title: Louse-Borne Relapsing Fever with Meningeal Involvement in an Immigrant from Somalia to Italy, October 2015.
abstract: Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia.
  
  
  
  In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1.
  
  
  
  LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.
authors.affiliation: 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .|2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy .
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zammarchi
authors.affiliation: 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .|3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .
authors.forename: Laura
authors.initials: L
authors.lastname: Bartolini
authors.affiliation: 4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pecile
authors.affiliation: 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy .
authors.forename: Michele
authors.initials: M
authors.lastname: Trotta
authors.affiliation: 2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy .
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Rogasi
authors.affiliation: 5 UF Igiene e Sanità Pubblica, ASL 10 Zona Firenze, Florence, Italy .
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Santini
authors.affiliation: 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .
authors.forename: Beatrice
authors.initials: B
authors.lastname: Dilaghi
authors.affiliation: 6 Dipartimento di Medicina d'Urgenza, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .|3 Dipartimento di Biotecnologie Mediche, Università di Siena , Siena, Italy .|4 SOD Microbiologia e Virologia, Azienda Ospedaliera Universitaria Careggi , Florence, Italy .|7 I.R.C.C.S. Fondazione Don Carlo Gnocchi , Florence, Italy .
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.affiliation: 1 Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze , Florence, Italy .|2 SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi , Florence, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001898:Borrelia / Q000145:classification / Q000302:isolation & purification; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use; D054242:Emigrants and Immigrants; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000382:microbiology*; D010374:Pediculus / Q000382:microbiology*; D012061:Relapsing Fever / Q000453:epidemiology* / Q000382:microbiology; D012998:Somalia / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D004318:Doxycycline
keywords: Borrelia recurrentis; Immigrants; Italy; Louse-borne relapsing fever; Meningitis; Migrants; Somalia