Case study IDs B. miyamotoi as cause of meningoencephalitis

(HealthDay)—The spirochete, Borrelia miyamotoi, may be an underrecognized cause of meningoencephalitis, according to a case study published in the Jan. 17 issue of the New England Journal of Medicine.

Joseph L. Gugliotta, M.D., of the Robert Wood Johnson Medical School in New Brunswick, N.J., and colleagues report the case of a B. miyamotoi infection-associated meningoencephalitis which developed in an immunocompromised patient.

According to the report, an 80-year-old woman who lived on a farm in New Jersey, who had been treated twice for Lyme Disease and was immunocompromised due to treatment for non-Hodgkin's lymphoma, developed progressive cognitive decline over a four-month period. She was admitted to the hospital and diagnosed with meningoencephalitis. Although Koch's postulates were not met, the woman's illness was posited to be caused by infection with the spirochete B. miyamotoi as the organism was directly detected in cerebrospinal fluid using both microscopy and polymerase chain reaction assay. Following treatment with antibiotics, the patient's physical and mental conditions improved.

"In older persons, changes in mental status are often attributed to dementia or the aging process. Exposure of such persons to diverse microbial agents, including those thought to be nonpathogenic, such as B. miyamotoi, may represent possibilities for pathologic processes to occur," the authors write. "Immunocompromise in older patients should always prompt a more rigorous laboratory analysis, because such persons may serve as sentinels for poorly recognized or novel pathogens."

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