We report the case of an 18-year-old patient who received an allogeneic bone marrow transplant from an HLA-identical unrelated donor for a Ph+ acute lymphoblastic leukemia, in his third complete remission. Cyclophosphamide and busulfan were used as conditioning treatment. Acute graft-versus-host disease developed on day +9, and the response to adequate treatment (steroids) was favourable. On day +45 the patient developed an acute severe haemorhragic cystitis, and BK polyomavirus was demonstrated in urine samples using electron microscopy and polymerase chain reaction. Urinary symptoms did not improve in spite of palliative treatment, but a response was evident after 2 weeks of cidofovir treatment.

Echoviruses are the commonest cause of aseptic meningitis (AM). Echovirus type 13 (EV-13) was the second enterovirus serotype associated with different local outbreaks of AM in Spain between February and October 2000. It was the first time that an epidemic AM caused by this virus was recognized in Spain. The index case appeared in the Canary Islands (Canarias). The EV-13 virus was isolated from 135 patients, predominantly from cerebrospinal fluid (CSF). All isolates were from children under 13 years. The age specific peak incidence was in infants under 1 year. Most patients had fever, headache and other meningeal signs. This enterovirus serotype, not previously detected in Spain, caused severe illness with a high attack rate.

We report an unusual case of cerebral toxoplasmosis associated with Guillain-Barré syndrome (GBS) in a 25-year-old patient diagnosed with chronic myelogenous leukaemia (CML), who underwent a mismatched allogeneic peripheral stem cell transplantation (PSCT). On day +83 he started with fever, and 7 days later tremor, muscular weakness, diplopia, dysarthria, respiratory difficulty, and universal arreflexia appeared, compatible with GBS. As the patient had a positive cytomegalovirus (CMV) antigenemia, this was the aetiology suspected for his neurologic findings, but specific treatment failed to improve his clinical situation, and he died on day +123. Necropsy demonstrated cerebral toxoplasmosis and axonal degeneration of nerve roots compatible with the axonal form of GBS. Interestingly, the polymerase chain reaction (PCR) signal for Toxoplasma gondii in two different cerebrospinal fluid (CSF) samples had been negative. In addition, this case showed unique magnetic resonance imaging (MRI) abnormalities. We conclude that a negative PCR on CSF cannot exclude toxoplasmosis in a transplant patient, and we emphasise the importance of considering Toxoplasma as an aetiology of fever and neurological symptoms in the transplant setting.

No abstract

A serosurvey for Lyme disease was conducted by the National Reference Center for Microbiology in Spain. All serum specimens received from patients with erythema migrans (EM), arthritis, and cardiac and neurological disorders were tested for antibodies to Borrelia burgdorferi. Sera from 499 patients were tested. Of these patients, 310 had neurological disease, 101 had carditis, 79 had arthropathies, and 9 had EM; for 35 patients, a diagnosis of Lyme disease was confirmed. Of these 35, 68% had neurological disease, 6% had carditis, and 26% had EM. Twelve probable cases of Lyme disease were noted. The male-to-female ratio of patients with confirmed or probable disease was 1.6; all age groups were represented, but 25% of patients were within the age group of 0-9 years. The number of cases of Lyme disease decreases from the north of Spain (41%) to the south (26%), a distribution that is in agreement with the known range of Ixodes ricinus. Borrelia burgdorferi is a frequent cause of infection in some areas of Spain. It is possible that relapsing fever accounts for some of the serological reactivity to B. burgdorferi in residents of the south of Spain.