Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology

Morrison, Candis; Seifter, Ari; Aucott, John N.

doi:10.3122/jabfm.2009.02.080130

Cited by 13 publications

(7 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Full-blown spirochetemia in Lyme borreliosis is a transient phenomenon and occurs within the first 30 days of the disease [35]. Any free bacterial DNA in the circulating blood left over from an early full-blown spirochetemia would be degraded or excreted within 42 h [36] after the spirochetes vanished from the circulating blood, and certainly would have been excluded when the bacteria were pelleted by differential centrifugation to be tested according to our laboratory procedures.…”

Section: Resultsmentioning

confidence: 99%

DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi and Borrelia miyamotoi Infections

Lee

Vigliotti

et al. 2014

IJMS

View full text Add to dashboard Cite

A highly conserved 357-bp segment of the 16S ribosomal RNA gene (16S rDNA) of Borrelia burgdorferi sensu lato and the correspondent 358-bp segment of the Borrelia miyamotoi gene were amplified by a single pair of nested polymerase chain reaction (PCR) primers for detection, and the amplicons were used as the templates for direct Sanger DNA sequencing. Reliable molecular diagnosis of these borreliae was confirmed by sequence alignment analysis of the hypervariable regions of the PCR amplicon, using the Basic Local Alignment Search Tool (BLAST) provided by the GenBank. This methodology can detect and confirm B. burgdorferi and B. miyamotoi in blood samples of patients with off-season spirochetemia of low bacterial density. We found four B. miyamotoi infections among 14 patients with spirochetemia, including one patient co-infected by both B. miyamotoi and B. burgdorferi in a winter month when human exposure to tick bites is very limited in the Northeast of the U.S.A. We conclude that sensitive and reliable tests for these two Borrelia species should be implemented in the microbiology laboratory of hospitals located in the disease-endemic areas, for timely diagnosis and appropriate treatment of the patients at an early stage of the infection to prevent potential tissue damages.

show abstract

Section: Resultsmentioning

confidence: 99%

DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi and Borrelia miyamotoi Infections

Lee

Vigliotti

et al. 2014

IJMS

View full text Add to dashboard Cite

show abstract

“…Often the first thought with new-onset Horner syndrome would not be Lyme disease, but that is what is presented in a case report by Morrison et al 19 Once again, we see that Lyme disease can be a great imitator and cause a great variety of clinical manifestations, including Horner syndrome.…”

Section: Clinical Case Reports From Primary Carementioning

confidence: 85%

Women's Physical Health, Mental Health, and Practical Hints for Common Practice Issues

Bowman¹,

Neale²

2009

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

“…Early LD is a clinical diagnosis in endemic areas in patients presenting with EM rash, predominantly in the months of May through August. Serologic testing can be misleading because the false negative rate is as high as 60% in the first 2–4 weeks of infection [11]. …”

Section: Discussionmentioning

confidence: 99%

“…The presence of leukopenia, thrombocytopenia, and high-grade fever should raise suspicion for anaplasmosis, while the presence of severe anemia alone should raise suspicion of babesiosis [11]. When there is a suspicion of either babesiosis or anaplasmosis, PCR test can be used for confirmation [11]. Mehrzad and Bravoco reported a unique case of pancytopenia in a patient with LD.…”

Section: Discussionmentioning

confidence: 99%

A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

Kantamaneni

Sunder

Bilal

et al. 2017

Case Reports in Infectious Diseases

View full text Add to dashboard Cite

Lyme disease (LD) is a tick-borne illness caused by Borrelia burgdorferi sensu stricto. An 80-year-old female from Pennsylvania, USA, presented to an outside hospital with fever, confusion, lower extremity weakness, and stool incontinence. CT head and MRI spine were unremarkable. An infectious work-up including lumbar puncture was negative. She was transferred to our tertiary care hospital. Patient was noted to have mild unilateral right-sided facial droop and a diffuse macular rash throughout the body. She denied any outdoor activities, tick bites, or previous rash. Intravenous ceftriaxone was started for suspected LD. The patient's symptoms including facial droop resolved within 24 hours of antibiotic therapy. Polymerase chain reaction of the blood, IgM ELISA, and IgM Western blot testing for LD came back positive a few days after initiation of therapy. She was treated for a total of 21 days for neurological LD with complete symptom resolution. Not all patients have the classic “targetoid” EM rash on initial presentation, rash could develop after neurological manifestations, and prompt initiation of antibiotics without awaiting serology is paramount to making a quick and a full recovery. There should be a high index of suspicion for early disseminated LD, as presentations can be atypical.

show abstract

Unusual Presentation of Lyme Disease: Horner Syndrome with Negative Serology

Cited by 13 publications

References 22 publications

DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi and Borrelia miyamotoi Infections

DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi and Borrelia miyamotoi Infections

Women's Physical Health, Mental Health, and Practical Hints for Common Practice Issues

A Case of Early Disseminated Neurological Lyme Disease Followed by Atypical Cutaneous Manifestations

Contact Info

Product

Resources

About