title: Fatal encephalitis caused by concomitant infection with tick-borne encephalitis virus and Borrelia burgdorferi.
abstract: We describe a 38-year-old farmer from the southwestern archipelago of Finland where both tick-borne encephalitis (TBE) virus and Borrelia burgdorferi are endemic. He presented with fever and headache, developed severe meningoencephalitis in 3 days, and, after 1 month, died without regaining consciousness. High titers of IgG and IgM antibodies to TBE virus were present in both serum and CSF. Serology for Borrelia was negative. Autopsy revealed necrotizing encephalitis and myelitis with involvement of the dorsal root ganglion. With use of polymerase chain reaction tests, segments of two separate genes of B. burgdorferi were amplified from the patient's CSF. This case demonstrates that the possibility of dual infection should be considered for patients residing in geographic areas where Ixodes ticks may carry both the TBE virus and B. burgdorferi. We believe that the most severe damage in this case was caused by TBE virus rather than by B. burgdorferi. Nevertheless, the coinfection might have contributed to the fatal outcome that has not been previously observed in Finnish patients with TBE.
authors.affiliation: Department of Medicine, Turku University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Oksi
authors.forename: M K
authors.initials: MK
authors.lastname: Viljanen
authors.forename: H
authors.initials: H
authors.lastname: Kalimo
authors.forename: R
authors.initials: R
authors.lastname: Peltonen
authors.forename: R
authors.initials: R
authors.lastname: Marttía
authors.forename: P
authors.initials: P
authors.lastname: Salomaa
authors.forename: J
authors.initials: J
authors.lastname: Nikoskelainen
authors.forename: H
authors.initials: H
authors.lastname: Budka
authors.forename: P
authors.initials: P
authors.lastname: Halonen
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D004675:Encephalitis, Tick-Borne / Q000150:complications* / Q000175:diagnosis; D004679:Encephalomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use; D007275:Injections, Intravenous; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D016133:Polymerase Chain Reaction; D012293:Rifampin / Q000008:administration & dosage / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014640:Vancomycin; D015378:Imipenem; D012293:Rifampin