Volume 29, Number 5—May 2023
Dispatch
Borrelia miyamotoi Infection in Immunocompromised Man, California, USA, 2021
, Anne M. Kjemtrup, Grace E. Marx, Shanna Cronan, Christopher Kilonzo, Megan E.M. Saunders, Jamie L. Choat, Elizabeth A. Dietrich, Kelly A. Liebman, and Sarah Y. Park
Table 1
Laboratory test results for patient with Borrelia miyamotoi Infection, California, USA, 2021*
| Blood test (reference values) | Dec 2021 | May 2022 |
|---|---|---|
| Leukocytes (4.0–11.0 k/uL) | 5.1 | 4.8 |
| Hemoglobin (13.5–18.0 g/dL) | 13.3 (low) | 15.2 |
| Hematocrit (40.0%–52.0%) | 38.5% (low) | 43.4% |
| Thrombocytes (150–400 l/uL) | 96,000 (low) | 224,000 |
| Sodium (136–145 mmol/L) | 134 (low) | 137 |
| Creatinine (0.70–1.30 mg/dL) | 0.82 | 0.98 |
| Albumin (2.8–4.7 g/dL) | 3.6 | 4.7 |
| Aspartate transaminase (<40 U/L) | 45 (high) | 41 (high) |
| Alanine transaminase (<65 U/L) | 46 | 46 |
| Alkaline phosphatase (<38 U/L) | 81 | 60 |
| Total bilirubin (<1.0 mg/dL) | 1.0 | 0.8 |
| C-reactive protein (<5.0 mg/L) | 47.2 (high) | 0.2 |
| Procalcitonin (<0.10 ng/mL) | 1.89 (high) | <0.10 |
| COVID-19/influenza/RSV PCR | Not detected | ND |
| Peripheral blood cultures (2 cultures in Dec 2022) | No growth at 5 days | ND |
| Hepatitis B surface Ab (>10 mIU/mL) | 113 | ND |
| Hepatitis B surface Ag | Nonreactive | ND |
| Hepatitis B core Ab | Nonreactive | ND |
| Hepatitis C Ab | Nonreactive | ND |
| EBV VCA IgM (<36 U/mL) | <36 U/mL | ND |
| EBV VCA IgG Ab (<18 U/mL) | 248 (high) | ND |
| EBV EBNA IgG (<18 U/mL | 255 (high) | ND |
| CMV IgM (<30 AU/mL) | <30 | ND |
| CMV IgG (<0.6 U/mL) | <0.6 | ND |
| Cryptococcus Ag | Not detected | ND |
| Coccidioides Ab, CF (<1:2) | <1:2 | ND |
| Coccidioides Ab, ID | Negative | ND |
| Histoplasma Ab, CF (<1:8) | <1:8 | ND |
| Histoplasma, ID | Negative | ND |
| Histoplasma Ag, urine (<0.2 ng/mL) | <0.2 | ND |
| Blastomyces Ab, ID | Negative | ND |
| Bartonella Ab | Negative | ND |
| Coxiella burnetti Ab IgM and IgG | Negative | ND |
| Rickettsia Ab panel | Negative | ND |
| Syphilis (Treponema) screen by RPR (nonreactive) | Nonreactive | ND |
| Quantiferon-TB Gold Plus | Negative | ND |
*Additional testing: February 2022, Borrelia burgdorferi, Brucella, and Leptospira Ab results all negative; March 2022, β-d-glucan (reference value <60 pg/mL), <31 pg/mL; galactomannan Ag (reference value <0.5), 0.018; Coccidioides Ag, serum, negative; sequencing of microbial cell–free DNA in plasma performed at Karius, Inc. (https://kariusdx.com) (reference value <10 DNA MPM), Borrelia miyamotoi 56 DNA MPM; relapsing fever PCR performed at CDC, Borrelia PCR positive group B. miyamotoi .Ab, antibody; Ag, antigen; CDC, Centers for Disease Control and Prevention; CF, complement fixation; CMV, cytomegalovirus; EBV, Epstein-Barr virus; EBNA, Epstein-Barr nuclear Ag; ID, immunodiffusion; MPM, molecules/mL; RPR, rapid plasma reagin; RSV, respiratory syncytial virus; VCA, viral capsid antigen.