Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient

Khan, Abdul Moiz; Shahzad, Sheikh Raza; Ashraf, Muhammad Farhan; Naseer, Usman

doi:10.1136/bcr-2019-231645

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Meanwhile, a study from New York reported that up to 29% of ticks were co-infected with these 2 pathogens. A unique combination of co-infection was recently reported in a case of a patient who had POWV encephalitis, Lyme carditis, and severe babesiosis [ 17 ]. Due to changes in seasonal tick activity compounded by climate change contributing to the expansion of the vector I. scapularis, we may expect to see a significant increase in these infections and co-infections in years to come [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“Double Trouble”: Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin

et al. 2021

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Patient: Male, 76-year-old Final Diagnosis: Powassan virus encephalitis Symptoms: Confusion • fever • respiratory distress Medication: Immunoglobulin • ceftriaxone Clinical Procedure: — Specialty: Infectious Diseases • General and Internal Medicine • Neurology 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 hyper-capnic 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.

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Section: Discussionmentioning

confidence: 99%

“Double Trouble”: Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin

et al. 2021

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“…On these patients, five patients had a triple acute active infection [ 11 ]: EM was observed with a proven HGA and TBE. Two more patients were found to have a triple active infection but did not meet the criteria of a confirmed infection [ 12 , 13 ]. For four patients, diagnosis of one of the three infections did not meet the clinical criteria [ 14 , 15 ].…”

Section: Resultsmentioning

confidence: 99%

Human Co-Infections between Borrelia burgdorferi s.l. and Other Ixodes-Borne Microorganisms: A Systematic Review

et al. 2022

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When it comes to tick-borne diseases, co-infections are often mentioned. This concept includes several entities. On the one hand, tick vectors or vertebrate reservoir host can harbor several microorganisms that can be pathogenic for humans. On the other hand, human co-infections can also be understood in different ways, ranging from seropositivity without clinical symptoms to co-disease, i.e., the simultaneous clinical expression of infections by two tick-borne microorganisms. The latter, although regularly speculated, is not often reported. Hence, we conducted a systematic review on co-infections between B. burgdorferi s.l., the etiological agent of Lyme borreliosis, and other microorganisms potentially transmitted to humans by Ixodes spp. ticks. A total of 68 relevant articles were included, presenting 655 cases of possible co-infections. Most cases of co-infections corresponded to patients with one tick-borne disease and presenting antibody against another tick-borne microorganism. Co-disease was particularly frequent in two situations: patients with clinical symptoms of high fever and erythema migrans (EM), and patients with neurological symptoms linked to the TBEv or a neuroborreliosis. No impact on severity was evidenced. Further studies are needed to better appreciate the frequency and the impact of co-infections between several tick-borne microorganisms.

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“…POWVs are rapidly transmitted in tick saliva, cause an acute febrile illness and, in severe cases, encephalitis with long term neurologic damage in patients [1,4,[33][34][35][36][37][38][39][40][41][42] . POWV seroprevalence studies suggest that infections are largely undetected or undiagnosed in patients and this has limited human neuropathology studies.…”

Section: Discussionmentioning

confidence: 99%

Age-dependent Powassan Virus Lethality and Neuropathogenesis in Mice

Mladinich¹,

Himmler²,

Conde³

et al. 2023

Preprint

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Powassan viruses (POWV) are emergent tick-borne flaviviruses that cause severe neurologic disease in humans. Subcutaneous inoculation of C57BL/6 mice with POWV (strain LI9) resulted in overt brain damage resembling spongiform encephalitis. Noting higher POWV lethality in older mice, we assessed neurovirulence as a function of age. We found that POWV LI9 inoculation was lethal in 80% of 50 wk old mice, 10-15 dpi, and that lethality was sequentially reduced in 40, 30, 20, 10 wk old mice to <10%. Lethality was conferred by 2-20 POWV FFUs, and POWV neuropathology was evident as early as 5 dpi, with lethal disease 10-15 dpi correlated with sustained POWV RNA levels in brains of aged mice. Histology of POWV infected 50 wk old murine brains revealed severe spongiform neuronal necrosis, microgliosis, and inflammation with increased brainstem and cerebellar damage. These findings delineate an age-dependent murine model of lethal POWV infection that mirrors human POWV disease and permits analysis of age-dependent neurovirulence determinants.

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Powassan virus encephalitis, severe babesiosis and lyme carditis in a single patient

Cited by 8 publications

References 15 publications

“Double Trouble”: Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin

“Double Trouble”: Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin

Human Co-Infections between Borrelia burgdorferi s.l. and Other Ixodes-Borne Microorganisms: A Systematic Review

Age-dependent Powassan Virus Lethality and Neuropathogenesis in Mice

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