Borrelia mayonii. Several spirochaetes were observed on Giemsa-stained thin blood films (Fig. 1). Borrelia mayonii spirochaetes were recovered in culture initiated with 0.5 mL of blood (see Supplementary material, Video S1), with subsequent confirmation by genome sequencing. The patient was treated with an initial dose of intravenous ceftriaxone and doxycycline, followed by 21 days of oral doxycycline and experienced resolution of symptoms.
      Fig. 1
      Fig. 1Spirochaetes observed on Giemsa-stain thin films of EDTA peripheral blood.
      Lyme borreliosis is the most common vector-borne disease in North America and is primarily caused by Borrelia burgdorferi sensu stricto. Infection with this organism is associated with low levels of spirochaetemia, and spirochaetes have not been reported on blood film microscopy. Borrelia mayonii has recently been reported as a rare cause of Lyme borreliosis in the upper midwestern USA and has been associated with unusually high levels of spirochaetaemia [
      • Pritt B.S.
      • Mead P.S.
      • Hoang Johnson D.K.
      • Neitzel D.F.
      • Respicio-Kingry L.B.
      • Davis J.P.
      • et al.
      Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study.
      ]. This case serves as a reminder that B. mayonii cases continue to be diagnosed in the upper midwestern USA and that spirochaetes may occasionally be seen in blood films.

      Transparency declaration

      The authors declare that they have no conflicts of interest.
      No funding was received.

      Author contributions

      BSP contributed to the investigation, image creation, writing the original draft, and reviewing and editing the article. ECF, AJR, LCK, MPS and JMP contributed to the investigation and to reviewing and editing the article. AJR also created the video.

      Appendix A. Supplementary data

      The following is the Supplementary data to this article:
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      Reference

        • Pritt B.S.
        • Mead P.S.
        • Hoang Johnson D.K.
        • Neitzel D.F.
        • Respicio-Kingry L.B.
        • Davis J.P.
        • et al.
        Identification of a novel pathogenic Borrelia species causing Lyme borreliosis with unusually high spirochaetaemia: a descriptive study.
        Lancet Infect Dis. 2016; 16: 556-564