TY - JOUR
T1 - “Double Trouble”
T2 - Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin
AU - Dumic, Igor
AU - Glomski, Bridget
AU - Patel, Janki
AU - Nordin, Terri
AU - Nordstrom, Charles W.
AU - Sprecher, Lawrence J.
AU - Niendorf, Eric
AU - Singh, Amteshwar
AU - Simeunovic, Kosana
AU - Subramanian, Anand
AU - Igandan, Olandapo
AU - Vitorovic, Danilo
N1 - Publisher Copyright:
© Am J Case Rep, 2021; 22.
PY - 2021
Y1 - 2021
N2 - Objective: Rare co-existance of disease or pathology Background: Powassan virus (POWV) is an emerging tick-borne flavivirus transmitted to humans by ticks. While infection is asymptomatic in some people, others develop life-threatening encephalitis with high mortality rates. Co-infection between POWV and Borrelia burgdorferi is rare despite the fact that both pathogens can be transmitted through the same tick vector, Ixodes scapularis. It is unclear if co-infection leads to more severe clinical presentation and worse outcome. Case Report: A 76-year-old Wisconsin man was admitted for meningoencephalitis complicated by hypoxemic and hypercapnic respiratory failure requiring endotracheal intubation. The patient had no known tick bites but lived in a heavily wooded area. Extensive work-up for infectious, autoimmune, and paraneoplastic causes was positive for Borrelia burgdorferi and Powassan virus infection (POWV). Following treatment with ceftriaxone for neuroborreliosis and supportive care for POWV infection, the patient failed to improve. Intravenous immunoglobulins (IVIG) were started empirically, and the patient attained gradual neurological improvement and was successfully extubated. Conclusions: Treatment for POWV infection is supportive, and at this time there are no approved targeted antivirals for this disease. At this time, it remains unclear if co-infection with 2 pathogens leads to a more severe clinical presentation and higher mortality. In the absence of contraindications, IVIG might be beneficial to patients with POWV infection who are not improving with supportive care.
AB - Objective: Rare co-existance of disease or pathology Background: Powassan virus (POWV) is an emerging tick-borne flavivirus transmitted to humans by ticks. While infection is asymptomatic in some people, others develop life-threatening encephalitis with high mortality rates. Co-infection between POWV and Borrelia burgdorferi is rare despite the fact that both pathogens can be transmitted through the same tick vector, Ixodes scapularis. It is unclear if co-infection leads to more severe clinical presentation and worse outcome. Case Report: A 76-year-old Wisconsin man was admitted for meningoencephalitis complicated by hypoxemic and hypercapnic respiratory failure requiring endotracheal intubation. The patient had no known tick bites but lived in a heavily wooded area. Extensive work-up for infectious, autoimmune, and paraneoplastic causes was positive for Borrelia burgdorferi and Powassan virus infection (POWV). Following treatment with ceftriaxone for neuroborreliosis and supportive care for POWV infection, the patient failed to improve. Intravenous immunoglobulins (IVIG) were started empirically, and the patient attained gradual neurological improvement and was successfully extubated. Conclusions: Treatment for POWV infection is supportive, and at this time there are no approved targeted antivirals for this disease. At this time, it remains unclear if co-infection with 2 pathogens leads to a more severe clinical presentation and higher mortality. In the absence of contraindications, IVIG might be beneficial to patients with POWV infection who are not improving with supportive care.
KW - Encephalitis, Tick-Borne
KW - Immunoglobulins, Intravenous
KW - Lyme Disease
KW - Powassan virus, co-infection
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U2 - 10.12659/AJCR.929952
DO - 10.12659/AJCR.929952
M3 - Article
C2 - 33758161
AN - SCOPUS:85102895716
SN - 1941-5923
VL - 22
SP - 1
EP - 6
JO - American Journal of Case Reports
JF - American Journal of Case Reports
IS - 1
M1 - e929952
ER -