(HealthDay News) – Tick-exposed patients who present with acute febrile illness but have delayed response to doxycycline therapy or negative confirmatory test results for human granulocytic anaplasmosis (HGA) should be analyzed for evidence of infection with the newly recognized spirochete Borrelia miyamotoi, according to a case report published in the July 2 issue of the Annals of Internal Medicine.

Hanumara Ram Chowdri, MD, of Hawthorn Medical Associates in New Bedford, MA, and colleagues report on cases of two patients presenting with acute fever at two primary care medical centers, one in Massachusetts and one in New Jersey.

The researchers found that two patients presenting with acute febrile illness were initially diagnosed with HGA. However, fever did not resolve rapidly with doxycycline therapy and laboratory tests showed no evidence of infection with Anaplasma phagocytophilum. Molecular diagnostic assays detected Borrelia miyamotoi in the peripheral blood of both patients. No evidence of infection with other tickborne pathogens endemic to the area was found for either case.

“In North American sites, and indeed globally across the Holarctic where Lyme disease and HGA are commonly zoonotic, clinicians need to be aware of this newly recognized pathogen and include Borrelia miyamotoi infection in the differential diagnosis of tick-exposed patients presenting with fever, myalgia, and elevated aminotransferase levels,” the authors write.

Several authors disclosed financial ties to Imugen.

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