In March 2017, a patient became febrile within 4 days after visiting a rustic conference center in Austin, Texas, USA, where Austin Public Health suspected an outbreak of tickborne relapsing fever a month earlier. Evaluation of a patient blood smear and molecular diagnostic assays identified Borrelia turicatae as the causative agent. We could not gain access to the property to collect ticks. Thus, we focused efforts at a nearby public park, <1 mile from the suspected exposure site. We trapped Ornithodoros turicata ticks from 2 locations in the park, and laboratory evaluation resulted in cultivation of 3 B. turicatae isolates. Multilocus sequencing of 3 chromosomal loci (flaB, rrs, and gyrB) indicated that the isolates were identical to those of B. turicatae 91E135 (a tick isolate) and BTE5EL (a human isolate). We identified the endemicity of O. turicata ticks and likely emergence of B. turicatae in this city.
Congenital parvovirus infection was diagnosed in two liveborn premature infants born at 24 and 35 weeks of gestational age. The illnesses were associated with placentomegaly, petechial rash, edema, hepatomegaly, anemia and thrombocytopenia, respiratory insufficiency, and death at 5 and 6 days of age. The syndromes exhibited by these cases shared common but nonspecific features with other life-threatening congenital infections. Serological studies in one case supported the diagnosis of parvoviral infection. Postmortem examination of both revealed nuclear inclusions in erythroid precursor cells characteristic of parvovirus infection. Use of the polymerase chain reaction confirmed the presence of parvovirus DNA in one of the cases. Intrauterine parvovirus B19 infection is most commonly associated with hydrops fetalis, "transient" hydrops, or a favorable outcome in infants found to be viremic after birth. These and previously reported examples of congenital B19 disease exemplify an exceptional form of human parvovirus infection.
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Dengue is caused by infection with any of four mosquitotransmitted dengue viruses (DENV-1-4) and is characterized by fever, headache, myalgia, and leukopenia (1). Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory syndrome that can be familial or acquired, and is characterized by persistent fever, pancytopenia, hepatosplenomegaly, and increased serum ferritin (2). Acquired HLH is most frequently associated with Epstein Barr virus infection but also has been associated with dengue (3). This report describes a fatal case of acquired HLH that was apparently triggered by infection with DENV-3. The patient developed an acute febrile illness in August 2012 during a 1-month vacation in New Mexico. After returning to her home in Texas, she was initially diagnosed with West Nile virus (WNV) infection, developed pancytopenia, liver failure, and disseminated intravascular coagulopathy, and died. DENV-3 was detected in a premortem bone marrow biopsy in which erythrophagocytosis was evident. This case underscores the need for clinicians in the United States to be vigilant for dengue and request diagnostic testing for suspected cases, which should be reported to public health authorities. Case InvestigationOn September 2, 2012, a woman aged 63 years went to an outpatient clinic in central Texas with a 7-day history of fatigue, anorexia, headache, hematuria, and leg pain (Figure 1). She had a history of Crohn's disease treated with mercaptopurine and mesalamine, hysterectomy because of uterine cancer, thyroidectomy, hypertension treated with lisinopril, coronary artery disease, hyperlipidemia, chronic renal disease with microhematuria, obesity, and depression treated with fluoxetine. Upon examination, the patient was febrile, hypotensive, and had low oxygen saturation (SaO 2 = 92% [normal = ≥95%]). Laboratory values revealed leukopenia (white blood cell count = 3,600/mm 3 [normal = 3,800-10,600/mm 3 ]) (Figure 2, top panel). She was diagnosed with dehydration, given 1 L of intravenous normal saline, and instructed to see her primary care physician if her symptoms did not resolve.On September 4, the patient went to her primary care physician and reported fatigue, anorexia, headache, leg cramps, fever, and chills. She did not have respiratory, gastrointestinal, or urinary symptoms. Physical examination revealed hypotension and fever. Lisinopril was discontinued, serum was drawn for typhus and WNV serology, and doxycycline was prescribed. A weakly positive anti-WNV immunoglobulin M (IgM) diagnostic test result was received on September 10, and the patient was prescribed bed rest for 2 weeks. Doxycycline was discontinued because of negative typhus serology.
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