Volume 23, Number 8—August 2017
Serologic Evidence of Powassan Virus Infection in Patients with Suspected Lyme Disease1
|Patient no.||POWV test results||Borrelia burgdorferi test results†||Clinical features||Comorbidities||CDC case classification||Travel history||Location of tick exposure‡||Vaccine history§|
|Suspected TBD patients|
|1¶||IgG >1:40||IgG and IgM||56-year-old man with 2-wk history of erythema migrans. Treated with doxycycline for 14 d.||Metabolic syndrome, hypertension, 9 y previous had WNV infection||–||Midwest||–|
|2||IgG >1:40, PRNT 1:160||IgG and IgM||53-year-old man with 3-d history of urticarial rash, malaise, fever, and fatigue. Patient had chills 3 wks prior that resolved. CBC results: leukocytes 7.3 × 109/L, Hb 13.6 g/dL, Hct 39.9%, Plt count 322 × 103/µL; CRP 3.9 nmol/L. PCR neg for Anaplasma sp., Babesia sp., and Ehrlichia muris. Treated with doxycycline for 21 d with complete resolution of symptoms. No history of neuroinvasive disease or TBD.||Hyperlipidemia||–||–||–|
|3||IgM >1:20||IgG and IgM||14-year-old girl with 3-d history of urticarial rash. CBC results: leukocytes 8.8 × 109/L, Hb 13.0 g/dL, Hct 40.3%, Plt 393 × 103/µL; CRP 3.6 nmol/L. Treated with doxycycline for 14 d.||None||–||–||–|
|4||IgM >1:20||IgG and IgM||4-year-old girl with 1-wk history of fever (103°F), listless, headache, fatigue, and maculopapular rash. PCR neg for Anaplasma sp., Babesia sp., and Ehrlichia muris. Treated with amoxicillin for 21 d.||None||Probable||–||–||–|
||IgG and IgM
||3-year-old girl with 1-wk history of intermittent fever, fussiness, and erythema migrans. After development of an urticarial rash, treatment with cefuroxime was changed to amoxicillin for 21 d.
|Patients screened by chemical methods|
|1c||IgG >1:40||Neg||68-year-old man with no signs or symptoms of acute infectious disease. No history of neuroinvasive disease or TBD. Died from liver cirrhosis.||Coronary artery disease, liver cirrhosis, end stage renal disease||–||–||–|
|2c||IgM >1:20, IgG >1:40||Neg||76-year-old woman with 2-d history of fever, chills, and MRSA infection of the right hand. Mild abdominal pain and diarrhea occurred later in course. CBC results: leukocytes 13.7 × 109/L, Hb 9.2 g/dL, Hct 29.7%, Plt 180 × 103/µL; CRP 1.5 nmol/L; Procalcitonin 0.1 µg/L. Received daptomycin for 16 d with full recovery. Currently deceased, unknown cause of death.||Congestive heart failure, rheumatoid arthritis on immune-suppressive medications||Probable||–||–||–|
*CBC, complete blood cell count; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein; Hb, hemoglobin; Hct, hematocrit; IFA, immunofluorescence antibody; MRSA, multidrug-resistant Staphylococcus aureus; neg, negative; Plt, platelet; POWV, Powassan virus; PRNT, plaque reduction neutralization test; WNV, West Nile virus; TBD, tickborne disease; –, no history.
†Samples were screened by EIA and followed up by Western blot.
‡Patient-reported tick exposure.
§Known history of vaccination against yellow fever virus, Japanese encephalitis virus, or tick-borne encephalitis virus.
¶Cross-reactivity on POWV IgG IFA assay is consistent with a history of West Nile virus infection.
1Preliminary results from this study were presented at IDWeek; October 26–30, 2016; New Orleans, Louisiana, USA.