http://www.nejm.org/doi/full/10.1056/NEJMoa1209039?query=featured_neurology-neurosurgery&
Meningoencephalitis from Borrelia miyamotoi in an Immunocompromised Patient
Joseph L. Gugliotta, M.D., Heidi K. Goethert, Sc.D., Victor P. Berardi, B.S., and Sam R. Telford, III, Sc.D.
N Engl J Med 2013; 368:240-245January 17, 2013DOI: 10.1056/NEJMoa1209039
Ixodes ticks serve as vectors for Borrelia burgdorferi, the agent of Lyme disease. Globally, these ticks often concurrently harbor B. miyamotoi, a spirochete that is classified within the relapsing-fever group of spirochetes. Although humans presumably are exposed to B. miyamotoi, there are limited data suggesting disease attributable to it. We report a case of progressive mental deterioration in an older, immunocompromised patient, and even though Koch's postulates were not met, we posit B. miyamotoi as the cause, owing to its direct detection in cerebrospinal fluid (CSF) with the use of microscopy and a polymerase-chain-reaction (PCR) assay. It is likely that B. miyamotoi is an underrecognized cause of disease, especially in sites where Lyme disease is endemic.
http://www.nejm.org/doi/full/
Microscopy is SO important yet it's the one thing the government health labs won't do.
