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Table 1 Characteristics of four patients suffering from louse-borne relapsing fever (Borrelia recurrentis) diagnosed in Switzerland from June to December 2015

From: Louse-borne relapsing fever – report of four cases in Switzerland, June-December 2015

Case Sex, age Origin Travel route Location of first febrile episode Symptoms Platelet count (on admission, nadir; × 109) CRP (on admission, peak; mg/L) Other laboratory features Treatment
1 M, 25 y Eritrea ER, SU, LB, IT, CH Libya Fever, abdominal pain, epistaxis 56, 30 312, 312 Mild anemia, hyponatremia and hypokalemia Ceftriaxone for 2 days followed by doxycycline for 7 days
2 M, 29 y Somalia SO, KE, SU, LB, IT, CH Italy (infestation with body lice in Libya) Fever, abdominal pain, headache, muscle aches 141, 54 245, 245 Mild anemia, leukocytosis and hyponatremia Ceftriaxone for 1 day followed by doxycycline for 7 days plus
HRZEb
3 F, 21 y Somalia SO, KE, UG, SU, LB, IT, CH Italy Fever, pollakisuria, swollen/painful cervical/axillary lymphadenopathy 45, 27 367, 367 Mild anemia, leukocytosis and hyponatremia, elevated creatinine (mild), bilirubin and LDH (both moderate) Doxycycline for 5 days
4 M, 17y Somalia SO, ET, SU, LB, IT, CH Libya Fever, chills, cough, urinary incontinence 167, 62 127, 235 Moderate anemia, mild hyponatremia, hypokalemia, elevated creatinine and LDH (both mild) Doxycycline for 3 days plus Artemether/lumefantrinea
  1. Abbreviations: F female, M male, Y year, CRP C-reactive protein, HRZE antimycobacterial treatment with isoniazid (H), rifampicin (R), pyrazinamide (Z) and ethambutol (E)
  2. Travel route: CH Switzerland, ER Eritrea, ET Ethiopia, IT Italy, LB Libya, SU Sudan, SO Somalia, UG Uganda
  3. Platelet count, norm: 150–450 × 109/L; C-reactive protein, norm: <10 mg/L
  4. aArtemether/lumefantrine treatment was administered for concurrent Plasmodium falciparum malaria infection
  5. bAntimycobacterial treatment consisting of HRZE for two months followed by HR for four months was administered for concurrent M. tuberculosis lymphadenitis