Louse-borne relapsing fever (Borrelia recurrentis) in an Eritrean refugee arriving in Switzerland, August 2015

Abstract

We report an imported case of louse-borne relapsing fever in a young adult Eritrean refugee who presented with fever shortly after arriving in Switzerland. Analysis of blood smears revealed spirochetes identified as Borrelia recurrentis by 16S rRNA gene sequencing. We believe that louse-borne relapsing fever may be seen more frequently in Europe as a consequence of a recent increase in refugees from East Africa travelling to Europe under poor hygienic conditions in confined spaces.

Louse‐borne relapsing fever in Finland in two asylum seekers from Somalia

“…European Centre for Disease Prevention and Control (ECDC) monitors the spread of LBRF in Europe and updated information can be found on the ECDC website . LBRF cases have been reported from many countries, and while the reported numbers of patients are small, they may merely represent the tip of the iceberg .…”

Diagnosis of Louse-Borne Relapsing Fever despite Negative Microscopy in Two Asylum Seekers from Eastern Africa

“…To our knowledge, they represent a new observation of disease occurrence in Europe after those initially reported between June and December 2015. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Both cases were highly suggestive for LBRF based on their clinical presentation and epidemiologic features even if direct microscopic examination of patient blood smears was repeatedly negative. It should be emphasized that in our patients that the correct diagnosis was possible because of the high index of clinical suspicion due to our previous experience with LBRF and, ultimately, only by molecular testing.…”

“…In addition, very high levels of both CRP and procalcitonin (PCT) are reported as almost universal findings among patients with LBRF observed in Europe. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Table 1). Both CRP and PCT are well-known biomarkers of the inflammatory response, and PCT is increasingly used in patients who are admitted to the intensive care unit to guide early antibiotic therapy when an undifferentiated infection or sepsis are suspected and the results of blood cultures are still pending.…”

“…From June to December 2015, around 50 cases of LBRF were described among asylum seekers from Eastern Africa arriving to Europe with reports from Germany, Italy, Belgium, Switzerland, the Netherlands, and Finland. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The latest report of imported LBRF in Europe regards a patient observed in Italy in June 2016 and coming from Mali. 20 In all published instances described as yet, migrants had stationed in overcrowded refugee camps in Libya before arriving to Italy after having crossed the Mediterranean Sea, with the exception of two patients who were probably infected in Turin, Italy, while sheltered in the same asylum as other individuals with the disease.…”

Fourth case of louse-borne relapsing fever in Young Migrant, Sicily, Italy, December 2015. Mini Review Article

“…Our search identified five publications reporting 26 cases of LBRF between July and October 2015 in migrants recently arrived in Europe: eight had been described in Italy (three in Sicily and five in Piedmont); one in Switzerland; two in the Netherlands; 15 in Germany (Bavaria). 3,8,10,11,12 Data regarding the clinical characteristics, diagnostic methods, therapy and outcome of these patients and of the new case we report, are analytically listed in Table 1. The majority of cases (21) involved Somali people, five cases Eritrean people, one case an Ethiopian patient.…”